Duffy v. Aviva General Insurance, 2022 CanLII 78788

Duffy v. Aviva General Insurance, 2022 ONLAT 19-008134/AABS

Licence Appeal Tribunal File Number: 19-008134/AABS

In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.

Between:

Bartholomew Duffy Applicant

and

Aviva General Insurance Respondent

DECISION

ADJUDICATOR: Ulana Pahuta

APPEARANCES:

For the Applicant: Kathryn McRae Hill, Paralegal

For the Respondent: Jonathan White, Counsel

HEARD: By Way of Written Submissions

BACKGROUND

1Bartholomew Duffy (the “applicant”) was involved in an automobile accident on November 2, 2016, and sought benefits pursuant to the Statutory Accident Benefits Schedule, Effective September 1, 2010 (including amendments effective June 1, 2016)¹. The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).

PRELIMINARY ISSUES

2The Case Conference Report and Order of Adjudicator John dated September 30, 2020, lists four issues in dispute for this written hearing, itemized as numbers (i) to (iv) at paragraph 13, below.

3However, in his written submissions, the applicant listed two additional issues as being in dispute:

(i) The applicability of the Minor Injury Guideline (“MIG”); and

(ii) The applicant’s entitlement to an award under section 10 of Regulation 664², for unreasonably withheld or delayed payments.

4In its responding materials, the respondent contested the inclusion of these issues, submitting that at the conference resumption on September 21, 2020, the applicant withdrew MIG as an issue in dispute.

5Further, the respondent submitted that the applicant has never claimed an entitlement to an award under section 10 and did not seek to properly add the issue at any point during the course of these proceedings.

6I find that the applicant is not entitled to add the applicability of the MIG as an issue in dispute, but is entitled to add an award as an issue in dispute in this written hearing.

The Addition of MIG as an Issue in Dispute

7Two case conferences were held in this matter – one on January 8, 2020 and a resumption on September 21, 2020. The Case Conference Order, dated January 8, 2020, listed 10 issues in dispute, including whether the applicant had sustained predominantly minor injuries under the Schedule³.

8However, at the subsequent case conference resumption, the applicant withdrew six of the issues in dispute, including the issue of the applicability of the MIG. This withdrawal was explicitly noted in Adjudicator John’s Case Conference Report and Order dated September 30, 2020⁴ (“CCRO”). The CCRO listed the issues moving forward to a written hearing as being the first four issues listed in paragraph 13 below. The applicant clearly had this CCRO, as he provided it as part of his written submissions in this hearing.

9Rule 14.2 of the Common Rules of Practice and Procedure⁵ sets out the scope of a case conference. In particular, Rule 14.2(c) states that a case conference is for the identification, clarification, simplification and narrowing of the issues in dispute.

10The case conference resumption on September 21, 2020, clarified and narrowed the issues, including removing the applicability of the MIG as an issue in dispute. The applicant did not protest this withdrawal of the issue in the eight months prior to the filing of his written submissions. The applicant also did not reach out to the respondent to seek its consent to re-adding this issue, or bring a Motion to the Tribunal to include this withdrawn issue in advance of the scheduled written hearing. In his submissions, the applicant did not provide any explanation as to why he attempts to re-introduce this issue at this late stage. I have therefore decided to disallow the re-introduction of this issue by the applicant.

The Addition of an Award as an Issue in Dispute

11Section 10 of Regulation 664 states that if the Tribunal finds that an insurer has unreasonably withheld or delayed payments, the Tribunal may award a lump sum up to 50 percent of the amount to which the person was entitled to at the time of the award together with interest. As such, an adjudicator has the inherent jurisdiction to add an award at any point in the hearing process.

12Given that the threshold for adding the issue of an award is low and that the Tribunal routinely adds it to hearings, I will consider an award as an issue in dispute for this written hearing.

ISSUES

13The disputed claims in this hearing are:

i. Is the applicant entitled to the cost of temporomandibular joint (“TMJ”) treatment in the amount of $6,415.00 recommended by Novo Medical Services in a treatment plan (“OCF-18”) dated July 20, 2018?

ii. Is the applicant entitled to psychological services in the amount of $3,641.09 recommended by Novo Medical Services in an OCF-18 dated January 21 2019?

iii. Is the applicant entitled to the cost of a TMJ assessment in the amount of 2,005.00, recommended by Novo Medical Services in an OCF-18 dated June 4, 2018?

iv. Is the applicant entitled to interest on any overdue payment of benefits?

v. Is the respondent liable to pay an award under Regulation 664 because it unreasonably withheld or delayed payments to the applicant?

RESULT

14Based on the totality of the evidence before me, I find that:

(i) The applicant is not entitled to $6,415.00 for TMJ treatment;

(ii) The applicant is not entitled to $2,005.00 for a TMJ assessment;

(iii) The applicant is partly entitled to the OCF-18 for psychological services in the amount of $2,000.00, plus interest in accordance with s.51 of the Schedule; and

(iv) The respondent is not liable to pay an award under Regulation 664.

ANALYSIS

15Sections 14, 15 and 16 of the Schedule set out that an insurer shall pay for all reasonable and necessary expenses incurred by or on behalf of an insured person as a result of an accident.

16The applicant has the onus of proving on a balance of probabilities that the treatment plans are reasonable and necessary because of the accident. To meet this burden, the applicant should identify the goals of the plan, how the goals are being met to a reasonable degree and whether the time and cost expended to achieve these goals is proportional to the benefit.

17Prior to the subject accident, the applicant had also been involved in two earlier automobile accidents - on November 29, 2008 and on August 8, 2015.

18The applicant submits that he suffered a severe blow to the jaw and the front of the head as a result of the subject accident, resulting in significant dental and TMJ impairment, and necessitating the proposed TMJ treatment. The applicant further submits that he suffers from psychological impairments, including depression, anxiety somatization and post-traumatic stress disorder, as a result of the accident, and requires psychological treatment.

19The respondent submits that there is no evidence that the applicant sustained a TMJ injury as a result of the subject accident. The respondent further submits that any injury to the applicant’s teeth was caused as a result of the earlier August 8, 2015 accident. With respect to the disputed OCF-18 for psychological services, the respondent disputes the hourly rate charged for the therapeutic sessions.

Is the Applicant Entitled to $6,415.00 for TMJ treatment?

20After considering the evidence and submissions of the parties, based on a balance of probabilities, I find that the applicant has failed to meet his evidentiary onus to demonstrate that the OCF-18 for TMJ treatment is reasonable and necessary.

21The applicant submits that the OCF-18 dated July 20, 2018 is reasonable and necessary, as he suffered cracked teeth and injured his jaw as a result of the accident. In support of his claim, the applicant relies on a TMJ Assessment Report conducted by Dr. Leon Treger, dentist, of Novo Medical Services where the applicant was diagnosed with: anterior disc displacement; capsulitis of the temporomandibular joint; joint stiffness and pain in the jaw; and temporal tendinitis⁶. The treatment proposed in the OCF-18 includes: implant and external appliances related to TMJ; root canals; tooth extraction and crowns⁷.

22The respondent submits that the there is no evidence that the applicant injured any of his teeth or sustained a TMJ injury as a result of the accident. Rather, the respondent asserts that the evidence indicates that the applicant reported chipping his teeth in a previous accident, on August 8, 2015. The respondent further relies on its s.44 Insurer’s Examination (“IE”) report, where Dr. Michael Rozeluk, dentist, did not find any evidence of TMJ dysfunction and concluded that the applicant did not sustain any tooth damage from the subject accident⁸.

23On review of the submissions and medical evidence, I find that the applicant has not led sufficient objective evidence that he sustained a dental injury and impairment as a result of the accident.

24The applicant provided substantial medical records as part of his submissions, including 110 pages of clinical notes and records (“CNRs”) from his family physician’s office, Dr. Joyce Samuel. The applicant attended at Dr. Samuel’s office on November 2, 2016, the day of the accident, reporting headaches, a sore left arm, back and neck stiffness, and dizziness⁹. There was no mention of any dental injury or TMJ pain. From November 2016 to December 2018, the applicant attended at Dr. Samuel’s offices approximately 30 more times with various medical and pain complaints, but did not raise any dental or TMJ issue in any of these visits.

25Rather, the medical records suggest that the applicant sustained a dental injury as a result of a prior car accident, which took place on August 5, 2015. The CNRs of Dr. Samuel contain an entry on August 15, 2015, referencing the car accident “last week”. Dr. Samuel noted that “teeth needed to be fixed”¹⁰. Similarly, the dental records of the applicant indicate that on April 12, 2016, more than six months before the accident in question, the applicant attended at Victoria Park Square Dental Office. The entry from this date states “#11/21 fracture happened Aug 8/15 from a car accident.”¹¹. Finally, in the applicant’s medical legal assessment relating to chronic pain dated September 17, 2017, Dr. George Gale noted that “the MVA of August 8, 2015 caused the sternal fracture, as well as his chipped teeth.”¹²

26In addition, in the s.44 IE Dental Assessment, Dr. Rozeluk did not find any facial pain, limitations in opening his mouth or jaw pain or clicking or popping. Dr. Rozeluk also conducted a joint vibration analysis which revealed no TMJ dysfunction. Finally, Dr. Rozeluk noted that no dental x-rays or notes were available to corroborate the applicant’s claim that he chipped his tooth at the time of the accident.

27When comparing the s.44 Dental Assessment of Dr. Rozeluk and the TMJ Assessment Report conducted by Dr. Treger, I prefer the evidence of Dr. Rozeluk, as Dr. Rozeluk’s conclusions are consistent with the objective medical and dental evidence.

28Dr. Treger had concluded that the applicant had fractured his tooth and suffered a severe blow to the jaw as a result of the subject accident. However, this was based solely on the applicant’s self-reports and is not corroborated by the CNRs of the family physician or dental records. The applicant did not report any dental or jaw pain to his family physician after the November 2016 accident or at any point thereafter. The applicant did however report to a number of medical professionals that he had suffered a dental injury after the August 2015 accident.

29As a result, I find that the applicant has not met his burden of proof to establish that he sustained a dental or TMJ impairment from the subject accident or that the TMJ treatment proposed in the OCF-18 is reasonable and necessary pursuant to the Schedule.

Is the Applicant Entitled to $2,005.00 for a TMJ assessment?

30I find that the applicant has failed to prove on a balance of probabilities that the OCF-18 for a TMJ assessment is reasonable and necessary. For the reasons outlined above, the applicant has failed to adduce sufficient objective medical evidence that he suffered a dental and TMJ impairment from the subject accident.

31In his submissions, the applicant also raised the issue of the sufficiency of the respondent’s denial letter and asserted that the respondent was not in compliance with s.38 of the Schedule. The applicant submits that the respondent failed to provide medical reasons and any other applicable rationale for the denial of the OCF-18. However, the applicant inaccurately identifies the insufficiency as being that the respondent did not advise the applicant that the MIG applied, and that the respondent used boiler plate and vague language that “based upon a review of the information and medical information provided to date, we do not agree to pay for the…(OCF-18).”¹³

32The applicant’s submissions erroneously cite language that was not contained in the respondent’s denial letter. In the denial letter, dated September 6, 2018, the respondent identifies the June 4, 2018 treatment plan and advises that the respondent does not agree to pay for it. The letter provides a medical reason in stating that the recommended treatment is not reasonable and necessary for the injuries sustained in the accident and references and encloses the IE report prepared by Dr. Rozeluk, dated August 24, 2018, which formed the basis for the opinion. I am uncertain as to why in his submissions the applicant misquoted this denial letter, as he included the September 6, 2018 letter as part of his materials.

33I find the September 6, 2018, denial meets the necessary requirements outlined in section 38(8).

Is the Applicant Entitled to $3,641.21 for Psychological Services?

34I find that the applicant is entitled to partial payment of the OCF-18 for psychological services, in the amount of $2,000.00, for the following reasons:

35In support of his claim for psychological treatment, the applicant submitted a psychological assessment report dated January 8, 2018, prepared by Dr. Romeo Vitelli, psychologist. I note that the date of the report may have been mistakenly recorded as 2018 rather than 2019, given that the date of the examination was October 24, 2018. Dr. Vitelli conducted an interview with the applicant, along with psychological testing including: the Beck Anxiety Inventory; Beck Depression Inventory II; Patient Pain Profile; and Chronic Pain Assessment Questionnaire.

36Dr. Vitelli concluded that the applicant met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (“DSM-5”) criteria for an adjustment disorder with mixed anxiety and depressed mood, and specific phobia – vehicular, and was at risk for developing Somatic Symptom Disorder¹⁴. Dr. Vitelli recommended 10-12 sessions of cognitive behavioural therapy.

37The applicant further provided psychotherapy notes, indicating that he attended at 12 therapeutic sessions conducted by Shawna Fleisher, Master of Social Work (“MSW”), from February 4, 2019 to May 14, 2019. At the end of the 12 sessions, the applicant reported to Ms. Fleisher that he had found the sessions helpful and that he would like to continue with them¹⁵.

38In its submissions, the respondent does not appear to dispute the reasonableness or necessity of the incurred psychological treatment. Rather, the respondent disputed the hourly rate charged by Ms. Fleisher, which will be addressed below. The respondent submits that it “is agreeable to fund the treatment plan at $100 per hour to a maximum cost of $2,000.00.”¹⁶

39In terms of evidence, the respondent did not provide a rebuttal s. 44 report or reference any evidence to argue that psychological treatment was not warranted. The sole argument the respondent appeared to advance in questioning the treatment, was to assert that Dr. Vitelli, who had prepared the assessment report, has been disciplined by the College of Psychologists of Ontario for his lack of supervision in conducting assessments.

40Given that the respondent states in its submissions that it is agreeable to partially approving the OCF-18, subject to adjustment of the appropriate hourly rate, and that it has not led evidence to rebut the diagnoses of Dr. Vitelli, I infer that the respondent is not disputing the reasonableness and necessity of the OCF-18 for psychological services.

41However, even if the respondent did dispute the reasonableness and necessity of the psychological treatment, I find that the applicant has met his burden of proof in this regard. Dr. Vitelli’s psychological report referenced objective diagnostic testing and conducted an interview with the applicant prior to making his diagnoses.

42Moreover, additional medical providers have referenced the applicant’s psychological impairment. For example, in the Chronic Pain Assessment Report dated July 20, 2018, prepared by Dr. Jakub Sawicki, physician with Certification in the College of Family Physicians, Dr. Sawicki diagnosed the applicant with chronic neuropathic pain syndrome and adjustment disorder with mood features, in addition to physical injuries¹⁷. As a result, I find that the applicant has adduced sufficient evidence that the OCF-18 for psychological services is reasonable and necessary.

43With respect to the hourly rate to be charged for such psychological services, the respondent submits that the $149.61/hour proposed in the OCF-18, exceeds the maximum rate set under the Professional Services Guideline¹⁸ (the “Guideline”). The respondent submits that as Ms. Fleisher is a registered social worker, the unregulated hourly rate set under the Guideline is $58.19. However, I note that pursuant to the Guideline, the amount payable by an insurer related to services not covered by the Guideline may be determined by the parties involved.

44The respondent conceded in its submissions that in the case of M.I.A. v. Aviva General Insurance, the Tribunal found that an hourly rate of $100.00 for social workers was reasonable¹⁹. As a result, the respondent submitted that it was agreeable to fund the OCF-18 at $100.00 per hour to a maximum cost of $2,000.00, based on the decision of M.I.A. v. Aviva.

45The applicant did not provide persuasive submissions to counter the proposed $100.00 hourly rate. In his reply submissions, the applicant inaccurately asserted that the respondent claimed that an hourly rate of $55.00 per hour should be paid, as the treatment provider was a psychotherapist. The applicant then went on to provide caselaw in support of the argument that a psychotherapist should be paid the same rate as a psychologist²⁰ and submitted that Ms. Fleisher, a psychotherapist, should be paid at the same rate as a psychologist. The applicant included Ms. Fleisher’s curriculum vitae (“CV”) with its reply submissions.

46The applicant’s reply submissions with respect to this issue are inaccurate. The respondent did not submit that Ms. Fleisher be paid $55.00 per hour, but that she be paid $100.00 per hour. The respondent had also noted that the unregulated hourly rate set under the Guideline is $58.19, not $55.00 per hour. Further, the respondent did not at any point in its submissions refer to Ms. Fleisher as a psychotherapist, but as a social worker. It is not clear why the applicant refers to Ms. Fleisher as a psychotherapist, although the confusion may lie in the fact that the OCF-18 had listed the proposed treatment as being “Individual Psychotherapy” and Ms. Fleisher’s name was included in a list of potential providers who were described as “regulated practitioners in psychotherapy”²¹.

47However, the CV relied upon by the applicant lists Ms. Fleisher’s education as being a MSW, with her career objective being to practice social work and her current employment experience as being a Social Worker/Transition Navigator. Ms. Fleisher is a member of the Ontario and Canadian Associations of Social Workers and the Ontario College of Social Workers and Social Service Workers. I do not see any indications from Ms. Fleisher’s CV that she has trained, worked or been registered as a psychotherapist. If the applicant was asserting that Ms. Fleisher was a regulated practitioner of psychotherapy, the onus was on him to provide evidence of such qualifications and experience. Given that he has not adduced any evidence in this regard, the applicant’s submissions that Ms. Fleisher is a psychotherapist who should be paid the same rate as a psychologist, cannot be accepted.

48I did not find the applicant’s submissions regarding the cases of A.S. v. Aviva Insurance Company and D.J. v Aviva Insurance Company of Canada²², to be persuasive, as these cases related to treatment providers that were psychotherapists, rather than social workers. I also do not have any evidence before me as to what hourly rate Ms. Fleisher would charge in private practice.

49Given that the respondent has submitted that it is agreeable to fund the OCF-18 at $100.00 per hour to a maximum cost of $2,000.00, an amount significantly higher than the unregulated rate for social workers under the Guideline; And the applicant has not provided a persuasive argument as to why this amount is not appropriate for a social worker, I find that the rate of $100.00/hour is an appropriate hourly rate for the psychological services provided by Ms. Fleisher.

50Since the OCF-18 proposed 12 sessions each lasting 1.5 hours, the amount payable for Ms. Fleisher’s therapy sessions is $1,800.00. As the respondent agreed to pay $2,000.00 as a partial payment of the OCF-18, the remaining $200.00 would cover one of the documentation costs listed on the OCF-18 – namely the “documentation, support activity for claim form”, which was $200.00.

51The OCF-18 further lists additional fees for:

i. Brokerage, service - $149.61

ii. Preparation, service - $149.61

iii. Documentation, support activity - $448.83

52In his submissions, the applicant did not provide any arguments or evidence as to why the treatment provider required documentation fees beyond the $200.00 prescribed by the Guideline.

53As such, I am bound by section 15(2)(b) of the Schedule, which states that the respondent is not liable to pay for medical goods or services that exceed the maximum rate. Therefore, I find that the applicant has not proven on a balance of probabilities that the remaining fees, namely, $149.61 for brokerage services, $149.61 for preparation time and $448.83 for documentation support activity are reasonable and necessary, and accordingly, they are not payable.

54Finally, the applicant also disputed the sufficiency of the respondent’s denial letter and asserted that the respondent was not in compliance with s.38 of the Schedule. The applicant submits that the respondent failed to provide medical reasons for the denial of the OCF-18.

55However, the applicant inaccurately identifies the insufficiency as being that the respondent did not advise the applicant that the MIG applied, and that the respondent used boiler plate and vague language that: “Your limits of medical and rehabilitation coverage have been exhausted and there is a lack of documentation in the file to support the medical necessity.”²³

56The applicant’s submissions appear to erroneously cite language that was not contained in the respondent’s denial letter. In the denial letter dated February 1, 2019, included at Tab 29 of the applicant’s materials, the respondent in fact states that the applicant remains in non-compliance with its attached Section 33 request dated Sept. 13, 2018, where it requested clinical notes and records from a number of treatment providers, including Dr. Samuel and Dr. Gale. The respondent went on to state in its denial letter that upon receipt of these records, it will be in a position to address the OCF-18. I am uncertain as to why the applicant in his submissions misquoted the denial letter, as the applicant provided the February 1, 2019 denial letter as part of his submissions.

57The respondent re-stated in its submissions that the applicant’s non-compliance with Section 33 was the reason for its denial. However, the applicant did not address this issue in his reply submissions. The applicant did not adduce evidence as to whether these CNRs were in fact provided, and if so, when they were provided to the respondent. As there is no evidence before me that the applicant cured this non-compliance with section 33, I find that the applicant has not proven on a balance of probabilities that the insurer’s denial letter was insufficient.

Is the applicant entitled to interest on any overdue payments?

58The applicant submitted that he was entitled to interest on all benefits in dispute based on section 51 of the Schedule.

59The respondent asserts that as no amounts are owed to the applicant, interest is not payable.

60After considering the submissions of the parties, based on a balance of probabilities, I find that interest is payable on the overdue claims in dispute, namely the $2,000.00 for psychological services.

Is the applicant entitled to an award for unreasonably withheld or delayed payments?

61I find that the applicant is not entitled to an award for unreasonably withheld or delayed payments.

62Section 10 of Regulation 664 states that if the Tribunal finds that an insurer has unreasonably withheld or delayed payments, the Tribunal may award a lump sum up to 50 percent of the amount to which the person was entitled to at the time of the award together with interest.

63As I have found that the applicant is not entitled to the cost of the TMJ treatment or assessment, there is no basis upon which to consider an award with respect to those issues. With respect the remaining issue of the cost of psychological treatment, the applicant provided limited particulars as to why he is entitled to an award for this payment.

64In his submissions, the applicant makes general statements that the respondent breached his fiduciary duty to adjust the claim in good faith.²⁴ However, the applicant has provided limited evidence in this regard.

65Firstly, the applicant submits that given that he had significant pre-existing injuries, he should have been taken out of the MIG prior to September 2020. However, as previously discussed, the applicability of the MIG is not an issue in dispute in this hearing. Secondly, the applicant claims that the respondent did not properly consider medical the opinions of his family physician and Dr. Gale, which denied him the right to “enjoy a pain free life”²⁵. However, with respect to chronic pain complaints, the applicant’s claims relating to a chronic pain assessment and physical physiotherapy treatment were also withdrawn at the September 21, 2020 case conference resumption, and so are not before me today. Moreover, the applicant does not provide any particulars of what opinion was provided by Dr. Samuel with respect to psychological services, which the applicant asserts the respondent should have considered.

66Although I have found that the applicant is entitled to the cost of psychological services, this does not automatically entitle the applicant to an award. It is well settled that an award should not be ordered simply because an insurer made an incorrect decision. Rather, in order to attract an award under Regulation 644 the insurer’s conduct must be excessive, imprudent, stubborn, inflexible, unyielding or immoderate, and the evidentiary onus is on the applicant to demonstrate this. The applicant has not established that the respondent acted unreasonably in withholding or delaying payment and so, is not entitled to an award.

CONCLUSION AND ORDER

67For the reasons outlined above, I find that:

(i) The applicant is not entitled to $6,415.00 for TMJ treatment;

(ii) The applicant is not entitled to $2,005.00 for a TMJ assessment;

(iii) The applicant is partly entitled to the OCF-18 for psychological services in the amount of $2,000.00, plus interest in accordance with s.51 of the Schedule; and

(iv) The respondent is not liable to pay an award under Regulation 664.

Footnotes

1. 1O. Reg. 34/10 as amended.
2. 2R.R.O. 1990, Regulation 664: AUTOMOBILE INSURANCE.
3. 3Respondent’s Submissions, Tab C, Case Conference Order of Adjudicator Sharda, dated January 8, 2020
4. 4Applicant’s Submissions, Tab 2, Case Conference Report and Order of Adjudicator John, dated September 30, 2020
5. 5Licence Appeal Tribunal, Animal Care Review Board and Fire Safety Commission, Common Rules of Practice and Procedure, October 2, 2017, as amended.
6. 6Applicant’s Submissions, Tab 8, TMJ Report of Dr. Treger dated July 11, 2018
7. 7Applicant’s Submissions, Tab 28, OCF-18 dated July 20, 2018
8. 8Respondent’s Submissions, Tab L, Dental Assessment Report of Dr. Rozeluk, dated August 31, 2018
9. 9Applicant’s Submissions, Tab 6, Clinical Notes and Records of Dr. Samuel, dated November 2, 2016
10. 10Applicant’s Submissions, Tab 6, Clinical Notes and Records of Dr. Samuel, dated August 15, 2015
11. 11Respondent’s Submissions, Tab G, Victoria Park Square Dental Records, April 12, 2016
12. 12Applicant’s Submissions, Tab 5, Medical Legal Assessment of Dr. Gale dated September 17, 2017 at p.38-39
13. 13Applicant’s Submissions, page 9, par 15
14. 14Applicant’s Submissions, Tab 7, Psychological Assessment Report of dr. Vitelli, dated October 24, 2018
15. 15Applicant’s Submissions, Tab 11, Psychotherapy Notes – Novo Medical Services, entry dated May 14, 2019
16. 16Respondent’s Submissions, pg. 13, para 32.
17. 17Applicant’s Submissions, Tab10,p.249, Chronic Pain Assessment Report of Dr. Jakub Sawicki dated May 20, 2018
18. 18Professional Fees Guideline - Superintendent’s Guideline No. 03/14
19. 19M.I.A. v. Aviva General Insurance, 2020 CanLII 94805 (ONLAT) at para 29.
20. 20A.S. v. Aviva Insurance Company, 2020 CanLII 12787 (ONLAT) and J.V. v. Intact, 2019 CanLII 76995 (ONLAT)
21. 21Applicant’s Submissions, Tab 9, OCF-18 dated January 21, 2019
22. 22D.J. v Aviva Insurance Company of Canada, 2020 CanLII 40340 (ON LAT) at para. 17.
23. 23Applicant’s Submissions, page 8
24. 24Applicant’s Submissions, at p. 8.
25. 25Applicant’s Submissions, at p. 4.