Banh v. Aviva Insurance Company, 2022 CanLII 78907

Citation: Banh v. Aviva Insurance Company, 2022 ONLAT 20-007898/AABS

Licence Appeal Tribunal File Number: 20-007898/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:

Nu Banh

Applicant

and

Aviva Insurance Company

Respondent

DECISION

ADJUDICATOR: Ulana Pahuta

APPEARANCES:

For the Applicant: Sareena Samra, Counsel

For the Respondent: Maia Abbas, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Nu Banh, (the applicant), was involved in an automobile accident on October 18, 2016, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (“Schedule”)¹. The applicant was denied certain benefits by Aviva Insurance Company, (the respondent), and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).

2In her submissions for this written hearing, the applicant stated that she was withdrawing the issue of an attendant care assessment, Item 3 from the Case Conference Report and Order dated November 25, 2020². As such I have removed the attendant care assessment as an issue in dispute in this hearing.

ISSUES

3The disputed claims in this hearing are:

a. Is the applicant entitled to a medical benefit in the amount of $1,977.66 for chiropractic services proposed by Easy Health Centre in a treatment plan (“OCF-18”) dated March 31, 2018?

b. Is the applicant entitled to a medical benefit in the amount of $898.64 for prescriptions and medications proposed in an Expenses Claim Form (“OCF-6”) dated March 17, 2020?

c. Is the applicant entitled to a medical benefit in the amount of $4,925.62 ($16,825.62, less $11,900.00 approved by the respondent), for catastrophic determination assessments proposed by Somatic Assessments & Treatment Clinic in an OCF-18 dated November 15, 2019?

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

RESULT

4I find the applicant is not entitled to the disputed treatment plan and benefits, as she has not met her onus to prove that they are reasonable and necessary. As no benefits are owing, no interest is payable.

BACKGROUND

5The applicant was involved in a motor vehicle accident on October 18, 2016 and was taken to Grand River Hospital by ambulance.

6Soon after the accident, the applicant began to experience pain in multiple locations and was advised by her family physician to begin physical therapy and was prescribed pain medication. Since October 2016, the applicant has attended for chiropractic treatment, massage, acupuncture, electrotherapy and physical rehabilitation treatment at a number of treatment facilities.

7The applicant also began to suffer from psychological symptoms and began psychological treatment in February 2018, in addition to being prescribed prescription medication.

8On April 3, 2020, the applicant submitted an Application for Determination of Catastrophic Impairment pursuant to Criteria 7 and 8 of the Schedule. On May 3, 2021, the respondent designated the applicant as catastrophically impaired pursuant to Criterion 8 (impairment due to mental or behavioural disorder).

9The applicant submits that since the motor vehicle accident, she continues to suffer from long-lasting physical and psychological injuries, necessitating the medical benefits for chiropractic services, prescriptions and medications currently in dispute. The applicant also claims entitlement to the denied portions of the partially approved catastrophic assessments.

ANALYSIS

Are the Treatment Plans Reasonable and Necessary?

10Sections 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 as a result of an accident.

11The 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.

Is the Applicant Entitled to $1,977.66 for chiropractic treatment, acupuncture and massage therapy?

12I find that the applicant is not entitled to the cost of the chiropractic, acupuncture and massage therapy services, as she has failed to meet her evidentiary burden to prove that this treatment plan is reasonable and necessary.

Parties’ Positions

13The applicant submits that she had a bona fide need for the proposed treatment, as she continues to experience not only serious psychological impairments as a result of the accident, but also chronic pain which has led to severe functional limitations. To establish this claim, the applicant relies on:

(i) the clinical notes and records (“CNR’s”) of her family physicians Dr. M. Rayhaan Dawood and Dr. Francis Lang, which report persistent complaints of chronic pain and prescriptions for a number of pain medications in the years post-accident. The applicant’s family physicians also referred her to a number of specialists due to her ongoing pain complaints.

(ii) the diagnoses of various specialists her family physicians had referred her to - Dr. Tariq Suhail, rheumatologist, diagnosed the applicant with fibromyalgia in January 2018³. In addition, the applicant submits that Dr. Scott Cook, a specialist in Physical Medicine and Rehabilitation noted the applicant’s drastically limited range of motion at the lumbar and cervical spine, and decreased sensation throughout the extremities. Dr. Cook diagnosed the applicant with chronic myofascial pain of the cervical and lumbar spine, in addition to other psychological diagnoses⁴.

(iii) the treatment records of the various clinics the applicant attended from 2016-2021, which indicate that the applicant continued to report functionally-limiting pain, headaches and decreased range of motion for years after her motor vehicle accident. The applicant submits that she found the treatments to be helpful, although the pain always returned.

(iv) the numerous assessments conducted by both the applicant’s and respondent’s assessors. The applicant submits that the CAT Determination Assessment Reports of Dr. Georgia Palantzas, chiropractor, Mr. Raymond Wong, occupational therapist, and Dr. Bruce Cook, psychologist, all establish the applicant’s severe functional limitations. Dr. Palantzas noted the applicant’s chronic injuries, severe muscle weakness and radiculopathy⁵. Further, the applicant argues that the respondent’s assessors have also found the applicant to be catastrophically impaired and suffering from chronic pain.

14In response, the respondent submits that the applicant was designated catastrophically impaired as a result of mental and behavioural impairments and not physical impairments. The respondent argues that the applicant has failed to establish any musculoskeletal impairment or that further physical treatment would provide any further therapeutic benefits. In support of this claim, the respondent relies on:

(i) diagnostic imaging, conducted post-accident - the respondent submits that x-rays, MRIs and CT scans establish that there is no significant trauma related issue. The x-rays conducted soon after the accident of the applicant’s cervical spine noted degenerative changes, with no subluxation, and the x-ray of her lumbar spine was normal.⁶ The CT scans in January, March and May 2017 of her head were found to be normal and unremarkable.⁷ The MRI of the applicant’s cervical spine in April 2017 noted long-standing degenerative changes, with no central canal stenosis or obvious neural compromise.⁸ And the MRI of her lumbar spine noted a mild long-standing left paracentral broad-based disc protrusions at L5-S1 which abuts the left S1 nerve root. There was no nerve root impingement or central canal stenosis.⁹

(ii) the IE physiatry assessment of Dr. Tonya Ballard dated April 3, 2018, indicated that there was no further role for facility-based treatment¹⁰.

(iii) the CAT Assessments conducted in May 2021. The respondent submits that the IE Physiatry CAT Assessment conducted by Dr. Shariff Dessouki failed to identify any objective musculoskeletal impairments and expressly noted the applicant’s self-limitation and pain focussed behaviours. The IE Neurocognitive CAT assessment conducted by Dr. Konstantine Zakzanis found that there were no cognitive impairments that could be objectively confirmed. Finally, the respondent submits that the IE ADL Functional, Community Function, and Occupational Therapy CAT assessments conducted by Ms. Lynn Rutledge found that the applicant displayed the required physical abilities to perform the various tasks, but her emotional barriers impacted her ability to complete them.

15The respondent suggests that it would be unreasonable to continue with treatment that is ineffective. It submits that during the more than four and a half years since the accident, and despite undergoing more than $35,000.00 of treatment, the applicant has consistently reported minimal or no improvement in her physical condition. The respondent further submits that the OCF-18 in dispute was not even intended to assist with pain reduction or pain management, as the stated goals were identified as being only: increase in strength, increased range of motion, and return to activities of normal living.

The Treatment Plan is not Reasonable and Necessary

16Upon review of the submissions and the medical evidence, I have determined that the applicant has not adduced sufficient objective medical evidence to establish that the stated goals of the OCF-18 in dispute, can be met to a reasonable degree by the proposed treatment. Although I acknowledge that the applicant has been found to be suffering from a number of accident-related limitations, she has failed to prove on a balance of probabilities that the proposed physical treatment would provide any therapeutic benefit.

17Firstly, although the applicant claims in her submissions that she has found physical treatments to be helpful, the medical evidence submitted does not establish that the various treatment modalities the applicant received over the four years post-accident were beneficial in either improving her functional limitations or significantly assisting with pain reduction. The applicant consistently reported to her family physicians Dr. Dawood and Dr. Lang that despite the therapeutic treatment, there were no changes in her pain symptoms¹¹. The CNR’s note the lack of improvement, with entries such as “symptoms as they have always been, difficult to treat”¹² and “same pains as always as per patient”¹³.

18This lack of improvement was reported to or noted by her therapeutic treatment providers as well. The applicant attended at CBI Health Centre, Walsh Health and Wellness Centre, Perfect Physio and Rehab Centre, Beechwood Chiropractic Clinic and Easy Health Centre and received various combinations of chiropractic treatment, massage, acupuncture, electrotherapy and physical rehabilitation treatment. The treatment records indicate that at the applicant’s last session at CBI Health Centre on March 3, 2017 when asked how her pain was compared to the first visit, her response was that it was the “same” ¹⁴. It was further noted in this entry that she was still restricted in her walking, sitting, standing, work and travel. The records of Walsh Health and Wellness Centre similarly indicate that the applicant consistently noted no change to her symptoms and reported pain in all her movements. The applicant also noted in her registration form that she only found relief through medication¹⁵. Finally, in a progress report from Beechwood Chiropractic Clinic dated July 27, 2017, it was noted that the applicant reported minimal lasting changes since the last exam, even with increased active care¹⁶.

19The applicant similarly reported to various specialists that the numerous physical therapeutic treatments were not effective. Dr. Cook, the pain specialist her family physician had referred her to, reported that “(t)hus far, all medication, massage, acupuncture and chiropractic treatments have not helped.”¹⁷ In the Orthopaedic Assessment Report prepared for the applicant’s CAT Determination by Dr. Georgia Palantzas on March 11, 2020, it is noted that the applicant’s reported symptoms of immobility, severe muscle weakness and pain have only minimally improved with active rehabilitation and both active and passive pain management. Dr. Palantzas went on to note “I see no potential end in sight for the patient’s condition to get any better.”¹⁸

20Although the applicant states in her submissions that she sustained physical injuries as a result of the accident, there is a lack of objective evidence of physical impairment. The diagnostic imaging, including x-rays, MRIs and CT scans establish that there is no significant physical accident-related impairment. Similarly, the respondent’s assessors conducting the Catastrophic Impairment Assessment Report, found limited physical accident-related injuries – namely, musculoligamentous injuries of the cervical and lumber spine and bilateral shoulder sprain and strain¹⁹. Although the applicant has not established a significant physical impairment causing her pain, her persistent pain symptoms are well documented.

21The applicant was diagnosed fibromyalgia in January. However, I do not find that this diagnosis establishes the reasonableness and necessity of the proposed treatment plan, as Dr. Suhail, the rheumatologist that diagnosed her with fibromyalgia, did not recommend any kind of physical therapy for this condition. Rather, his plan of care referenced medication (Cymbalata, Baclofen and Flexeril) and potentially local steroid injections.

22The respondent’s assessors consistently found that the applicant’s emotional and psychological barriers were the significant factor in her physical limitations. Dr. Patel noted that one of his psychological diagnoses, namely Somatic Symptom Disorder with Predominant Pain, involves disproportionate thoughts about somatic symptoms or health concerns, such as disproportionate thoughts about the seriousness of one’s symptoms. This excessive rumination causes the person to be marked by the sense that they are handicapped because of their pain experience²⁰. The respondent’s various assessors noted that it was these psychological self-limiting pain avoidance behaviours that were causing the applicant’s physical limitations, rather than physical impairments²¹.

23These psychological pain avoidance limitations have been noted by the applicant’s doctors and treatment providers as well. Dr. Cook, her pain specialist reported that “(h)er mental health issues have lead to kinesiophobia and fear avoidance behaviours that are limiting her ability to progress”²². Her chiropractor Dr. Jaclyn Witt noted that the applicant was pain focused and self-restricted/avoided movement due to pain.²³ This was similarly noted by her chiropractor Dr. Shelby Aitcheson at Walsh Health and Wellness Centre.²⁴

24Given that the applicant’s doctors and treatment providers have noted that the applicant’s psychological pain avoidance behaviours are self-limiting her movements, it is difficult to see how the OCF-18’s stated goals of increase in strength and increase in range of motion could be achieved, without the primary focus being pain management and overcoming the psychological barriers to pain. However, pain reduction was not listed as a stated goal in the OCF-18. In the applicant’s Orthopedic Assessment Report included with her Application for Determination of CAT Impairment, physical therapy was not recommended. Rather, the recommendations put forward by her assessor were for the applicant to see a psychologist for her psychological conditions, a social rehabilitation program and an extensive chronic pain program. None of these treatment recommendations are put forth in the present OCF-18.

25The only other stated goal in the OCF-18 in dispute was a return to the activities of normal living. However, the applicant’s own assessors stated that the applicant’s injuries are serious, chronic, and permanent and will continue to reduce the applicant’s ability to function in the future and that there is “no end in sight for her symptoms to be resolved”.²⁵ The applicant has not provided any evidence as to how the proposed treatment would assist her in a return to normal living.

26As a result, it is difficult to see how the facility-based treatment proposed in the disputed OCF-18 could meet its stated goals to a reasonable degree. I find that the applicant has not met her burden of proof to establish that the additional treatments proposed in the disputed OCF-18 are reasonable and necessary pursuant to the Schedule.

Is the applicant entitled to $898.64 for prescriptions and medications proposed in an OCF-6 dated March 17, 2020?

27The applicant submitted an OCF-6 with prescription receipts and a receipt for Cannabidiol (“CBD”) capsules. In her submissions, the applicant notes that the prescription records and respondent’s IE assessors have documented her long-term reliance on medication.

28The respondent argues that in her OCF-6, the applicant simply provided the receipts without corresponding prescriptions, that the prescriptions submitted are typically prescribed to manage diabetes, blood pressure, antibiotics and GERD and that there were no CNR’s from the cannabis clinic to provide an explanation as to the purpose of the CBD capsules. In its Explanation of Benefits (“EOB”) dated May 6, 2020, the respondent requested written documentation to support the claim that the prescriptions were for injuries directly related to the accident. The respondent further submits that there is no confirmation from the applicant as to whether the expenses were submitted to the applicant’s collateral benefits provider.

29The applicant did not submit any evidence to establish that she provided the respondent with the information and documentation requested in the EOB. In addition, despite having the right of reply in these proceedings, the applicant did not provide any submissions clarifying whether the expenses had been submitted to her collateral benefits provider. Although the prescription receipts attached to the OCF-6 indicate that a portion of the cost of the medication was charged to Assure Health, the applicant has not confirmed that this is in fact her collateral benefits provider.

30The applicant also did not provide any submissions to support the claim that the specific medications prescribed, and CBD capsules were for injuries directly related to the accident. Although in her submissions the applicant states that the OCF-6 was for CBD capsules and other prescription medication “as recommended by her family doctor²⁶”, the footnote reference for the applicant’s submission only refers to the OCF-6 itself. Although the applicant submits that her family physician recommended the medications, she does not refer to any particular CNR of her family physician or documentation in support of this claim. Without this information, I am unable to find that the applicant has met her onus to show that the prescription receipts and receipts for CBD capsules are a reasonable and necessary expense as a result of her accident-related injuries. As such, the amounts claimed in the OCF-6 are not payable.

Is the applicant entitled to $ 4,925.62 for catastrophic determination assessments?

31The applicant submitted an OCF-18 dated November 15, 2019, proposing a series of CAT assessments, for a total amount of $16,825.62. This OCF-18 was partially approved by the respondent in the amount of $11,900.00, leaving an outstanding balance of $4,925.62²⁷.

32In its responding submissions, the respondent states that the amounts that were approved in full, were for five CAT determination assessments in the amount of $2,000.00 each, namely: a Psychology Assessment; Occupational Therapy Assessment; Neurological Assessment; Orthopaedic Assessment; and an Overall Assessment Summary, Analysis, Final Rating. The respondent also approved in full two charges for $200.00 each for Documentation support activity for claim form.

33In its EOB dated December 3, 2019, the respondent noted that partial approval was being given for one additional file documentation review in the amount of $1,500.00 rather than the $2,000.00 claimed. The respondent further explained that the interpretation expense claimed is not required to be submitted on HCAI, but that the respondent would pay an interpretation fee separately, upon receipt of the stipulated information²⁸. The respondent also clarified that the transportation expenses of the applicant would similarly be paid separately from the OCF-18, subject to the 50 km deductible, once the stipulated information related to the transportation was received²⁹.

34In its EOB, the respondent denied in full three additional amounts of $1,000.00 each, which were listed as additional “catastrophic determination assessments”. These amounts were submitted by the same doctors preparing the Occupational Therapy, Psychological and Chiropractic catastrophic determination assessments for $2,000.00 each, already claimed on the OCF-18 (and approved by the respondent). In its submissions, the respondent identified these $1,000.00 amounts as being clinic file review assessments. In its EOB, the respondent denied these costs as they were over and above the approved $2,000.00 assessment fee.

35In its submissions, the respondent asserted that under s. 25(5) of the Schedule, it is not obligated to pay more than $2,000.00 for any one assessment. It argues that s.25 mandates that the $2,000.00 fee for each assessment includes the examination and preparing reports in connection with it. The respondent relies on the Tribunal decisions of MG v. Aviva Insurance Canada³⁰ and KYC v. Unica Insurance Inc.³¹ in support of its submission that a medical or file review is a necessary component of an assessment and captured within the $2,000.00 payment limit, rather than being an additional expense.

36In contrast, the applicant submitted that the respondent is obligated to pay for reasonable fees for preparing an application for determination of a catastrophic assessment, relying on the decision of 18-007227 v. Unica Insurance Inc.³². The applicant states in her submissions that the monetary limit of $2,000.00 in s.25(5)(a) “only applies to ‘any one assessment or examination and for preparing reports in connection” with that one assessment or examination.”³³ (applicant’s emphasis). She further submits that the FSCO Bulletin No. A-21/10 states that in applications for determination of CAT impairment, HST is payable in addition to the $2,000.00 cap. From these submissions, I infer that the applicant is arguing that the $2,000.00 payment limit mandated by s.25(5)(a), does not include the additional fees of $1,000.00 each, which the respondent had described as file assessment fees.

37Upon review of the submissions and evidence, I find that the applicant has failed to meet her burden to prove that she is entitled to the disputed balance of the OCF-18, for the following reasons:

The Cost of an Assessment Includes a File Review and Report Preparation

38I agree with the respondent’s submissions that an expense relating to a file review is included in the $2,000.00 payment limit mandated by s.25(5)(a) and is not a separate examination expense. These $1,000.00 fees were described as “catastrophic determination assessments” in the OCF-18, which appears to be a duplication of the $2,000.00 catastrophic determination fee already being submitted by these providers. The applicant did not provide reply submissions disputing the respondent’s characterization of these fees as file assessment reviews nor provide any clarification as to what services are covered by these $1,000.00 fees. Instead, in her submissions the applicant discussed why the catastrophic impairment assessments were reasonable and necessary. However, the respondent did not dispute the reasonableness and necessity of catastrophic assessments, rather, it disputed the additional $1,000.00 fees.

39I find the Tribunal decisions MG v. Aviva Insurance Canada³⁴ and KYC v. Unica Insurance Inc.³⁵ persuasive in their interpretation that a file review is a necessary and inherent component of an assessment and as such would be subject to the $2,000.00 payment limit stipulated by s.25(5). The applicant did not provide caselaw to dispute this interpretation. Rather, the applicant provided general assertions and caselaw that reasonable fees should be paid with respect to s.25(1)(5) of the Schedule. However, the applicant did not provide caselaw specific to the issue of fees charged above the $2,000.00 cap. The applicant also provided submissions that HST should be paid in addition to the $2,000.00 cap. However, HST is not in dispute in the matter at hand. The applicant appears to be arguing that these $1,000.00 fees are independent assessments unto themselves, but has provided no evidence to clarify or support this submission.

40As the applicant has not provided any evidence or submissions explaining or justifying the three disputed $1,000.00 fees, I find that she has not met her onus to establish that they are reasonable and necessary and therefore, are not payable.

Interpretation and Transportation Fees

41In its EOB, the respondent explained that it would pay the applicant’s interpretation and transportation fees expense separately from the OCF-18 upon receipt of the stipulated information³⁶. The respondent also noted that the transportation expense was subject to the 50km deductible. The applicant did not make any submissions with respect to this issue or to indicate whether the requested information was provided to the respondent or whether payment was provided outside of HCAI.

42I find the respondent’s requests for addition information such as details of the interpretation costs, the hourly rate, the length of the assessment and the location of the assessment, to be reasonable. Furthermore, s.25(4) of the Schedule provides that an applicant is entitled to authorized transportation expenses. This is defined under s.3(1) of the Schedule as not including the first 50km of a trip if the applicant is not catastrophically impaired. At the time of the assessments, the applicant was not catastrophically impaired.

43The applicant has not submitted any evidence or submissions that interpretation and transportation expenses are a reasonable and necessary component of the catastrophic impairment assessments. Further, the applicant did not dispute the respondent’s assertions in the EOB and in its submissions, that it would pay the expenses separately. As such, the applicant has not led sufficient evidence to establish that she is entitled to the unapproved balance of this treatment and assessment plan.

Interest

44Section 51(1) of the Schedule states that interest is due on a benefit that is overdue if the insurer does not pay the benefit within the time stated by the Schedule.

45As no benefits are overdue, no interest is payable under s.51.

CONCLUSION

46For the reasons outlined above, I find that the applicant is not entitled to the disputed treatment plans and benefits. As no benefits are owing, no interest is payable. The application is dismissed.

Footnotes

1. 1O. Reg.34/10, as amended.
2. 2Applicant’s Submissions, para 2(c)
3. 3Applicant’s Submissions, Tab 7, Records of Dr. Tariq Suhail.
4. 4Applicant’s Submissions, Tab 1, Hospital notes and records from Grand River Hospital, Report by Dr. Scott Cook dated November 25, 2018.
5. 5Applicant’s Submissions, Tab 17, Records from Somatic Assessments and Treatment Clinic, Orthopedic Assessment Report of Dr. Georgia Palantzas dated March 11, 2020.
6. 6Respondent’s Submissions, Tab C: X-rays of spine dated October 18, 2016.
7. 7Respondent’s Submissions, Tabs D and E: CT scans of head dated January 4, 2017 and March 12, 2017.
8. 8Respondent’s Submissions, Tab G: MRI of cervical spine dated April 4, 2017.
9. 9Respondent’s Submissions, Tab H: MRI of cervical spine dated April 4, 2017.
10. 10Respondent’s Submissions, Tab K, IE Physiatry Report of Dr. Tonya Ballard dated April 3, 2018.
11. 11Applicant’s Submissions, Tab 3, CNR’s of Dr. Lang and Dr. Dawood, entries dated September 12, 2017 and November 27, 2017.
12. 12Applicant’s Submissions, Tab 3, CNR’s of Dr. Lang and Dr. Dawood, entry dated January 10, 2019.
13. 13Applicant’s Submissions, Tab 3, CNR’s of Dr. Lang and Dr. Dawood, entry dated June 18, 2019.
14. 14Applicant’s Submissions, Tab 10, Records from CBI Health Centre, March 3, 2017.
15. 15Applicant’s Submissions, Tab 11, Records from Walsh Health and Wellness.
16. 16Applicant’s Submissions, Tab 13, Records from Beechwood Chiropractic, July 27, 2017 Progress Report.
17. 17Applicant’s Submissions, Tab 1, Hospital Notes from Grand River Hospital, letter from Dr. Scott dated November 25, 2018.
18. 18Applicant’s Submissions, Tab 17, Records from Somatic Assessments and Treatment Clinic, Orthopedic Assessment Report of Dr. Georgia Palantzas dated March 11, 2020 at p.65.
19. 19Respondent’s Submissions, Tab M, IE CAT Impairment Assessment Report, p.4.
20. 20Respondent’s Submissions, Tab M, IE CAT Impairment Assessment Report, p.86.
21. 21Respondent’s Submissions, Tab M, IE CAT Impairment Assessment Report p.5, p.21, p.22, p.23, p.135.
22. 22Applicant’s Submissions, Tab 1, Hospital Notes from Grand River Hospital, letter from Dr. Scott dated November 25, 2018.
23. 23Applicant’s Submissions, Tab 10, Records from CBI Health Centre, Discharge Letter dated April 20, 2017.
24. 24Applicant’s Submissions, Tab 11, Records from Walsh Health and Wellness, entry dated June 15, 2017.
25. 25Applicant’s Submissions, Tab 17, Records from Somatic Assessments and Treatment Clinic, Orthopedic Assessment Report of Dr. Georgia Palantzas dated March 11, 2020, p.12-13.
26. 26Applicant’s Submissions, p.4, para 11.
27. 27Respondent’s Submissions, Tab R, Explanation of Benefits dated December 3, 2019.
28. 28Ibid.
29. 29Ibid.
30. 30MG v Aviva Insurance Canada, 2019 CanLII 40256 (ON LAT) at paras 24-25.
31. 31KYC v. Unica Insurance Inc., 2020 CanLII 30388 (ONLAT) at paras 30-31.
32. 3218-007227 v. Unica Insurance Inc., 2019 CanLII 43885 (ONLAT) at para 9.
33. 33Applicant’s Submissions, p. 12 at para 40.
34. 34MG v Aviva Insurance Canada, 2019 CanLII 40256 (ON LAT) at paras 24-25.
35. 35KYC v. Unica Insurance Inc., 2020 CanLII 30388 (ONLAT) at paras 30-31.
36. 36Respondent’s Submissions, Tab R, Explanation of Benefits dated December 3, 2019.