Licence Appeal Tribunal File Number: 20-008934/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:
Roach Rajapaksha
Applicant
and
Aviva General Insurance Company
Respondent
DECISION AND ORDER
ADJUDICATOR:
Stephanie Kepman
APPEARANCES:
For the Applicant:
Sana Jaffery, Paralegal
For the Respondent:
Mark Vella, Counsel
HEARD:
By way of written hearing
REASONS FOR DECISION AND ORDER
BACKGROUND
1The applicant was involved in an automobile accident on December 14, 2017 and sought benefits pursuant to the Statutory Accident Benefits Schedule Effective September 1, 2010 (including amendments effective June 1, 2016)1 (“Schedule”). The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).
PRELIMINARY ISSUE
2The preliminary issue for the Tribunal to determine is:
i. Was the treatment plan (“OCF-18”) for substantive issue iii, meaning for the chronic pain assessment in the amount of $2,6800.00, properly submitted to Health Claims for Auto Insurance (“HCAI”), pursuant to section 38(2)2 of the Schedule?