Licence Appeal Tribunal File Number: 18-006807/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:
[M.S.G]
Applicant
and
Certas Direct Insurance Company
Respondent
DECISION
ADJUDICATOR:
Lori Marzinotto, Vice Chair
APPEARANCES:
For the Applicant:
[M.G], Estate Trustee of the Estate of [M.S.G] Frank Mercurio, Paralegal
For the Respondent:
Brittanny Tinslay, Counsel
HEARD in writing:
March 12, 2021
OVERVIEW
1The applicant was injured in an automobile accident on December 26, 2016 (the “Accident”). The applicant applied for benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”).
2The respondent paid the applicant income replacement benefits (“IRB”) which were terminated on December 20, 2017, on the basis of s. 44 Insurer Examinations (“IEs”) that determined the applicant no longer met the criteria for an IRB. The applicant disagreed with the respondent’s termination of IRB and submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) to dispute the termination of the IRB and the denial of a physiatry assessment.
3The applicant died on January 29, 2019 and the application before the Tribunal was continued by the Estate Trustee, [M.G].
ISSUES IN DISPUTE[^1]
4I confirm that the following issues are in dispute:
i. Is the applicant entitled to an income replacement benefit of $400.00 per week from December 20, 2017 to January 29, 2019, (the applicant’s date of death)?
ii. Is the applicant entitled to $2,460.00 for a physiatry assessment, recommended by Dr. Ghouse in a treatment plan (OCF-