Citation: Facey v. Aviva General Insurance Company, 2023 CanLII 13008 Licence Appeal Tribunal File Number: 20-013967/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:

Karlene Facey Applicant

and

Aviva General Insurance Company Respondent

DECISION

ADJUDICATOR: Terry Prowse

APPEARANCES:

For the Applicant: Michael Krylov, Counsel

For the Respondent: Rozlien Youkhana Brikha, Counsel

HEARD: By Way of Written Submissions

BACKGROUND

1Karlene Facey (the “applicant”) was involved in an automobile accident on July 26, 2016 and sought benefits from the Aviva Insurance Company (the “respondent”), pursuant to the Statutory Accident Benefits Schedule - effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”).

2The applicant was denied certain benefits by the respondent and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES IN DISPUTE

3The following issues are in dispute:

a. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline (the “MIG”)?

b. Is the applicant entitled to $4,022.42 for physiotherapy recommended by Focus Physio in a treatment plan/OCF-18 (“plan”) submitted on April 8, 2019, and denied on April 22, 2019?

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

RESULT

4The applicant’s injuries are predominantly minor. Therefore, it is not necessary to consider the disputed treatment plan and associated interest.

ANALYSIS

The MIG

5For the following reasons, I find the applicant’s injuries are predominantly minor.