Citation: Golrizkhatami v. Aviva Insurance Company, 2023 ONLAT 20-010902/AABS
Licence Appeal Tribunal File Number: 20-010902/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:
Pooya Golrizkhatami
Applicant
and
Aviva Insurance Company
Respondent
DECISION
ADJUDICATOR: Terry Prowse
APPEARANCES:
For the Applicant: Sevda Guliyeva, Paralegal
For the Respondent: Rozlien Brikha, Counsel
HEARD: By Way of Written Submissions
BACKGROUND
1Pooya Golrizkhatami, (the “applicant”), was involved in an automobile accident on August 13, 2018, and sought benefits from Aviva Insurance Company, (the “respondent”), pursuant to the Statutory Accident Benefits Schedule Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied certain benefits by the respondent, on the basis that they were not reasonable and necessary, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSES IN DISPUTE
2The following issues are in dispute:
a. Is the applicant entitled to chiropractic services, proposed by the Scarborough Medical Centre, as follows:
i. $187.30 ($1269.62 less $1082.32 approved) proposed in a treatment plan/OCF-18 (“plan”) dated October 15, 2018;
ii. $2,374.40 proposed in a plan dated September 25, 2019;
iii. $2,356.32 proposed in a plan dated November 15, 2019;
iv. $1,060.00 proposed in a plan dated December 16, 2019;
v. $1,923.04 proposed in a plan dated February 4, 2020;
vi. $1,300.00 proposed in a plan dated March 20, 2020; and
vii. $3,714.49 proposed in a plan dated April 2, 2020?
b. Is the applicant entitled to the assessments proposed by Q Medical as follows:
i. $2,401.26 for a Chronic Pain Assessment plan dated December 24, 2019;
ii. $1,804.07 for an Occupational Therapy Assessment plan dated December 13, 2019;
iii. $2,029.49 for an Assessment for Attendant Care Needs plan dated December 4, 2019; and
iv. $1,671.84 for a Social Work Assessment plan dated January 6, 2020?
c. Is the applicant entitled to $2,704.30 for physiotherapy services, proposed by Radmeh Arjmandi in a plan dated January 28, 2021?
d. Is the applicant entitled to interest on overdue payment of benefits?
RESULT
3The applicant is entitled to the chronic pain assessment plan dated December 24, 2019, plus interest pursuant to s. 51 of the Schedule.
4The applicant is entitled to the occupational therapy assessment plan dated December 13, 2019, plus interest pursuant to s. 51 of the Schedule.
5The applicant is not entitled to the remaining plans.
Procedural Issue – Submission Page Length
6The respondent requests that the Tribunal not consider a portion of the applicant’s submissions. It submits that the applicant did not comply with the Case Conference Report and Direction of Adjudicator Watson, by exceeding the permissible page count and spacing requirements. The respondent submits that the Tribunal should only consider the portion of the applicant’s submissions that would be captured in the first fifteen pages of the submissions.
7Rule 3.1 of the Common Rules of Practice & Procedure, (the “Rules”), describes that the Rules are to be liberally interpreted and applied to ensure procedural fairness. The Tribunal has the authority to apply, waive or vary the rules. Section 25.0.1 of the Statutory Powers Procedures Act, (the “SPPA”), provides authority for the Tribunal to control its processes, which includes making orders with respect to the procedures and practices that apply in any particular proceeding.
8While it is within my discretion to exclude any submissions that are in excess of the page limits imposed by the Tribunal, I decline to limit the applicant’s submissions in this case. It is true that the applicant exceeded the page limit, by two pages, but it is equally true that the respondent did the same, by one page. After reviewing the applicant’s submissions, I am satisfied that their length and contents would not prejudice the respondent’s case. The submissions will remain part of the record.
ANALYSIS
9Sections 14 and 15 of the Schedule provide that the insurer shall pay medical benefits to, or on behalf of, an applicant so long as the applicant sustains an impairment as a result of an accident and the medical benefit is a reasonable and necessary expense as a result of the accident.
10The applicant bears the onus of proving entitlement to the proposed treatment by demonstrating that the plans are reasonable and necessary for the injuries he sustained