21-002847/AABS
Licence Appeal Tribunal File Number: 21-002847/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:
Sukhvinder Bhullar
Applicant
and
TD General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Janet Rowsell
APPEARANCES:
For the Applicant:
Eddie Wiley, Counsel
For the Respondent:
Symone Marlowe, Counsel
HEARD: In Writing
By way of written submissions
OVERVIEW
1The applicant, Shelley Bhullar was involved in an automobile accident on November 11, 2016, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Insurer, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In Bhullar v. TD Insurance (2020 ONLAT 19-010667/AABS), the Tribunal determined separate treatment plans from those in dispute for the purpose of the within decision, which treatment plans were denied by the respondent with respect to the same accident on November 11, 2016. The applicant submitted new treatment plans for chiropractic care and physiotherapy which are addressed in these reasons for decision.
3At a case conference on November 8, 2021, the issue of the minor injury guideline (MIG) was withdrawn with the consent of the parties.
ISSUES
4The remaining issues in dispute are:
i. Is the applicant entitled to $5,905.72 for chiropractic services, proposed by Fit for Life Wellness and Rehab Centre, in a treatment plan/OCF-18 (“plan”) dated September 22, 2019?
ii. Is the applicant entitled to chiropractic services in the amount of $5,905.72, in a treatment plan/OCF-18 proposed by Atlantis Chiropractic, dated January 24, 2020?
iii. Is the applicant entitled to physiotherapy services in the amount of $2,095.25, in a treatment plan/OCF-18 (“plan”) proposed by Active Life Wellness Centre on February 8, 2021?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5The two chiropractic treatment plans in the amount of $5,905.72 each are reasonable and necessary pursuant to the Schedule.
6The physiotherapy treatment plan in the amount of $2,095.25 is a reasonable and necessary expense pursuant to the Schedule.
7The applicant is entitled to interest on any overdue payment of benefits.
ANALYSIS
8Sections 14 and 15 of the Schedule state that an insurer shall pay medical benefits to, or on behalf of an applicant so long as the impairment is sustained as a result of an accident and that the medical benefit in dispute is a reasonable and necessary expense incurred by the applicant as a result of the accident. Treatment plans by themselves do not prove that the proposed treatment is reasonable and necessary. There should be supportive objective medical evidence