Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 20-014446/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:
Amal Hashimi
Applicant
and
AIG Insurance
Respondent
DECISION
VICE-CHAIR: Monica Ciriello
APPEARANCES:
For the Applicant: Agal Lankeswaran, Paralegal
For the Respondent: Laura Emmett, Counsel
HEARD: In Writing
May 13, 2023
OVERVIEW
1Amal Hashimi, the applicant, was involved in an automobile accident on April 12, 2019, 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, AIG Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.
PRELIMINARY ISSUE
2The respondent took issue with the applicant's failure to comply with the Tribunal's Case Conference Report and Order ("CCRO") dated November 9, 2021, that set the page limit for the parties at 4 pages.
3The applicant's submissions were 6 pages. The respondent requested that the Tribunal not consider anything after page 4 of the applicant's submissions.
4The applicant offered no explanation as to the reason(s) for exceeding the length, nor did the applicant file a motion to extend the page limit in advance of the hearing.
5In reviewing the evidence, I note that the applicant made submissions 6 pages in length on May 13, 2022. On May 31, 2022, a Motion Order was issued by the Tribunal that extended the timeline for written submissions for the applicant until June 14, 2022. Paragraph 9 of the Motion Order stated that the page limits remain as set in the CCRO.
6Despite the extension, the applicant did not amend the original submissions to be in compliance with the CCRO page limit.
7I find that the applicant's submissions do not comply with the CCRO, as they are 6 pages in length and not the 4 ordered. I find that the respondent did comply with the CCRO.
8As a result, I will not admit the applicant's submissions after page 4.
9I would be remiss if I did not caution the parties that anytime there is non-compliance with a previous Order, parties risk exclusion of the submissions or evidence or both.
ISSUES
10The issues in dispute are:
i. Is the applicant entitled to $1,678.10 for physiotherapy, proposed by Midland Wellness Centre in a treatment plan ("OCF-18") dated August 24, 2020?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
11I find that:
i. The applicant is not entitled to $1,678.10 for physiotherapy, proposed by Midland Wellness Centre in the OCF-18 dated August 24, 2020.
ii. The applicant is not entitled to interest.
Analysis
OCF-18 for Physiotherapy is Not Reasonable and Necessary
12I am not persuaded that the applicant is entitled to the OCF-18 for physiotherapy in the amount of $1,678.10 as it is not reasonable and necessary pursuant to the Schedule.
13To receive payment for a treatment plan under s. 15 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
14The applicant did not include the OCF-18 in its submission to the Tribunal. The applicant did submit the Application for Accident Benefits ("OCF-1") and the Disability Certificate ("OCF-3").
15The applicant's submissions provide generalized submissions with respect to his post-accident injuries. The submissions have no details of the physiotherapy treatment sought, the goals of the treatment, or the evidence to support the need for the treatment. I find that there is no evidence from any expert, physician or health care provider which establishes why physiotherapy treatment is reasonable and necessary.
16The applicant failed to provide persuasive analysis as to why the OCF-18 is reasonable and necessary. The applicant's submissions are insufficient to meet his burden of proof. That is enough to dispose of this issue against the applicant; however, I also considered the respondent's evidence.
17I am persuaded by the insurer's examination ("IE") assessment of Dr. John Heitzner, physiatrist, dated November 14, 2019. Dr. Heitzner concluded that the applicant sustained a cervicothoracic strain WAD II, mild; and a lumbar strain with no objective neurological impairments. The applicant had no objective musculoskeletal impairments. Dr. Heitzner opined that the applicant had reached maximum medical recovery and no further physical rehabilitation and or clinical based exercise was reasonable and necessary.
18I further agree with the respondent's submissions that the applicant should not point vaguely to a body of evidence and expect the Tribunal to puzzle through a document dump in order to decipher and then assemble an evidentiary foundation of the applicant's case. The applicant merely listed medical records without any analysis or directing the Tribunal to the evidence to support their arguments. This is generally insufficient to meet the applicant's burden of proof.
19I thereby find that the OCF-18 is not reasonable and necessary.
Interest
20Since I found no benefits payable, the applicant is not entitled to interest.
ORDER
21For the foregoing reasons, I find that:
i. The applicant is not entitled to $1,678.10 for physiotherapy, proposed by Midland Wellness Centre in the OCF-18 dated August 24, 2020.
ii. The applicant is not entitled to interest.
Released: May 24, 2023
__________________________
Monica Ciriello
Vice-Chair