Licence Appeal Tribunal File Number: 21-007972/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:
Angie Brush
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Stephanie Kepman
APPEARANCES:
For the Applicant:
David A Morin, Counsel
For the Respondent:
Alexander Hartwig, Counsel
HEARD:
In writing
OVERVIEW
1Angie Brush (the “applicant”) was involved in an automobile accident on February 25, 2018, 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 Aviva Insurance Company of Canada (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for the resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to $287.76 for medication, submitted on a claim form (OCF-6) submitted on October 28, 2020, and denied on March 10, 2021?
ii. Is the applicant entitled to $123.55 for medication, submitted on a claim form (OCF-6) submitted on April 6, 2021 and denied on May 21, 2021?
iii. Is the applicant entitled to $92.25 for medication, submitted on a claim form (OCF-6) submitted May 20, 2021, and denied May 21, 2021?
iv. Is the applicant entitled to $114.46 for medication, submitted on a claim form (OCF-6) submitted June 18, 2021, and denied June 21, 2021?
v. Is the applicant entitled to $743.67 for medication, submitted on a claim form (OCF-6) submitted on March 17, 2022, and denied on March 28, 2022?
vi. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is not entitled to payment for the expenses in the amounts of $287.76, $123.55, $92.25, $114.46 and $743.67, as she failed to attend the required insurer’s examinations and has also failed to show that said expenses are reasonable and necessary.
4The applicant is not entitled to interest.
5The applicant withdrew issue vi concerning an award.
ANALYSIS
The applicant is not entitled to the disputed medications, cannabis and parking expenses
6The applicant submits that as a result of her accident-related injuries, she is entitled to payment for five Expense Claim Forms (“OCF-6”s), totalling $1,334.69, which consist of:
i. OCF-6 dated October 28, 2020, in the amount of $287.76.
ii. OCF-6 dated April 6, 2021, in the amount of $123.55.
iii. OCF-6 dated May 20, 2021, in the amount of $92.25
iv. OCF-6 dated June 18, 2021, in the