Licence Appeal Tribunal File Number: 20-013707/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:
Marites Matias
Applicant
and
Wawanesa Mutual Insurance
Respondent
DECISION
ADJUDICATOR:
Kate Grieves
APPEARANCES:
For the Applicant:
Carla Barcelo, Paralegal
For the Respondent:
Harkamal Hehar, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Marites P. Matias, the applicant, was involved in an automobile accident on October 8, 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 Wawanesa Mutual Insurance, the respondent, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
- Is the applicant entitled to medical benefits and costs of examination expenses recommended by Scarborough Medical Centre as follows:
i. $2,925.60 for chiropractic services in a plan dated January 2, 2019?
ii. $298.90 ($1,995.64 less $1,696.10 approved) for a psychological assessment in a plan dated December 1, 2018?
iii. $1,080.00($3,963.64 less $2,883.64 approved) for psychological treatment in a plan dated January 15, 2019?
iv. $2,925.76 for chiropractic services in a plan dated April 26, 2019?
v. $1,800.00 for chiropractic services in a plan submitted July 13, 2019?
vi. $2,500.64 for chiropractic services in a plan dated August 27, 2019?
vii. $1,700.00 for chiropractic services in a plan dated October 7, 2019?
viii. $2,294.08 for chiropractic services in a plan dated January 10, 2020?
ix. $1,051.41 for assistive devices in a plan dated April 29, 2019?
Is the Applicant entitled to $4,114.93 for occupational therapy services recommended by Q Medical in a plan dated April 29, 2019?
Is the Applicant entitled to interest on overdue payment of benefits?
PROCEDURAL ISSUES
3Several of the treatment plans in dispute, including the plan listed above for $1,800.00, were not included with the parties’ submissions. The Tribunal contacted the parties and requested that they provide copies of the missing OCF-18s. While the other plans were provided, the Tribunal did not receive a plan for chiropractic services in the amount of $1,800.00. The applicant provided a different plan in the amount of $2,000.00 for a chronic pain assessment. Given that the issue was not properly identified, the parties made no submissions on the reasonableness and necessity of such an assessment, I am unable to consider it.
RESULT
4The applicant is entitled to the plans for chiropractic services, identified above as issues (1) i, iv, vi, vii,