Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 21-005945/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:
Emanuel Micallef
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR: Bonnie Oakes Charron
APPEARANCES:
For the Applicant: Courtney Madison, Counsel
For the Respondent: April C. Snow, Counsel
HEARD: In Writing
OVERVIEW
1Emanuel Micallef, the applicant, was involved in an automobile accident on December 31, 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 the respondent, Aviva General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are the following:
i. Is the applicant entitled to $4,743.04 for psychological treatment, proposed by Elite Assessment Centre in a treatment plan/OCF-18 (“plan”) denied on March 15, 2021?
ii. Is the applicant entitled to $922.40 for psychological treatment, proposed by Elite Assessment Centre in a treatment plan/OCF-18 (“plan”) denied on December 2, 2019?
iii. Is the applicant entitled to $3,069.06 for physiotherapy, proposed by West Medical Centre in a treatment plan/OCF-18 (“plan”) denied on December 10, 2020?
iv. Is the applicant entitled to $1,750.00 for occupational therapy proposed by Elite Assessment Centre in a treatment plan/OCF-18 (“plan”) denied on September 24, 2019?
(Note: Submissions identify this plan as an in-home assessment.)
v. Is the applicant entitled to $2,000.00 for a general physician assessment, proposed by Elite Assessment Centre in a treatment plan/OCF-18 (“plan”) denied on September 29, 2021?
vi. Is the