Citation: Lei v. Aviva General Insurance Company, 2023 ONLAT 21-003030/AABS
Licence Appeal Tribunal File Number: 21-003030/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:
Samuel Lei
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Derek Grant
APPEARANCES:
For the Applicant:
Courtney Madison, Counsel
For the Respondent:
Jessica Bacopulos, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Samuel Lei (“S.L.”), the applicant, was involved in an automobile accident on October 9, 2018, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). S.L. was denied benefits by the respondent, Aviva, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is S.L. entitled to an attendant care benefit (“ACB”) at the rate of $1,104.17 per month from April 1, 2021 to date and ongoing?
ii. Is S.L. entitled to $99.75 ($1,275.36, less $1,175.61 approved) for chiropractic services, proposed by Church Wellesley Rehab in a treatment plan (OCF-18) dated March 19, 2019?
iii. Is S.L. entitled to $3,727.75 for physiotherapy services, proposed by Health Bound Network Inc. (“Health Bound”) in an OCF-18 dated July 26, 2019?
iv. Is S.L. entitled to $4,647.03 for physiotherapy services, proposed by Health Bound in an OCF-18 dated August 12, 2020?
v. Is S.L. entitled to $1,909.22 for an attendant care assessment proposed by Health Bound in an OCF-18 submitted March 21, 2021?
vi. Is S.L. entitled to $1,554.87 for an L-shaped smart desk, proposed by Health Bound in an OCF-18 dated March 25, 2021?
vii. Is S.L. entitled to $2,793.35 for an ergonomic chair proposed by Health Bound in an OCF-18 dated July 30, 2021?
viii. Is S.L. entitled to $4,607.22 for physiotherapy, chiropractic and massage treatment from Health Bound in an OCF-18 dated April 27, 2021?
ix. Is S.L. entitled to $1,957.50 ($4,250.00, less $2,292.50 approved) for social work services from Health Bound in an OCF-18 dated August 13, 2021?
x. Is S.L. entitled to $2,708.60 for a chronic pain assessment from Excel Medical in an OCF-18 dated January 10, 2020?
xi. Is Aviva liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to S.L.?
xii. Is S.L. entitled to interest on any overdue payment of benefits?
3In a letter dated October 31, 2022, S.L. advised that issues 2 i. and ii. above were withdrawn. As such, this decision will focus on the remaining issues in dispute.
RESULT
4S.L. is entitled to the OCF-18s for physiotherapy; the chronic pain assessment; and the OCF-18s for the L-shaped desk and ergonomic chair. Interest is payable pursuant to s. 51 of the Schedule.
5S.L. is not entitled to the remaining OCF-18s in disputed.
6I decline to order an award to S.L.