Licence Appeal Tribunal File Number: 22-009954/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:
Ali Vahdati
Applicant
and
Allstate Insurance
Respondent
DECISION
ADJUDICATOR:
Ulana Pahuta
APPEARANCES:
For the Applicant:
Adesina John, Paralegal
For the Respondent:
Greg Specht, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Ali Vahdati, the applicant, was involved in an automobile accident on March 19, 2020, 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, Allstate Insurance, 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. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline limit?
ii. Is the applicant entitled to $3,894.20 for physiotherapy services, proposed by Alpha Rehab Inc. in a treatment plan (“OCF-18”) submitted September 14, 2020?
iii. Is the applicant entitled to $600.00 ($1,797.50 less $1,197.50 approved) for physiotherapy services, proposed by Alpha Rehab Inc. in an OCF-18 submitted November 28, 2020?
iv. Is the applicant entitled to $499.25 for physiotherapy services, proposed by Alpha Rehab Inc. in an OCF-18 submitted March 12, 2021?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
i. The applicant has not established that his accident-related impairments warrant removal from the MIG; and
ii. The applicant is not entitled to the treatment plans in dispute or interest.
PROCEDURAL ISSUES
4In its responding submissions, the respondent requests that the applicant’s s. 25 psychological assessment report and chronic pain assessment report be excluded as evidence for this written hearing. It argues that it received these reports for the first time on January 17, 2024, with the applicant’s written hearing submissions. The respondent submits that these reports were served well outside the production deadlines stipulated in the Case Conference Report and Order dated May 16, 2023 (“CCRO”) and that it has suffered significant prejudice due to this late disclosure.
5I grant the respondent’s request to exclude the applicant’s s. 25 psychological assessment report. However, I deny the respondent’s request to exclude the s. 25 chronic pain assessment report, and this report will be considered as evidence in this written hearing.
6I find that the applicant has not led sufficient evidence to prove that the psychological assessment report of Dr. Belyakova was provided prior to the applicant’s written hearing submissions. In his reply submissions the applicant argues that the report was provided to the respondent before the production