Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 22-009290/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:
Claude Plumton
Applicant
and
Wawanesa Insurance
Respondent
DECISION
ADJUDICATOR:
Rachel Levitsky
APPEARANCES:
For the Applicant:
Filipe Santos, Counsel
For the Respondent:
James Schmidt, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Claude Plumton, the applicant, was involved in an automobile accident on August 16, 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, Wawanesa 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 (“MIG”) limit?
ii. Is the applicant entitled to a non-earner benefit (“NEB”) of $185.00 per week from September 14, 2020, to August 16, 2022?
iii. Is the applicant entitled to $338.46 (989.74 less $651.28 approved) for physiotherapy services, proposed by 101 Physio in a treatment plan dated June 2, 2021?
iv. Is the applicant entitled to $2,460.00 for a psychological assessment proposed by 101 Assessments in a treatment plan dated June 2, 2021?
v. Is the applicant entitled to $2,210.00 for psychological counselling, proposed by 101 Assessments in a treatment plan dated October 19, 2021?
vi. Is the applicant entitled to $2,460.00 for a neurological assessment, proposed by 101 Assessments in