Licence Appeal Tribunal File Number: 21-014419/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:
Saroj Luthra
Applicant
and
Aviva Insurance Canada
Respondent
DECISION
ADJUDICATOR:
Dagmara Szczudlo
APPEARANCES:
For the Applicant:
Sandy Williams, Counsel
Aafreen Irani, Student-at-law
For the Respondent:
Leanne Zabudsky, Counsel
HEARD: By way of written submissions
OVERVIEW
1Saroj Luthra, the applicant, was involved in an automobile accident on May 16, 2017, 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 Insurance Canada, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant is raising the issue of an improper denial with respect to one of the treatment plans in dispute. This issue will be addressed as part of this decision.
ISSUES
3The issues in dispute are:
- Is the applicant entitled to the assessments proposed by Ayur Rehab Physiotherapy Inc., as follows:
(i) $5,510.41 for physiotherapy sessions, in a treatment plan submitted on July 11, 2021, and denied on July 26, 2021;
Note: the Case Conference Report and Order released October 28, 2022 (“CCRO”) incorrectly identified this plan as psychological sessions as opposed to physiotherapy sessions as listed in the applicant’s and respondent’s written submissions.
(ii) $7,395.06 for physiotherapy sessions, in a treatment plan submitted on March 26, 2022, and denied on June 6, 2022?
Note: the CCRO incorrectly identified the amount in dispute as $3,795.06 instead of $7,395.06 as listed in the applicant’s and respondent’s written submissions (OCF-18 dated March 26, 2022).
Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant has not demonstrated that the treatment plan for $5,510.41 for physiotherapy sessions is reasonable and necessary or payable. No interest applies on this treatment plan.
5The respondent must pay for any goods, services, and examinations set out in the physiotherapy treatment plan in the amount of $7,395.06 starting on the 11th business day after the day that Aviva received the OCF-18.
6Interest is payable on any overdue amounts in accordance with s. 51 of the Schedule.
7The applicant is not entitled to an award under Regulation 664.
ANALYSIS
The applicant is not entitled to $5,510.41 for physiotherapy sessions proposed by Ayur Rehab Physiotherapy Inc, in a treatment plan submitted on July 11, 2021, and denied on July 26, 2021.
8The applicant has not demonstrated that the treatment plan for $5,510