Licence Appeal Tribunal File Number: 21-014076/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:
Izzatullah Abdul Khaliq
Applicant
and
BelairDirect
Respondent
DECISION
ADJUDICATOR:
Bonnie Oakes Charron
APPEARANCES:
For the Applicant:
Kathy Noohi, Counsel
For the Respondent:
Cole O'Reilly, Counsel
Written Hearing:
Heard by way of written submissions
OVERVIEW
1Izzatullah Khaliq, the applicant, was involved in an automobile accident on May 1, 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, BelairDirect, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant was involved in a prior motor vehicle accident on July 1, 2015.
ISSUES
3The 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?
Note: The parties were silent as to whether any funding remains in the MIG.
ii. Is the applicant entitled to the assessments proposed by Doctor’s Rehabilitation Clinic Inc., as follows:
$4,630.25 for chiropractic services, in a plan dated February 7, 2020; and
$3,297.68 for psychological services, in a plan dated March 23, 2021?
iii. Is the applicant entitled to $2,200.00 for psychological services, proposed by Perfect Choice Psychological Services Inc., in a treatment plan/OCF-18 (“plan”) dated October 12, 2021?
iv. Is the applicant entitled to $3,441.83 for physiotherapy services, proposed by Prime & Care Health Centre, in a treatment plan dated October 6, 2021?
v. Is the applicant entitled to $5,390.00 for out-of-pocket expenses?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
vii. 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?
RESULT
4The applicant has not demonstrated that his accident-related injuries warrant removal from the MIG.
i. He remains subject to the MIG treatment limit of $3,500.00. The parties were silent as to whether any funding remains in the MIG.
ii. The applicant is not entitled to the treatment plans or expenses, except to the extent that any amount remains within the $3,500.00 MIG limit as of the date of this decision. Such benefits, if incurred, are deemed reasonable and necessary pursuant to s. 40(8) of the Schedule. Interest applies to the payment of any such benefits in accordance with s. 51 of the Schedule.
iii. The applicant is not entitled to an award.
PROCEDURAL ISSUES
Late Submissions and Procedural Compliance
5The respondent submits that the Tribunal should not accept the applicant’s submissions because they were filed after the deadline established by the