Jefford v. Aviva General Insurance, 2024 CanLII 67361

OVERVIEW

1Arthur Jefford, the applicant, was involved in an automobile accident on February 21, 2014, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, Aviva General Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2Following a videoconference hearing held from October 3 – 6, 2022, the Tribunal released a decision on November 8, 2022. In short, the Tribunal found the applicant had not sustained a catastrophic impairment, and that he was not entitled to the two disputed medical benefits, interest, or an award.

3On March 15, 2024, the Tribunal released a reconsideration decision that cancelled the decision. It then ordered a rehearing of the matter by a different adjudicator. The hearing was ordered to take place in writing, and the respondent was ordered to “provide a copy of the transcript of the initial hearing to the Tribunal and to the Applicant, along with copies of the exhibits filed at the initial hearing.” The parties were then invited to provide “additional written submissions” in accordance with a timetable set out in the reconsideration decision.

ISSUES

4The issues in dispute are:

i. Has the applicant sustained a catastrophic impairment as defined by the Schedule?

ii. Is the applicant entitled to a medical benefit in the amount of $3,779.54 ($4,492.10 less the partially approved amount of $712.56) for a chronic pain