Long Qi Wang v. Aviva General Insurance, 2024 CanLII 898

Citation: Wang v. Aviva General Insurance, 2024 ONLAT 21-007111/AABS

Licence Appeal Tribunal File Number: 21-007111/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:

Long Qi Wang

Applicant

and

Aviva General Insurance

Respondent

DECISION

ADJUDICATOR: Harry Adamidis

APPEARANCES:

For the Applicant: Philip Kai Kwong Yeung, Paralegal

For the Respondent: Yann Grand - Clement, Counsel

Written Hearing: Heard by way of written submissions

OVERVIEW

1Long Qi Wang, the applicant, was involved in an automobile accident on February 28, 2019, 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 General 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. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Somatic Assessments and Treatment Clinic in a treatment plan/OCF-18 submitted on July 18, 2019 and denied on July 24, 2019?

ii. 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?

iii. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant is not entitled to a psychological assessment, nor interest.

4The respondent is not liable to pay an award.

ANALYSIS

Psychological assessment and interest

5The applicant is not entitled to a psychological assessment.

6To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.

7In particular for an assessment, the applicant must show that it is reasonable and necessary to investigate a condition.

8The applicant submits that the treatment and assessment plan completed by Dr. Maneet Bhatia documents that he has been emotionally distressed since the accident. According to him, this evidence establishes that it is reasonable to investigate his psychological condition.

9The respondent submits that a treatment plan alone is not compelling enough to support entitlement to this benefit. It submits that the applicant has not met his evidentiary burden of proving that this plan is reasonable and necessary.

10I agree with the respondent. A treatment plan on its own is insufficient to meet the applicant’s burden. There must also be objective and compelling evidence to justify that the medical benefit is reasonable and necessary. The applicant has not pointed me to any other evidence supporting the disputed psychological assessment.

11A treatment plan for a medical benefit without more evidence is not enough to establish entitlement. Consequently, I find that the proposed psychological assessment is not reasonable and necessary.

12I further find the applicant is not entitled to interest pursuant to s. 51 of the Schedule as there is no overdue payment of benefits.

Award

13As there is no outstanding payment, the respondent cannot be found liable to pay an award under s. 10 of O. Reg. 664.

ORDER

14The applicant is not entitled to a psychological assessment, nor interest.

15The respondent is not liable to pay an award under s. 10 of O. Reg 664..