Licence Appeal Tribunal File Number: 24-000440/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:
Daniel Correia
Applicant
and
Primmum Insurance Company
Respondent
DECISION
ADJUDICATOR:
Laura Goulet
APPEARANCES:
For the Applicant:
Joseph Lam, Counsel
For the Respondent:
Naguena Alingary, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Daniel Correia, the applicant, was involved in an automobile accident on January 12, 2016, and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, Primmum Insurance Company, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2On July 23, 2021, the applicant applied to the Tribunal with respect to the denial of a treatment plan for psychological services submitted on June 1, 2021, in the amount of $2,018.86 (the “first application”). The respondent subsequently approved the treatment plan. The applicant withdrew the claim for the treatment plan but proceeded on the issue of a special award. On January 4, 2024, the Tribunal released a decision on the first application, dismissing it and finding that the respondent was not liable to pay an award.
3On January 12, 2024, the applicant applied to the Tribunal with respect to the denial of a treatment plan for psychological services submitted on October 25, 2023, in the amount of $3,242.49 (“this application”). The respondent subsequently approved the treatment plan. The applicant withdrew the claim for the treatment plan but proceeded on the issue of a special award.
PRELIMINARY ISSUE
4Is the applicant barred from proceeding to a hearing by the doctrine of res judicata?
SUBSTANTIVE ISSUES
5The substantive issues in dispute are:
i. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
ii. Is the applicant liable to pay costs to the respondent?
6In its submissions, the respondent requested costs. Accordingly, this issue was added, above.
RESULT
7The applicant is not barred from proceeding to a hearing.
8The respondent is not liable to pay an award.
9The applicant is not liable to pay costs to the respondent.
ANALYSIS
The applicant is not barred from proceeding to a hearing
10For the following reasons, I find that the applicant is not barred from proceeding to a hearing.
11The respondent submits that the applicant is barred from proceeding to a hearing by the doctrine of res judicata.
12The decision of Danyluk v. Ainsworth Technologies Inc., 2001 SCC 44 (“Danyluk”) deals with the doctrine of res judicata. The test in Danyluk incorporates issue estoppel, which is a branch of the broader doctrine of res judicata.
13I find that the doctrine of issue estoppel does not apply in this case.
14The doctrine of issue estoppel prevents a party from relitigating an issue that has already been decided. The Supreme Court of Canada in Toronto (City) v. C.U.P.E. Local 79, [2003 SCC 63](https://www