Licence Appeal Tribunal File Number: 24-000789/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:
Rochelle Becker
Applicant
and
North Blenheim Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
Leo Demarce
APPEARANCES:
For the Applicant:
Bernard Verbanac, Counsel
For the Respondent:
Gregory Van Berkel, Counsel
HEARD:
In Writing
OVERVIEW
1Rochelle Becker, the applicant, was involved in an automobile accident on December 6, 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, North Blenheim Mutual Insurance Company, 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 $7,776.00 for Hearing aids, proposed by Berge Hearing in a treatment plan/OCF-18 (“plan”) dated June 20, 2023 and denied June 30, 2023?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant is not entitled to $7,776.00 for Hearing aids plus interest because section 20(1)(a) of the Schedule prohibits payment of benefits beyond 260 weeks after the date of loss.
4The applicant is seeking to have a medical benefit for hearing aids to be paid by the insurer outside of the 260 week limit imposed by the legislature in section 20(1)(a) of the Schedule. The applicant argues that the treatment is reasonable and necessary, that not to approve it would be considered absurd, and as a result the LAT has the ability to set aside the 260 week limit in order to approve the treatment plan.
ANALYSIS
5To 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.
6I find that the treatment plan is reasonable and necessary and the respondent agrees. If the treatment plan was within the 260 week limit that it would be approved, in fact a similar treatment plan was approved when applied for when the applicant was within the 260 week limit.
7The applicant contends that the 260 week limit should be set aside as it would offend the principles of statutory interpretation and that it would be ‘absurd’ and lead to a ridiculous result as contemplated in Aviva Insurance Company of Canada v. Danay Suarez, 2021 ONSC 6200 (“Suarez”) if the Respondent were to benefit at the expense of the Applicant by virtue of the already approved and necessary devices needing replacement outside of the 260 week period.
8Suarez cites:
i. where the “legislature does not intend to produce absurd consequences and an interpretation can be considered absurd if it leads to ridiculous or frivolous consequences, if it is extremely unreasonable or inequitable, if it is illogical or incoherent,”
9The applicant then argues that the LAT has the ability to set aside the 260 week limit, that it has the authority to remedy the situation by ordering the respondent to pay for the devices plus interest. This ability to step outside of the legislation, according to the applicant, is cited in Stegenga v. Economical Mutual Insurance Company 2019 ONCA 615;
i. Taken together, the words of s. 280(1) cover a wide array of disagreements connected in some way to the SABs to which an insured person was or is entitled. Viewed in the context of the purpose and history of the dispute resolution provisions, those words include disagreements about when the insurer’s obligation to provide SABs should be or should have been performed, and how the obligation to provide them should be or should have been performed.
10The respondent’s submission is to stand on s. 20(1)(a) of the Schedule which states that no medical, rehabilitation and attendant care benefit is payable for expenses incurred more than 260 weeks after the accident.
The request for benefits are denied
11I find that the applicant is not entitled to $7,776.00 for Hearing aids. There is no doubt that the treatment plan is reasonable and necessary, and that there was more than sufficient funds available in the policy limits. I also feel that this outcome is absurd in that the applicant clearly needs this device and it was a direct result of the accident.
12However, I am not able to set aside the 260 week limit as set out in s. 20(1)(a) of the Schedule. In order for me to do so I would need to consider the intent of the legislature; is the 260 week limit firm? In this instance it is very clear, the Schedule was amended in 2016 where the timeframe for applying for benefits under the Schedule was reduced from 10 years to 5 years (260 weeks) leaving no doubt as to the legislature’s intent that the 260 week limit is firm. I give more weight to the legislature’s intent on the time limit and am not able to exercise any authority to provide the remedy that the applicant seeks.
13I find that the applicant’s claim for a treatment plan for hearing aids is subject to the limits in s. 20 of the Schedule, and therefore not payable.
Interest
14Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no benefits payable there is no interest payable.
ORDER
15The applicant is not entitled to $7,776.00 for Hearing aids, and as a result there is no interest payable.
Released: December 12, 2025
Leo Demarce
Adjudicator