Said v. Certas Home and Auto Insurance
Licence Appeal Tribunal File Number: 22-013923/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:
Liban Said
Applicant
and
Certas Home and Auto Insurance
Respondent
DECISION
ADJUDICATOR:
Lisa Holland
APPEARANCES:
For the Applicant:
Julia Logoutova, Paralegal
For the Respondent:
Kevin So, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Liban Said, the applicant, was involved in an automobile accident on May 13, 2022, 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, Certas Home and Auto 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. 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?
ii. Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $400.00 per week from May 20, 2022, to date and ongoing?
iii. Is the applicant entitled to physiotherapy services, proposed by 2430303 Ontario Inc. in the following treatment plans/OCF-18 (“plans”):
(a) $2,227.73 in a plan submitted September 6, 2022;
(b) $1,690.81 in a plan submitted October 14, 2022;
(c) $1,270.27 in a plan submitted December 7, 2022, and.
(d) $1,270.27 in a plan submitted February 23, 2023?
iv. Is the applicant entitled to $2,300.00 for a mental health assessment, proposed by 2430303 Ontario Inc. in a plan submitted October 18, 2022?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not demonstrated on a balance of probabilities that his accident-related impairments warrant removal from the MIG.
4In submissions, the respondent indicates that $227.72