Licence Appeal Tribunal
Citation: Caselle v. Aviva Insurance Company of Canada, 2025 ONLAT 23-009574/AABS Licence Appeal Tribunal File Number: 23-009574/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: Filomena Caselle (Applicant) and Aviva Insurance Company of Canada (Respondent)
Decision
Adjudicator: Lisa Holland
Appearances: For the Applicant: Maria Makarova, Paralegal For the Respondent: Yann Grand-Clement, Counsel
Heard: By Way of Written Submissions
OVERVIEW
1Filomena Caselle, the applicant, was involved in an automobile accident on November 26, 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 Insurance Company of Canada, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.
PRELIMINARY ISSUES
[2] The preliminary issue to be decided is: i. Is the applicant barred from proceeding to a hearing for $2,460.00 for a chronic pain assessment, proposed by Tier 1 Assessments Ltd. in a treatment plan/OCF-18 ("plan") dated May 15, 2019, because the applicant failed to dispute their denial within the two-year limitation period?
SUBSTANTIVE ISSUES
[3] The substantive issues in dispute are: i. Is the applicant entitled to $2,460.00 for a chronic pain assessment, proposed by Tier 1 Assessments Ltd., in a plan dated May 15, 2019? ii. Is the applicant entitled to $3,393.80 for a psycho-vocational assessment, proposed by Tier 1 Assessments Ltd., in a plan dated December 18, 2021? iii. Is the applicant entitled to $1,404.76 ($2,756.13 less $1,351.37 approved) for psychological services, proposed by Tier 1 Assessments Ltd., in a plan dated September 5, 2023? iv. Is the applicant entitled to $60.00 for chiropractic services, submitted on a claim form (OCF-6) dated November 22, 2023? 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?
4In her written hearing submissions, the applicant withdrew issues 3 (iii) and 3 (iv) listed in the Case Conference Report and Order dated February 7, 2024, for psychological services in a plan dated December 9, 2022, and for medication on a claim form (OCF-6) dated January 26, 2022. Therefore, I have removed these issues from the listed issues in dispute.
RESULT
5For the preliminary issue, I find that the applicant is barred by virtue of s. 56 of the Schedule, from disputing the chronic pain assessment treatment plan in the amount of $2,460.00 for failure to dispute the denied plan within the two-year limitation period.
6I find that the applicant has not demonstrated that the proposed treatment plans