Licence Appeal Tribunal File Number: 23-009455/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:
Christy Abarquez
Applicant
and
Pembridge Insurance Company
Respondent
DECISION
ADJUDICATOR:
Matthew Frontini
APPEARANCES:
For the Applicant:
Carlos Bernal, Paralegal
For the Respondent:
Jodie Therrien, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Christy Abarquez, the applicant, was involved in an automobile accident on September 3, 2021, 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, Pembridge Insurance Company, and applied to the Licence Appeal Tribunal Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The parties have confirmed in their submissions that the 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 $2,460.00 for an orthopaedic assessment, proposed by Medi Assess in a treatment plan/OCF-18 (“treatment plan”) treatment plan dated October 15, 2021?
iii. Is the applicant entitled to $1,826.85 for physiotherapy/massage therapy/chiropractic services, proposed by Success Rehab in a treatment plan dated April 20, 2022?
iv. Is the applicant entitled to $2,486.00 for a chronic pain assessment, proposed by HydroHealth in a treatment plan dated May 17, 2022?
v.