Licence Appeal Tribunal File Number: 23-009578/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:
Crystal Octave
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
Matthew Frontini
APPEARANCES:
For the Applicant:
Daniela Algieri-Boileau, Counsel
For the Respondent:
James Schimdt, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Crystal Octave, the applicant, was involved in an automobile accident on August 19, 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, Wawanesa 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. 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 $3,795.50 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan/OCF-18 (“treatment plan”) dated September 20, 2021?
iii. Is the applicant entitled to the assessment proposed by Princeton Hills Medical assessments, as follows:
$2,520.00 for an orthopaedic assessment, in a treatment plan dated September 1, 2021; and
$2,200.00 for a psychological assessment, in a treatment plan dated October 1, 2021?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
i. The applicant’s injuries are predominantly minor and therefore are subject to treatment within the $3,500.00 limit of the MIG;
ii. The applicant is not entitled to the disputed treatment plans;
iii. The applicant is not entitled to interest on any overdue payment of benefits, pursuant to s. 51 of the Schedule;
iv. The applicant is not entitled to an award under s. 10 of Reg 664; and
v. The application is dismissed.
ANALYSIS
The applicant is not removed from the MIG
4The applicant is not removed from the MIG. She has not established on a balance of probabilities that she has suffered more than a minor injury because of the accident.
5Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury. Section 3(1) defines a “minor injury” as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
6An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, under s.