Licence Appeal Tribunal File Number: 24-006457/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:
Hind Abou-Elhouda
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Leo Demarce
APPEARANCES:
For the Applicant:
Ivy So, Paralegal
For the Respondent:
Maia Abbas, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Hind Abou-Elhouda, the applicant, was involved in an automobile accident on April 24, 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, Security National 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 the treatment plans/OCF-18 (“plan”) proposed by Total Wellness as follows:
a. $1,657.89 ($2,937.79 less $1,279.90 approved) for physiotherapy in a plan dated May 20, 2022;
b. $1,800.28 ($3,739.91 less $1,939.63 approved) for physiotherapy in a plan dated August 4, 2022; and
c. $1,224.49 ($2,221.99 less $997.50 approved) for physiotherapy in a plan dated September 28, 2022?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
3The applicant withdrew issues 1 (removal from the MIG), 2(iv), 2(v) and 3 as listed in the Case Conference Report and Order (“CCRO”).
RESULT
4The applicant is not entitled to the treatment plans/OCF-18s proposed by Total Wellness.
5The applicant is not entitled to interest as there are no overdue payment of benefits.
ANALYSIS
6I find that the respondent did not contravene s.38(8) of the Schedule which is the applicant’s sole submission regarding entitlement to the treatment plans. The applicant submits that the respondent failed to provide medical reasons for the denial of benefits.
7The respondent seeks a determination that the applicant’s injuries are subject to the MIG, that the applicant is not entitled to the treatment plans in dispute, and that the applicant is not entitled to interest.
8I will not make a decision with regards to the MIG as it is not an issue in dispute. As noted above, it was withdrawn