Citation: Santos v. Aviva Insurance Company of Canada, 2026 ONLAT 24-002838/AABS

Licence Appeal Tribunal File Number: 24-002838/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:

Marilyn Santos

Applicant

and

Aviva Insurance Company of Canada

Respondent

DECISION

ADJUDICATOR: Amar Mohammed

APPEARANCES:

For the Applicant: Tina Lubman, Paralegal

For the Respondent: Kari-Anne Layng, Counsel

HEARD: By Way Of Written Submissions

OVERVIEW

1Marilyn Santos, the applicant, was involved in an automobile accident on February 18, 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, Aviva Insurance Company of Canada, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUE

2Is the applicant barred from proceeding to a hearing for the following benefits: a psychological assessment, a neurological assessment, and a chronic pain assessment because the applicant failed to attend insurer’s examinations (“IEs”) under s. 44 of the Schedule?

SUBSTANTIVE ISSUES

3The substantive 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 a non-earner benefit (“NEB”) of $185.00 per week from March 22, 2022, to February 18, 2024?

iii. Is the applicant entitled to the services proposed by 101 Physio, as follows:

a. $2,764.36 for physiotherapy services, in a treatment plan/OCF-18 (“plan”) dated March 3, 2022?

b. $1,185.54 for physiotherapy services, in a plan dated August 4, 2022?

iv. Is the applicant entitled to the assessments and services proposed by 101 Assessments, as follows:

a. $2,560.00 for psychological services, in a plan dated July 22, 2022?

b. $2,460.00 for a psychological assessment, in a plan dated March 8, 2022?

c. $2,460.00 for a neurological assessment, in a plan dated July 20, 2022?

d. $2,460.00 for a chronic pain assessment, in a plan dated May 2, 2024?

e. $2,460.00 for a neuropsychological assessment, in a plan dated June 17, 2024?

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

4With respect to the preliminary issue, I find that the applicant is barred under s. 5