• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

IME

16-000045 v Aviva Canada, 2016 CanLII 60728 (ON LAT)

http://canlii.ca/t/gtqhk

Overview

[1]        The Applicant, A. P., was injured in a motor vehicle accident on March 19, 2015. She applied for and received benefits under theStatutory Accident Benefits Schedule – Effective after September 1, 2010 (the “Schedule”) including medical and Income Replacement Benefits (IRB).

[2]        Aviva terminated her IRB on February 16, 2016 taking the position that she did not meet the test for entitlement. She disputes that termination and argues that she should be paid IRB from February 17 to May 3, 2016 when she started part-time work.

[3]        Aviva also denied A. P.’s claim for medical benefits for physiotherapy and chiropractic treatment. The dispute over the medical benefit centres on the nature and extent of her injuries. A. P. submits that her injuries are extensive and that she is entitled to access a maximum of $50,000 of medical and rehabilitation benefits pursuant to s. 18(3) of the Schedule. Aviva takes the position that her injuries are predominately minor and that s. 18(1) caps medical and rehabilitation benefits at $3,500 for predominantly minor injuries. The $3,500 having been exhausted, Aviva takes the position that it has no further liability to A. P.. The resolution of this matter depends on the sufficiency of the medical evidence put forward by A. P. in support of her position.

[22]      A. P.  submits that I should accept Dr. Honsl’s determination over the determination of Aviva’s assessors. Aviva submits that Dr. Honsl simply ticked a box and has provided no further support for her methodology or conclusions. Aviva’s assessors, on the other hand, have provided a detailed report on both their methodology and their conclusions that is unchallenged by anything submitted by A. P.. I prefer Aviva’s submissions. The evidence currently before me overwhelmingly supports the conclusion that A. P.  was able to perform the essential tasks of her employment by February 16, 2016 when the IRB payment was stopped.

Conclusion:

[23]      In light of the foregoing, I find that:

  1.    A. P.  suffered predominantly minor injuries and there is no compelling evidence of a pre-existing medical condition that would prevent recovery beyond the $3,500 cap for medical and rehabilitation benefits, and
  2.    A. P.  is not entitled to the payment of IRB for the period from February 17, 2016 to May 3, 2016.

Comments are closed.