Injuries are a result of car accident - Applicant v Aviva LAT 16-003997

January 22, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Applicant v Aviva LAT 16-003997

Decision Date:   2017-12-20
Heard Before: Adjudicator Cezary Paluch, Member

ENTITLMENT TO BENEFITS: are injuries a result of the accident; are treatment plans reasonable and necessary; applicant provides evidence to support claims

The applicant was injured in a car accident on March 28, 2014 and sought benefits from Aviva pursuant to the SABs. When Aviva denied the claims, the applicant applied to the LAT.

Issues:

1. Is the applicant entitled to a medical benefit in the amount $3,080.96 for physical rehabilitation services from submitted on September 24, 2014?
2. Is the applicant entitled to a medical benefit in the amount $1,100.00 for acupuncture services as submitted on September 1, 2015?
3. Is the applicant entitled to interest on the overdue payment of benefits?
4. Is Aviva entitled to costs?

Result:

1. The applicant is entitled to payment for the physical rehabilitation services and acupuncture services because she has sufficiently proven that they are reasonable and necessary expenses.
2. The applicant is entitled to interest on the overdue payment of benefits.
3. Aviva is not entitled to costs.

The Adjudicator reviewed the law and the evidence and noted that sections 14 and 15 of the Schedule require Aviva to pay for medical benefits to or on behalf of the applicant so long as the applicant sustains an impairment as a result of the accident, and the medical benefit is a reasonable and necessary expense incurred by the applicant as a result of the accident.

Are the applicant’s injuries a result of the accident?

The applicant’s vehicle was rear ended by another car causing her head to strike the steering wheel.  Her son was also present in the vehicle. The applicant was transported via ambulance to the hospital. She was discharged the same day. The following day she felt dizziness and called an ambulance which took her to the hospital again.  She remained in hospital for over 24 hours. She submits that she sustained neck, head, back, shoulders and right leg injuries as a result of the accident. The applicant also submits that her depression has been exacerbated through the pain she suffered as a result of the subject accident.

Aviva has not addressed whether applicant’s injuries resulted from the accident and essentially focused their entire argument on the reasonable and necessity component of the test.

Upon review of the evidence the Adjudicator determined that the applicant’s injuries are a result of the accident and caused her pain and psychological distress.

Aviva also submits that medical benefits are not a reasonable and necessary expense incurred by the applicant as a result of the accident because the applicant has failed to provide any evidence that the treatment plans will provide any benefit. Aviva submits that the applicant has not submitted any proof that she has incurred any of the treatment plans in dispute. Having not met the definition of incurred, even if the treatment plans are reasonable and necessary, they are not payable because they have not been incurred.

Upon review of medical evidence as a whole, the Adjudicator determined that there is sufficient evidence to conclude that the two treatment plans are reasonable and necessary.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.