Aviva Insurance Company of Canada v Danay Suarez, 2021 ONSC 6200
Following a motor vehicle accident in 2013, Danay Suarez submitted an Application for Accident Benefits under the Statutory Accident Benefits Schedule – Effective September 1, 2010, O. Reg. 34/10 (the “Schedule”) to her insurer, Aviva Insurance Company of Canada (“Aviva”). The application included four chiropractic Treatment Plans submitted that Aviva denied on the basis that they were not reasonable and necessary to treat Ms. Suarez’s accident-related injuries. Following these denials, Ms. Suarez applied to the Licence Appeal Tribunal (“LAT”) to resolve their dispute. Although Ms. Suarez had not incurred the expenses associated with these treatment plans prior to the hearing, the LAT ultimately concluded that the Treatment Plans ought to have been approved and ordered that they were payable with interest. Aviva sought reconsideration of the LAT decision on the basis that the adjudicator had erred in determining entitlement by not considering whether the benefits had been incurred prior to the hearing. The request for reconsideration was ultimately dismissed. Adjudicator Grant upheld his decision to approve the treatment plans in question and commented that an adjudicator is permitted to make a finding that treatment is reasonable and necessary and order that a benefit be payable provided that the order complied with the Schedule.