16-003487/AABS v TD General Insurance Company

Jan 12, 2018

Adjudicator: Brian Norris

Issues:

a. Is the Applicant entitled to receive interest on income replacement benefits not paid between January 15, 2016 and August 1, 2017?

b. Entitlement to Rehabilitation benefit for orthopedic mattress

c. Entitlement to costs or award pursuant to s 10 of Regulation 664 of the Insurance Act?

 

Results:

a. Interest: Entitlement to IRBs was conceded by the Respondent. As per section 51 of the Schedule, it is clear that interest is payable on overdue benefits. Therefore, once it was conceded that IRBs were payable, interest became payable as well.

b. Orthopedic Mattress: The Applicant did not demonstrate that this was reasonable and necessary. They failed submit an OCF-18 in their materials, and only an excerpt of the OCF-18 was included in the report of the Respondent’s physiatrist. The evidence provided in support of the mattress amounted to several statements that the Applicant request a mattress however there was no explanation connecting the mattress to the Applicant’s specific impairment or how a mattress would assist.  Also, the Respondent’s own physiatrist was doubtful that a mattress would assist with pain management.

c. Costs: Rule 19.1 of the LAT Rules provides a test which is a particularly high bar to meet on costs, which requires that a party have acted unreasonably, frivolously, vexatiously or in bad faith.  No evidence was provided to meet any of these criterion and so no costs were awarded.

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