M.T. v RBC General Insurance Company

Financial Services Commission of Ontario

FSCO A11-001877

BETWEEN

M.T. Applicant

and

RBC GENERAL INSURANCE COMPANY Insurer

REASONS FOR DECISION

Before

Lloyd (J.R.) Richards

Heard

March 25, 26, 27, 28 and May 24, 2013 in Hamilton, Ontario.

Written submissions were received on June 28, 2013.

Appearances

Daniel Roncari for M.T.

Aldo Picchetti for RBC General Insurance Company

Overview

The Applicant, M.T., was injured in a motor vehicle accident on June 20, 2009. She applied for and received statutory accident benefits from RBC General Insurance Company ("RBC"), payable under the Schedule. RBC subsequently terminated M.T.'s benefits. The parties were unable to resolve their disputes through mediation and M.T. applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.1.8, as amended.

M.T. claims that she is entitled to receive income replacement benefits, housekeeping and home maintenance benefits, as well as attendant care benefits from RBC. She has not worked in any capacity since the motor vehicle accident, and even though she was not working at the time of the motor vehicle accident, it was always her intention to return to work and she was capable of doing so. Furthermore several medical practitioners are of the opinion that she cannot work in any capacity for the foreseeable future.

RBC claims that, because of the motor vehicle accident, M.T. suffered soft tissue injuries and an exacerbation of a pre-existing psychological condition. In its opinion, M.T. had removed herself from the work force due to psychological issues prior to the accident on June 20, 2009.

The particular issues in this hearing are

1. Is M.T. entitled to an income replacement benefit at the rate of $267.26 per week from March 22, 2010 to date and ongoing?
2. Is M.T. entitled to housekeeping and home maintenance benefits in the amount of $100.00 per week from March 22, 2010 to June 19, 2011?
3. Is M.T. entitled to attendant care benefits at the rate of $217.19 per month from June 20, 2009 to June 19, 2011?
4. Is M.T. entitled to a Special Award?
5. Is M.T. entitled to interest for the overdue payment of benefits?

Result

1. M.T. is entitled to an income replacement benefit at the rate of $267.26 per week from March 22, 2010 to date and ongoing.
2. M.T. is entitled to housekeeping and home maintenance benefits in the amount of $50.00 per week from August 1, 2009 to June 19, 2011.
3. M.T. is not entitled to an attendant care benefit from June 20, 2009 to June 19, 2011.
4. M.T. is not entitled to a Special Award.
5. M.T. is entitled to interest for the overdue payment of benefits.

For more details: M.T. v. RBC General Insurance Company

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