Alladina v. State Farm, FSCO A11-003519

The applicant, Tazlin Alladina, was injured in a motor vehicle accident on May 2nd, 2008. Afterwards, she was granted statutory accident benefits from State Farm, payable under the Schedule. Her employer, Scotiabank, accommodated her injuries by modifying her time and duties for three to four months following the accident. She returned to work full time by September 2008, and in 2009, she took a half day of accumulated vacation time nearly every second day. In the spring of 2010, she took four months off to rehabilitate at Miracle Rehab and Doctor’s Assessment Rehab. Having received treatment at the Rehab Centre from February 2010 to the end of 2010, the applicant is sought to have the costs for that treatment to be covered by State Farm.

The issues in this case were:
• Is Ms. Alladina entitled to medical benefits of $11,695 for treatment at the Rehab Centre?
• Is Ms. Alladina entitled to $1,462.44 for the cost of examinations?
• Is Ms. Alladina entitled to interest on the overdue payment of benefits?
• Is either party entitled to their expenses in respect of the arbitration?

State Farm relied on the cases of Waheed and Waheed v. RBC General Insurance Company and Ramballe v. Sate Farm, but the arbitrator did not find either of them to be helpful for this case. Unlike those cases, the credibility of this applicant was not in question. Instead, the arbitrator relied on Violi v. General Accident Assurance Co. of Canada, where the arbitrator eloquently analyzed the role of treatment in pain relief, medication reduction, and maintaining function together with sleep as reasonable goals for treatment. The applicant was deemed to have provided sufficient details about her treatment. The decision-maker believed that, based on witness testimony, Ms. Alladina benefited from and required the services of the Rehab Centre in order to continue working. They also found the medical treatment expenses claimed by the applicant to be reasonable and necessary, and as a result, awarded her the $11,695 for the treatment at the Rehab Centre. Since the arbitrator decided that her treatment was necessary and just, the $1,462.44 was also awarded for the examination expenses, as well as an entitlement to interest on overdue payments as prescribed by the Schedule. Lastly, no submissions on expenses were presented, but the arbitrator recommended that the parties try to resolve that issue through mediation.

After reading this case, its decision seems significant because it highlighted the importance of a credible applicant. In these types of matters, the arbitrator will undoubtedly take the credibility of the applicant into account as part of their decision-making process because if they are not fully convinced of the truthfulness of the claim, then they will likely dismiss it. The fact that the judge found the two cases cited by State Farm as unconvincing, at least in part, because of the difference in the credibility of the applicants, is not surprising. It would appear that Ms. Alladina was awarded her claim because she had testimony supporting her story of the necessity of her treatment. If it was shown that her treatment from the Rehab Centre was not required, contrary to her claim, then the arbitrator would have likely dismissed the case.

Adam Bustamante is a Paralegal student at Centennial College in Toronto studying professional communications with Omar Ha-Redeye.

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