H.A. v. Aviva General Insurance (16-003279)

The claimant sought entitlement to the form fee and HST associated with an assessment plan. The insurer indicated that the treatment plan was subject to the monetary cap under section 25(5). The claimant asserted the form fee was a separate cost, not subject to the cap. Adjudicator Christopher Ferguson referred to Superintendent’s Guideline No. 03/14 which noted the form fee is a separate expense, payable above the monetary cap. Reference was also made to correspondence from the insurer which suggested it adhered to the Guideline in the past. With respect to HST, Adjudicator Ferguson applied the same Guideline, despite being referred to Superintendent’s Guideline No. 03/16. HST was also found payable above the monetary cap.