Tribunal File Number: 17-009018/AABS

In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.

Between:

D.K.D.

Applicant

and

Aviva Insurance Canada

Respondent

DECISION

ADJUDICATOR: Gemma Harmison

Written Submissions by:

For the Applicant: Ioulia Logoutova, paralegal (Kanevsky Law Office)

For the Respondent: Jessica Rogers and David Koots, counsel (Evans Philip LLP)

Written Hearing: June 18, 2018

OVERVIEW:

1D.K.D. (the “applicant”) was involved in a motor vehicle accident on March 7, 2015 and sought benefits from Aviva Insurance Canada (the “respondent”) pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (“Schedule”).

2The applicant submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”) after the respondent denied him certain medical benefits and cost of examinations for which he had applied.

3The parties participated in a case conference on March 9, 2018, but were unable to resolve their dispute and a written hearing was scheduled to decide the matter.

4Central to the parties’ dispute is the respondent’s determination and continued position that the applicant sustained predominantly minor injuries as defined under the Schedule such that he is subject to treatment within the Minor Injury Guideline (“MIG”) and the MIG funding cap of $3,500.

5In their written submissions for the hearing, neither party expressly indicated that the $3,500 MIG funding cap had been fully exhausted. However, the applicant did submit as evidence an account activity print-out from his treating clinic¹ which shows both the amounts billed to, and paid by, the respondent. The amount paid to the clinic totaled $3,407.82 (which would leave only $92.18 remaining under the MIG funding cap).

6Because the disputed medical benefits and cost of examinations sought by the applicant would exceed the MIG funding cap, it flows that the first issue that must be decided is whether or not the applicant sustained predominantly minor injuries as defined by the Schedule.

7If the applicant is successful in proving that his injuries are not predominantly minor, then I must address if the medical benefits and cost of examinations are reasonable and necessary.

8If the respondent’s position is correct, then the applicant is subject to the $3,500 MIG funding cap and a determination of the reasonableness and necessity of the benefits in dispute would be unnecessary.

ISSUES IN DISPUTE:

9The case conference order listed the issues in dispute to be decided at this hearing as follows²:

1. Did the applicant sustain predominantly minor injuries as defined under the

Schedule?

2. Is the applicant entitled to receive medical benefits recommended by Health- Pro Wellness as follows:

(a) $1,790.04 for chiropractic services in a treatment plan (OCF-18)³ submitted on September 15, 2015, denied by the respondent on February 4, 2016;

(b) $200.00 for other goods and services in an invoice submitted on November 25, 2015⁴, denied by the respondent on November 25, 2015;

(c) $1,353.60 for chiropractic services in a treatment plan (OCF-18)⁵ submitted on November 30, 2015, denied by the respondent on February 4, 2016;

(d) $200.00 for other goods and services in an invoice submitted on January 4, 2016⁶, denied by the respondent on February 4, 2016.

3. Is the applicant entitled to payment for the cost of examinations proposed by Definitive Health as follows:

(a) $1,774.10 for an attendant care assessment recommended in a treatment plan (OCF-18)⁷, denied by the respondent on February 4, 2016;

(b) $2,562.84 for a psychological assessment recommended in a treatment plan (OCF-18)⁸, denied by the respondent on February 4, 2016.

4. Is the applicant entitled to interest on any overdue payment of medical benefits relating to issue 2(a)?⁹

RESULT:

10Based on the totality of the evidence before me, and for reasons set out below, I find that:

1. The applicant has failed to prove that his injuries fall outside the definition of a minor injury under the Schedule.

2. Given my finding on the first issue, the applicant is subject to treatment within the MIG funding cap of $3,500. Since the disputed medical benefits and cost of examinations exceed the MIG funding cap, it is unnecessary to address the reasonableness and necessity of the disputed benefits, or the issue of interest.

PRELIMINARY PROCEDURAL ISSUE:

11In its submissions for the hearing, the respondent raised a preliminary procedural issue, asserting that the applicant “should be precluded from adducing any new evidence or argument in his Reply Submissions which reasonably could have been included with the Applicant’s [initial] Submissions” [emphasis added], and citing caselaw in support of its assertion¹⁰.

12The applicant addressed the respondent’s preliminary procedural issue in his reply submissions, from which it is clear that the applicant believed the respondent was specifically objecting to and seeking to preclude the applicant from relying on a neck MRI report of May 13, 2018. That MRI report was included with the applicant’s submissions and evidence filed on May 22, 2018 (the due date for his initial submissions and evidence). The case conference order stipulated that evidence for the hearing would be limited to documents exchanged between the parties by April 20, 2018.

13The applicant’s reply was served on the respondent and filed with the Tribunal on June 11, 2018 (the due date for his reply submissions).

14After reviewing the applicant’s reply submissions, counsel for the respondent wrote a letter dated June 14, 2018, addressed to applicant counsel’s office and copied to the Tribunal, the purpose of which was to provide “clarification” of the preliminary procedural issue raised by the respondent. In this letter, counsel for the respondent advised:

i. The respondent’s preliminary procedural issue was raised on an “anticipatory” basis “in the event new evidence was adduced by the Applicant in [his] Reply Submissions.” [emphasis in original]

ii. The respondent “did not suggest in its submissions that the Applicant must be precluded from relying on the MRI of the neck dated May 13, 2018, and provided [with his initial submissions] on May 22, 2018.”

iii. The respondent addressed the MRI report of May 13, 2018 in its submissions for the hearing and outlined its position regarding the findings in that report.

15In view of the foregoing, I am satisfied that the respondent did not object to nor was it seeking an order to exclude the neck MRI report of May 13, 2018 from the applicant’s evidence.

16Further, no new evidence was submitted by the applicant in his reply submissions such that the respondent’s “anticipatory” preliminary procedural issue concerning the submission of new evidence in his reply is moot.

17Finally, although the applicant clearly and expressly articulated for the first time in his reply submissions his argument and basis for his removal from the MIG, I am not persuaded that he should be precluded from making that argument in his reply. The respondent addressed its position on that very argument in its submissions. I therefore see no prejudice to the respondent in allowing the applicant to advance that argument in his reply submissions.

ANALYSIS AND REASONS:

18As this was a written hearing, the only evidence submitted was documentary. I have considered the parties’ submissions and the documents each submitted and relied upon as evidence for the hearing.

The Accident

19The following description of the accident is based on the applicant’s self-reports as documented in the records of his family physician, his treating clinic, and his two neurologists, as well as two Insurer Examination (“IE”) reports.

20The applicant was the driver and sole occupant of his vehicle¹¹ when another vehicle travelling in the opposite direction made an unsafe turn in front of him, causing the front end of the applicant’s vehicle to collide with the side of the other vehicle in a “T-bone” manner. The airbags in the applicant’s vehicle did not deploy. The applicant did not experience a loss of consciousness. Neither police nor paramedics attended the scene. The applicant drove his vehicle to the collision centre to report the accident. He did not seek immediate medical treatment. He subsequently saw his family physician and also commenced therapy at a rehabilitation clinic, Health-Pro Wellness (“Health-Pro”).

21At the time of the accident the applicant was employed full-time as an optician.

He did not miss time from work and continued working as a full-time optician after the accident happened.

Post-Accident Treatment and Assessments

22According to the clinical notes and records (“CNRs”) of the applicant’s family physician¹², the applicant saw his physician for the first time post-accident on March 21, 2015 (two weeks post-accident). The record of that visit indicates that the applicant complained of neck and back pain, as well as right-sided headaches. The applicant reported to his physician that the headaches were constant daily and that he was taking Tylenol daily for relief. The family physician referred the applicant for x-rays¹³ as well as a head CT scan.

23On March 31, 2015, the applicant attended an initial assessment at Health-Pro.

The same day Dr. Aliya Salayeva, chiropractor at Health-Pro, completed a Disability Certificate (OCF-3)¹⁴. On the OCF-3, when asked to describe the applicant’s accident-related injuries and sequelae, starting with the most significant, Dr. Salayeva listed the following:

i. Post-traumatic stress disorder

ii. Tension-type headache

iii. Dizziness and giddiness

iv. Other sleep disorders

v. Myalgia¹⁵

vi. Whiplash associated disorder (WAD2) with complaint of neck pain with musculoskeletal signs

vii. Sprain and strain of thoracic spine

viii. Sprain and strain of other and unspecified parts of lumbar spine and pelvis

ix. Other sprain and strain of cervical spine

Dr. Salayeva completed a Treatment Confirmation Form (OCF-23)¹⁶ the same date for treatment for the applicant under the MIG. Dr. Salayeva subsequently completed a Minor Injury Treatment Discharge Report (OCF-24)¹⁷ requesting additional intervention outside the MIG along with an accompanying OCF-18¹⁸, and later completed the two OCF-18s for chiropractic services that are in dispute.

These OCF forms listed the same injuries and sequelae as outlined in the bullet points above; although at times they were listed in a somewhat different order, the description and terminology used was identical.

24The head CT scan was performed on April 8, 2015 and revealed “evidence of abnormal vascular shunting along the right side of the brain. The exact etiology of this is uncertain.”¹⁹

25The applicant next saw his family physician on April 11, 2015. The physician recorded the applicant’s complaints as “tender/spasm” in his left neck and trapezius area, and noted the applicant reported his headaches were the same. His physician referred him to a neurologist, Dr. Garry Moddel.

26Dr. Moddel saw the applicant on July 10, 2015. In his corresponding report²⁰, Dr.

Moddel outlined that the applicant reported getting “increased right-sided headaches with discomfort in his neck, shoulder and back” in the time following the accident. The applicant reported to Dr. Moddel that there had been some improvement in his symptoms. Dr. Moddel performed a neurological examination, the results of which were normal. In his report, Dr. Moddel went on to state the following: “His CT showed some abnormal shunting on the right side which certainly is not related to the motor vehicle accident…He may have an AV malformation. I will get a MRI organized.”

27At the request of the respondent, the applicant attended an IE Physician Assessment with Dr. Michael Boucher on November 9, 2015 to address the applicability of the MIG and one of the disputed OCF-18s for chiropractic treatment. In his corresponding report dated January 29, 2016²¹, Dr. Boucher outlined that the applicant reported two ongoing accident-related complaints: (1) low back pain; and (2) headaches, which the applicant reported experiencing once weekly without any associated photophobia, phonophobia, nausea, vomiting, or blurred vision. Based on his assessment and physical examination of the applicant, Dr. Boucher opined that the applicant’s injuries fell within the MIG.

28On January 18, 2016, the applicant attended an IE Psychological Assessment with Dr. Rod Day. In his corresponding report dated January 29, 2016²², Dr. Day indicated that during the clinical interview the applicant reported the following physical concerns: (1) low back pain; (2) headaches; and (3) recent left shin pain. In addition to the clinical interview, Dr. Day administered a number of psychometric tests. Dr. Day concluded that while the applicant reported some psychological symptoms following the subject accident, the applicant’s symptoms were “sub-syndromal”, he “did not meet the full diagnostic criteria for a DSM 5 disorder” related to the index motor vehicle accident (“MVA”), and there was “no significant index MVA-related psychological condition or impairment currently present.”

29The applicant saw neurologist Dr. Moddel again in follow-up on April 1, 2016. In his corresponding report²³, Dr. Moddel outlined that a neurological examination performed that date was “unremarkable”. Dr. Moddel indicated that the MRI showed a “giant arachnoid granulation” which he described as “quite a benign phenomenon”. Dr. Moddel concluded his report by indicating that the applicant had “no significant intracranial pathology” and that the “basic mode of therapy is reassurance.”

30After his first two post-accident visits with his family physician in March and April of 2015, the applicant next saw his family physician more than one year later on June 27, 2016. The record of that visit indicates that the applicant had been “seen in ER [emergency room]”²⁴ due to “sharp/throbbing” right head pain. A further MRI of the brain was to be arranged.

31The applicant saw his family physician again on August 8th and August 26th, 2016. The August 26th notation by the family physician indicated that the applicant was “[d]oing well” and that his headaches were “stable”.

32A brain MRI performed on November 1, 2016²⁵ showed a “stable appearance” of the giant arachnoid granulation.

33The applicant next saw his family physician on November 21, 2016. The record of that visit indicates the applicant’s headaches were “better” and “stable”. It appears a discussion took place at that time about a possible referral to another neurologist for a second opinion regarding the brain MRI results.

34The applicant next saw his family physician on February 27, 2017. That record indicates the applicant reported falling a few times while snowboarding one week earlier and the entry focusses primarily on that event. The entry does however refer to the applicant’s headaches as being “stable”.

35On March 2, 2017, the applicant attended an appointment with a second neurologist, Dr. Joanna Schaafsma. In her corresponding report²⁶, Dr.

Schaafsma indicates that the applicant had been referred “to discuss MRI findings done in the context of headaches.” Her report references the applicant’s history of complaints post-accident of right-sided headaches “irradiating [sic] down to the neck and the right shoulder”, and his post-accident treatment involving chiropractic, physical therapy, acupuncture and pain medication. Her report immediately thereafter reads:

“Over the last two years, his head and neck aches significantly reduced. Now, he mainly has residual neck and shoulder pain, but rarely headaches.”

Dr. Schaafsma reviewed the previous brain MRIs and concluded that the applicant had (1) most likely a large arachnoid granulation; and, (2) a developmental venous anomaly (DVA). Dr. Schaafsma noted that DVAs are “typically asymptomatic and cannot explain his symptoms” and opined that the “nature and course of his symptoms…are most likely related to the accident.” Dr. Schaafsma concluded that no treatment or follow-up was required.

36The next and last entry in the CNRs of the family physician is dated March 12, 2018. That entry indicates that the applicant reported still having occasional headaches, right head pain, and pain in his right neck and shoulder.

37On April 25, 2018, another MRI of the brain was performed²⁷, which again showed evidence of a vascular anomaly.

38On May 13, 2018, the applicant had a neck MRI performed²⁸, the results of which showed “minimal diffuse bulging” discs at C3-C4 and C5-C6 and “similar appearing disc” at C6-C7, as well as “very mild narrowing” of the right C3-C4 neural foramen and bilaterally at C6-C7.

Issue 1 – Applicability of the MIG

39The MIG establishes a framework for the treatment of minor injuries. The term “minor injury” is defined in section 3 of the Schedule as “one or more of a strain, sprain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.” The terms “strain”, “sprain”, “subluxation” and “whiplash associated disorder” are also defined in section 3.

40Section 18(1) of the Schedule limits the entitlement for medical and rehabilitation benefits for minor injuries to $3,500.

41The onus is on the applicant to show that his injuries fall outside of the MIG²⁹.

42In his initial submissions for the hearing, the applicant did not clearly or expressly address how and/or which of his accident-related injuries warrant his removal from the MIG.

43In its submissions, the respondent indicates that during the claims adjusting process, the applicant asserted that he should be removed from the MIG on the basis of both physical injuries and psychological impairment. The respondent submits that it appears the applicant abandoned the latter basis, given that he did not make submissions or advance any argument for his removal from the MIG on the basis of psychological impairment. I agree, particularly in view of the position expressed by the applicant in his reply submissions.

44In his reply submissions, the applicant expressly argued that he should be removed from the MIG on the basis that his accident-related physical injuries are not predominantly minor. Specifically, at paragraph six of his reply submissions, he relies on the findings of the neck MRI of May 13, 2018 which, per above, showed “minimal diffuse bulging” discs at C3-C4 and C5-C6 and “similar appearing disc” at C6-C7, as well as “very mild narrowing” of the right C3-C4 neural foramen and bilaterally at C6-C7.

45Because the applicant’s submissions (both initial and reply) also devoted much reference and attention to the applicant’s headaches, for the sake of completeness I find it reasonable to address that issue as well.

The Neck MRI of May 13, 2018

46I find that the applicant has failed to prove that he should be removed from the MIG based on the results of the neck MRI of May 13, 2018.

47Although not explicitly articulated in his submissions, the inference and essence of the applicant’s argument is that because the neck MRI in 2018 showed evidence of minimal diffuse bulging discs and very mild narrowing of the neural foramen at some levels in his neck, those findings must be due to the injuries he sustained in the accident in 2015.

48The respondent in contrast argues that there are causation issues given the 3- year lapse in time between the accident in March 2015 and the neck MRI in May 2018. It posits that minimal diffuse disc bulging is the result of non-accident related degenerative changes. It also points to the family physician’s CNR entry of February 27, 2017 which referenced the applicant falling while snowboarding. In addition, the respondent argues that the applicant has not provided any medical opinion that the neck MRI findings are accident-related.

49I do not dispute that the applicant experienced some neck pain and discomfort post-accident. All of the various OCF forms completed by Dr. Salayeva list WAD2 with complaint of neck pain and other sprain/strain of the cervical spine which, notably, fall within the definition of a minor injury. There are also notations elsewhere in the medical records - including the progress reports from the treating clinic in 2015 and his family physician’s records most predominantly during his appointments that took place between March 2015 to August 2016 - which reference the applicant’s complaint of neck pain and/or neck discomfort.

50However, I agree with the respondent that the 3-year lapse in time between the accident in 2015 and the neck MRI in 2018 raises causation issues.

51There are gaps in the medical records regarding the applicant’s complaint of neck pain. For example, there is no documented record of neck complaints by the applicant to his family physician during his appointments after August 8, 2016 onwards and over the next nineteen months until the appointment on March 12, 2018 when he reported neck pain among his ongoing complaints. The applicant attended three appointments with his family physician during that 19 month interval and none of those records include a notation of any neck complaints by the applicant.

52The applicant has presented in his evidence a neck MRI report from May 2018 which certainly shows the findings described above. What is absent from his evidence however is a medical letter, report or opinion that establishes a direct and causal link between those findings in May 2018 and the subject accident three years earlier in March 2015. I find the medical evidence he otherwise did provide is insufficient to establish such a direct and causal link either.

53The onus rests with the applicant to prove that the neck MRI findings are accident-related. I find he has not met that onus. Accordingly, I find he has failed to prove that he should be removed from the MIG on that basis.

Headaches

54Based on the evidentiary record before me, I find that the applicant has similarly failed to prove he should be removed from the MIG on the basis of headaches.

55While the evidence shows the applicant complained of headaches in the post- accident period, he has failed to convince me that his headaches are more than “clinically associated sequelae” of his minor sprain and strain injuries. I have reached this conclusion because:

i. All of the various OCF forms completed by Dr. Salayeva listed under the injury and sequelae section “tension-type headache”.

ii. Neurologist Dr. Moddel did not make any diagnosis attributable to the subject accident.

iii. Although the second neurologist Dr. Schaafsma opined that the applicant’s headaches were most likely accident-related, in her report of May 2017 she noted that in the 2 years post-accident the applicant’s complaints had “significantly” reduced and he reported “rarely” experiencing headaches. She also concluded that no treatment or follow- up was required.

iv. The applicant has pointed me to no caselaw or authority as to why headaches would fall outside the definition of a minor injury.

56Further, although in an affidavit submitted for the hearing³⁰ Dr. Salayeva (at paragraph 3) states that she diagnosed the applicant with “Headaches secondary to the MVA, post-concussion symptoms”, I note that:

i. A concussion diagnosis is outside the scope of practice for a chiropractor.

ii. As above, all of the various OCF forms completed by Dr. Salayeva listed under the injury and sequelae section “tension-type headache”. While she described elsewhere “severe post-traumatic headaches” on the three OCF-18s (including the two OCF-18s for chiropractic services specifically in dispute), none of the OCF forms contain any reference to a concussion or post-concussion symptoms.

iii. Neither of the applicant’s two neurologists diagnosed the applicant with a concussion, either attributable to the accident or otherwise. I agree with the respondent’s submissions that the applicant’s neurologists, by virtue of their specialty, would be best informed and most appropriately situated to make a concussion diagnosis and they did not.

iv. Similarly, the applicant’s family physician at no time refers to the applicant as having sustained a concussion as a result of the accident.

57Accordingly, I am not satisfied that the applicant sustained a concussion as a result of the subject accident and, by extension, am not satisfied that his headaches are of a “post-concussive” nature.

58For these reasons, I find the applicant has failed to prove that he should be removed from the MIG on the basis of headaches.

CONCLUSION:

59For reasons set out above, I find that:

1. The applicant has failed to prove that his injuries fall outside the definition of a minor injury under the Schedule;

2. Given my finding on the first issue, the applicant is subject to treatment within the MIG funding cap of $3,500. Since the disputed medical benefits and cost of examinations exceed the MIG funding cap, it is unnecessary to address the reasonableness and necessity of the disputed benefits, or the issue of interest.

Released: August 3, 2018

­_________________

Gemma Harmison

Adjudicator

Footnotes

1. 1Health-Pro Wellness Account Activity print-out dated May 17, 2018 included in the clinical notes and records (“CNRs”) of Health-Pro Wellness – Applicant’s Submissions Tab 1
2. 2The applicant’s initial submissions and reply submissions both made reference to the applicant seeking, among the relief being sought at this hearing, approval of a denied portion of an earlier OCF-18 dated June 30, 2015 which was for the total amount of $1,364.36 and which was partially approved by the respondent in the amount of $1,007.82. However that earlier OCF-18, and the partially denied amount, was not listed in the case conference order as being an issue in dispute as agreed to between the parties for the purpose of this hearing. In its submissions for the hearing, the respondent did not address the earlier June 30, 2015 OCF-18 or the partially denied amount, and it focused entirely on the disputed issues specifically identified in the case conference order. Because the earlier OCF-18 dated June 30, 2015 was not listed in the case conference order, and because I have no evidence before me that the respondent consented to that issue being added at this hearing, I am not satisfied that it is properly before me and accordingly will not consider it in this decision.
3. 3OCF-18 dated August 18, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
4. 4The parties in their submissions for the hearing agreed that the disputed amount of $200.00 in issue 2(b) relates to the cost of completion of an OCF-18 but they differed on which specific OCF-18. The applicant referenced this cost as being associated with the earlier OCF-18 dated June 30, 2015 which, per above, was not listed as an issue in dispute in the case conference order. According to the respondent, this $200.00 cost is for the cost of completion of the disputed OCF-18 for chiropractic services identified in 2(a). The CNRs of Health-Pro Wellness at Tab 1 of the Applicant’s submissions includes a copy of an invoice (OCF-21) for that amount and submitted that date which indicates that it was for the cost of completion of the disputed OCF-18 for chiropractic services identified in 2(a).
5. 5OCF-18 dated November 24, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
6. 6The CNRs of Health-Pro-Wellness at Tab 1 of the Applicant’s submissions includes a copy of an invoice (OCF-21) for that amount and submitted that date which indicates that it was for the cost of completion of the disputed OCF-18 for chiropractic services identified in 2(c).
7. 7A copy of this OCF-18 was not submitted by the parties in their evidence for the hearing. As a result, I am unable to definitively confirm the date of this OCF-18 and/or the date that it was submitted to the respondent. However, according to the document list appendices in the reports of the respondent’s IE physician and psychological assessors submitted as evidence by the respondent, it would appear this OCF-18 was dated September 30, 2015 and was completed by occupational therapist Chelsea Good.
8. 8A copy of this OCF-18 was not submitted by the parties in their evidence for the hearing. As a result, I am unable to definitively confirm the date of this OCF-18 and/or the date that it was submitted to the respondent. However, according to the report of the respondent’s IE psychological assessor, this OCF-18 was dated October 13, 2015 and was completed by psychologist Dr. Fahimeh Aghamohseni.
9. 9The case conference order indicated that the issue of interest was specific to the disputed OCF-18 for chiropractic services listed as issue 2(a).
10. 10Alcock Laight & Westwood Ltd. v. Patten, Bernard and Dynamic Displays Ltd. 1966 CanLII 282 (ON CA), [1967] 1 O.R. 18 (Ont. C.A.)
11. 11Paragraph one of the applicant’s initial submissions referred to the applicant as being the front seat passenger of the vehicle. However, in his self-reports to his family doctor, his treating clinic, and his neurologists, the applicant indicated that he was the driver of the vehicle. The applicant additionally self-reported to two IE assessors that he was the driver and lone occupant of his vehicle.
12. 12CNRs of family physician Dr. Anh Nguyen – Applicant’s submissions Tab 2 and Tab 5
13. 13According to the decoded OHIP Summary submitted as evidence by the applicant, it appears that radiographs of his cervical and lumbar/lumbosacral spine were performed on March 21, 2015. However actual copies of those radiographic reports were not submitted as evidence by the applicant.
14. 14OCF-3 dated March 31, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
15. 15Myalgia is a medical term for muscle pain
16. 16OCF-23 dated March 31, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
17. 17OCF-24 dated June 30, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
18. 18OCF-18 dated June 30, 2015 included in the CNRs of Health-Pro Wellness – Applicant’s Submissions Tab 1
19. 19Head CT Scan Final Report included in the CNRs of neurologist Dr. Garry Moddel – Applicant’s Submissions Tab 3
20. 20Report dated July 10, 2015 included in CNRs of neurologist Dr. Garry Moddel – Applicant’s Submissions Tab 3
21. 21Respondent’s Submissions - Tab 6
22. 22Respondent’s Submissions – Tab 7
23. 23Report dated April 1, 2016 included in CNRs of neurologist Dr. Garry Moddel – Applicant’s Submissions Tab 3
24. 24The corresponding ER records were not submitted by the applicant as evidence for the hearing.
25. 25Copy of November 1, 2016 MRI included in Applicant’s Submissions at Tab 9
26. 26Report of Dr. Schaafsma dated March 2, 2017 included in CNRs of family physician Dr. Anh Nguyen – Applicant’s Submissions Tab 2
27. 27Brain MRI report of April 25, 2018 included in CNRs of family physician Dr. Anh Nguyen – Applicant’s Submissions Tab 5
28. 28Neck MRI report of May 13, 2018 included in CNRs of family physician Dr. Anh Nguyen – Applicant’s Submissions Tab 5
29. 29Scarlett v. Belair, 2015 ONSC 3635 para.24
30. 30Affidavit of Dr. Aliya Salayeva dated May 15, 2018 – Applicant’s Submissions Tab 6```