Date: 2018-08-29

Tribunal File Number: 16-001308/AABS

Case Name: 16-001308 v TD General Insurance Company

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:

Applicant

Applicant

and

TD General Insurance Company

Respondent

DECISION

ADJUDICATOR: Ruth Gottfried APPEARANCES:

For the Applicant: Kasia Grzybowski, Paralegal For the Respondent: Michael Tompkins, Counsel

Hearing by Teleconference January 4, 2017 and by written submissions February 3, 2017

REASONS FOR DECISION AND ORDER

OVERVIEW:

1The applicant, aged approximately 56 years old, was injured in a motor vehicle accident on August 26, 2013. The applicant was the front-seat passenger of a car being driven by his wife. The car was struck on the passenger side by a car attempting to merge into their lane. Neither police nor ambulance attended at the scene. The applicant did not go to the hospital.

2At the time of the accident, the applicant was employed as an apartment building superintendent. He applied for and received statutory accident benefits, including income replacement benefits (“IRBs”), from TD General Insurance Company (“TD”) under the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule'').

3TD paid the applicant IRBs in the amount of $400.00 weekly from September 2, 2013 to April 15, 2014, when they were terminated by TD. The applicant disputes TD’s termination.

4As the parties were unable to resolve the dispute at the case conference, a hearing by teleconference was scheduled for January 4, 2017. Shortly after the beginning of the hearing both parties agreed that several documents remained outstanding and written submissions would suffice to provide all relevant information. The parties consented to a resumption of the hearing in writing on February 3, 2017.

THE ISSUES IN DISPUTE:

5The issues¹ to be determined at the hearing are:

a. Is the applicant statute barred under s. 56 of the Schedule from proceeding with his application²?

b. Is the applicant entitled to IRBs after April 15, 2014 and if so, for what period of time?

c. Is the applicant entitled to interest on any overdue payment of benefits?

d. Is the applicant entitled to an order for his expenses?³

RESULT:

6After reviewing the submissions and evidence of both parties, in writing and at the teleconference, I find that:

a. the application to the Tribunal is not statute barred;

b. the applicant is not entitled to IRBs after April 15, 2014

c. the applicant is not entitled to interest; and

d. I make no order for expenses.

IS THE APPLICATION STATUTE BARRED?

7TD advised the applicant by letter dated April 1, 2014 that it had determined he was not entitled to any IRBs and the payment of the benefit would be stopped effective April 15, 2014.

8The applicant initiated an Application for Mediation at FSCO on November 5, 2015, which was within the statutory time limit under section 56(1) of the Schedule.⁴ The mediation was unsuccessful and the mediator issued a report dated April 20, 2016. An application for dispute resolution was filed with the Tribunal on July 11, 2016.

9TD submits that because the Tribunal application was filed more than two years after the denial of benefits, that the applicant is statute barred from proceeding.

10Prior to the establishment of the Tribunal on April 1, 2016, section 56(2) of the Schedule granted a 90 day extension from the date of a mediator’s report to commence a court proceeding or arbitration.

11Section 56(2) was revoked when the new amendments to the Schedule came into effect on June 1, 2016, and there was no longer an ability to schedule mediations at FSCO. Adjudicator Go cites Vice Chair Flude’s decision in P.C. and State Farm Insurance Company in two of her own decisions⁵:

Prior to April 1, 2016 this Tribunal could not accept applications for dispute resolution. An aggrieved person seeking dispute resolution had no option but to apply for mediation at FSCO. If … after April 1, 2016 there is no 90 day extension, then all of those applicants whose limitation period expired prior to April 1, 2016, but who had applied for mediation and not received a report of a mediator by that date were left without a remedy. They could not apply to FSCO for arbitration since it had no further jurisdiction to accept applications for arbitration. … [T]hey also could not apply to this Tribunal because the limitation period had run its course. This clearly is an absurd outcome.

12I agree with Adjudicator Go and Vice Chair Flude. The applicant in this case was within the statutory periods both in his application to FSCO for mediation and in his application to the Tribunal, I do not find that the application before this Tribunal is statute barred.

ENTITLEMENT TO INCOME REPLACEMENT BENEFITS

13Under s. 5(1) of the Schedule an insurer shall pay an income replacement benefit to an insured person who sustains an impairment as a result of an accident if the insured person was employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffers a substantial inability to perform the essential tasks of that employment.

14The entitlement turns on whether the applicant suffered a substantial inability to perform the essential tasks of his employment. Typically, one must first establish whether the applicant is entitled to a benefit and then determine the time period to which the entitlement applies.

15However, in his application, the applicant gave no end date for the time-period in dispute for the IRBs. In fact, until the teleconference hearing, the period in dispute was mistakenly shown as the period for which the applicant actually received benefits, i.e. September 2, 2013 to April 15, 2014.

16The fact that no end date was given has led to confusion and ambiguity, not only between the applicant and TD, but also between the applicant and his own representative.

17At the hearing, the applicant’s representative stated that the period of dispute for IRBs was April 15, 2014 to September 2, 2015 – a period just over the 104-week mark. However, the representative confirmed verbally that no post-104 entitlement to IRBs was being sought.

18When I asked the representative to confirm the actual dates for which the applicant was seeking IRBs she indicated it would be from April 16, 2014 to June 2015. When I pressed for a specific date in June, the representative advised that the applicant was seeking benefits only until June 1, 2015 because he had returned to work but could not be specific about the date he returned, so the claim is from the beginning of June⁶. However, the applicant stated that he went back to work on July 23, 2015⁷.

19Because of the ambiguity of the testimony, I must look to the documents submitted to try to determine when the applicant was able to go back to work.

WHEN WAS THE APPLICANT ABLE TO GO BACK TO WORK

20Based on the documents submitted, there were only two windows: from April 16, 2014 – November 25, 2014 and May 20, 2015 – July 7, 2015, when the applicant was not working or under contract to work.

21The applicant entered into an employment contract with “S” for a job as a superintendent on November 26, 2014. The physical and other requirements for the position were clearly stated.

22The applicant remained in this employment until he was involved in a second motor vehicle accident on April 8, 2015. After a few months of not working as a result of injuries suffered in the second accident, he again entered into an employment contract as a superintendent.

23The applicant submits that the law allows for temporary returns to work during the 104 weeks after an accident without affecting his entitlement to a resumption of benefits.⁸ He submits further that he is being penalized by TD for doing so.

24I find that the applicant is not being penalized for attempting to return to work as suggested in his submissions. As I have outlined above, his own records show that he was able to return to work when he signed the employment contract dated November 26, 2014. From that time, the applicant was clearly working at “S” until injured in a subsequent accident on April 8, 2015, which is not at issue before me.

25Medical records provided make clear that the second “window” was as a result of serious injuries, including fractures, suffered in a subsequent motor vehicle accident on April 8, 2015 and therefore I have determined that during this time frame, the applicant was not entitled to IRBs as a result of the August 2013 accident.

26The applicant did not report his employment with “S” nor did he report the April 2015 accident.

27The applicant’s testimony both at the teleconference, in his submissions and his subjective reports to treatment providers and assessors are in direct contradiction to the documents provided, which raises a genuine issue with regard to the applicant’s credibility. Following, I have excerpted several examples from the documentary evidence provided.

28In a consult letter dated May 19, 2014 Dr. Alasair Ingram, a nephrologist indicates that the applicant has retinopathy, but “[h]e is otherwise pretty well. He uses no over the counter medication. He currently works as a superintendent.”

29In his response submissions⁹ the applicant suggests that he went back to work “sporadically and on a part time basis”¹⁰ with “S” and further, that he was not really working for “S” but rather had entered into a highly structured arrangement so he could split income with his wife and thereby get access to benefits. These statements are in direct contradiction to the EI documents and the documents found in the “S” employment file.

30The applicant references the ROE from “S”, which states he quit for health reasons. The ROE also states that the applicant worked 1238 hours in the five- month period from December 2014 to May 2015. I do not agree with the applicant that those hours reflect either “sporadic” or “part time” work. I do not find the applicant’s position credible.

31In the transcript¹¹, the applicant states that he was asked to do work for “S” and he could not, so they “let him go in May”. According to the documents submitted, that statement is simply untrue.

32By letters dated May 20, 2015 and August 28, 2015 written by “S” to the applicant, it is indicated that “S” provided unpaid leave for medical reasons to the applicant and offered to work with him on a return to work plan when he was able to do so. By letter dated September 4, 2015, they advised the applicant that they continued to be willing to discuss with him a return to work.

33The applicant’s employment records show that on July 8, 2015 he had accepted a job with another employer – “M”. Clearly, the applicant had not told “S” that not only had he accepted the job with “M”, but by August 28, 2015 he was already working for them.

34Dr. Varma, the applicant’s family doctor sent an “off work” letter dated May 15, 2015 that is vague. She writes: “Was seen in the clinic on May 15, 2015. Continue off work. Re-assess in 2 weeks.”

35Because of the documents provided, it is now known that the applicant was in a serious motor vehicle accident on April 8, 2015. Therefore, I do not agree with the applicant’s position that the “off work” note is for injuries sustained in the August 2013 accident.

36The second letter “off work” letter from Dr. Greenspoon, dated August 24, 2015 specifically references the second motor vehicle accident and he writes that the applicant is to remain off work from April 8, 2015 and his return to work is “unknown”.

37Among the documents provided by “S” were a contract of employment, signed and initialed on each page by the applicant and dated November 26, 2014; a payroll enrollment form indicating the applicant is a full time, salaried employee; and an employee performance appraisal summary for the applicant’s job performance for the month of December, 2014.

38The appraisal summary includes a category for maintenance and cleaning. The category is defined as: “The extent to which the employee responds to, records, and completes repairs and maintenance for tenants as well as ensures vacant units and building cleanliness.” The applicant has scored a “2” which is defined as “Meets Expectations: Consistently and fully meets the expected standards in all aspects”. The supervisor completing the form added the comment: “[The applicant] is usually on top of work orders and completes repairs in a timely manner”.

39I find that these detailed performance reviews are not what would be expected from a person who alleges was only pretending to work in order to get benefits.

40Also included in the “S” file is a copy of a “new plan member group insurance application” for the applicant with Equitable Life of Canada, signed by the applicant on February 25, 2015. The coverage applied for is “single”.

41The applicant references¹² that the appraisal summary states “[the applicant and his wife] will need to work on their communication” shows that both were employed with the company.

42I can only agree with the applicant’s submission that the summary indicates the applicant was employed. His wife’s employment is not at issue and I place no relevance on her being named in the appraisal summary. What is at issue is whether the applicant was employed and was he able to fulfill his employment duties. The documents indicate that the answer to both those statements is yes.

43The onus is on the applicant to show whether he has a substantial inability to do the tasks of his employment.

44The applicant signed an employment contract with “S” on November 26, 2014, and began work on December 10, 2014. His ROE from “S” shows that he worked until May 15, 2015, when he had to leave for “health reasons”, which we now know were subsequent to the April 2015 car accident.

45Therefore, the question of entitlement to IRBs is for the time period from April 16, 2014 to November 25, 2014. I find that the applicant is not entitled to IRBs for the period after November 25, 2014 as he did not have a substantial inability to engage in the tasks of his employment as a result of the motor vehicle accident of August 2013.

IS THE APPLICANT ENTITLED TO INCOME REPLACEMENT BENEFITS FROM APRIL 16, 2014 TO NOVEMBER 25, 2014?

46In the Tribunal case 16-000179 v Old Republic Insurance Company¹³, (“Republic”), cited by the applicant, there is a two-part test to assist in the determination of entitlement to IRBs: what are the essential tasks of the applicant’s employment; and, is the applicant substantially unable to perform those essential tasks? I find this a useful tool and have followed the test in my decision.

(a) What are the essential tasks of the applicant’s employment?

47The list of duties have been self-reported as well as listed by the applicant’s employers as part of their job description. They are basically the same. At the time of the subject accident, the applicant was working as a superintendent at “W” Apartments and advised that this duties were as follows:

a. Minor plumbing repairs such as changing water faucets. This may require him to assume low-level positions when accessing the area under the sink.

b. Plastering and painting holes in the drywall. This may require him to carry sheets of drywall weighing under 20 lbs.

c. Garbage disposal.

d. Cleaning of the common areas of the apartment such as the hallways and lobby: this involved vacuuming and mopping.

e. Shovelling snow from the sidewalk and main entry areas.

f. He also communicated with the tenants with regard to complaints and rental inquiries.

48In addition, at TD’s request, Dennis Polygenis, physiotherapist (“Polygenis”)¹⁴ completed a Job Site Analysis Report. He concluded that a superintendent job falls within the Light Physical Demand Characteristic and the physical demands of the position include¹⁵:

Frequent: Standing, stooping, immediate reaching and handling Occasional: Walking, climbing, crouching, overhead reaching,

lifting/carrying up to 20 lbs, pushing/pulling up to 20lbs.

Rare: Fingering, kneeling and sitting

49I have accepted the description of the applicant’s pre-employment tasks as fact.

(b) Is the applicant substantially unable to perform the essential tasks of his pre-accident employment as an apartment superintendent?

50It has been very difficult to establish the applicant’s injuries that may or may not have prevented him from working between April 1, 2014 and November 25, 2015. The treating physicians and assessors were often privy to only the applicant’s subjective reports and even those subjective reports were inconsistent, contradictory or missing. It is only by reading through the medical and employment documents that a clearer picture is obtained of the applicant’s medical situation.

51Some examples of contradictory information follow:

52The applicant’s resume indicates he worked at “W” apartments as a building manager/superintendent from 2007 to 2015. However, other documents show that he worked for “S” beginning in December 2014.

53In a medical visit note from Dr. Dale Williams on November 23, 2013 the applicant states that he has been unable to work as a construction worker because of the cellulitis in his knee since September 2013. He does not mention the subject motor vehicle accident at all.

54On December 15, 2014, Dr. Varma submitted an updated disability certificate for the applicant reinforcing that he “could not return back to work due to the ongoing problems with neck pain, sciatica and headaches.”¹⁶ It is apparent that the applicant’s own family doctor was not aware that he was already working for “S” when she completed the certificate.

55In a visit note dated April 1, 2015 Dr. Varma writes that the applicant continues to suffer from neck pain … and from chronic headaches. In a visit note dated April 3, 2015 she writes that the applicant has “ongoing neck pain, back pain and headaches and this has prevented him from going back to work.”¹⁷ This is obviously not the case, as the documents submitted by the applicant reveal that by this date he had been working for “S” for almost 4 months.

56The EMG study done on June 3, 2015 (after the second motor vehicle accident) states that the applicant self-reported that he began having sciatic pain at the end of December 2014 or early 2015. This time frame is over sixteen months from the date of the subject motor vehicle accident, and by then the applicant was working.

57Five months after the accident, TD arranged for examinations and reports from three assessors: Dr. Maria Nesterenko, G.P.¹⁸ (“Nesterenko”), Polygenis¹⁹ and Dr. Ken Scapinello, psychologist²⁰ (“Scapinello”). The original assessments were performed in early 2014 and both Nesterenko and Scapinello provided addendum reports in November 2016.

58Polygenis provided a Job Site Analysis and a Functional Abilities Evaluation. The other two assessors were requested to provide their opinions as to whether the applicant suffered from a substantial inability to perform the essential tasks of his pre-accident occupation.

59The respondent submits that the applicant “refused to complete several tests” for Polygenis. I find this statement somewhat misleading. The report²¹ actually states that some testing was terminated by the applicant “due to subjective reports of pain.” However, “overall, the applicant demonstrated a fair effort and the test results are considered a reasonable representation of the applicant’s current physical abilities.”

60Polygenis found that the applicant demonstrated the ability to meet the physical demands of his pre-accident employment, although the tests for stooping, crouching and kneeling were incomplete. As Polygenis did not have the applicant’s medical records he was not aware that the applicant had suffered from a serious infection of his knee and as late as December 2014 Dr. Catherine Wright, D.C. notes that the applicant still has pain complaints in the area of the left knee that had been affected by cellulitis.²²

61The applicant notes that on February 10, 2014 he saw Dr. Gwardjan whose opinion was the “opposite” of Polygenis’.²³ During that appointment, Dr. Gwardjan notes the applicant references neck pain, predominantly on the left, associated with headaches. It does not appear that Dr. Gwardjan performed significant testing of the applicant and he suggests symptomatic, pharmacological management with perhaps injections or nerve blocks.

62I do not find this opinion “opposite”, nor does Dr. Gwardjan opine on the applicant’s ability to perform employment tasks. He suggests only methods of symptomatic relief. I have found this consultation has little probative value with regard to the applicant’s ability to perform his pre-employment tasks and have given it little weight.

63TD’s assessors reached the conclusion that the applicant did not suffer from a substantial inability to perform the essential tasks of his pre-accident occupation. The assessors did not change their opinions in their addenda after receiving clinical notes and records. I find their reports persuasive.

64I agree with the respondent’s submissions that it must be noted that these initial reports were completed without family doctor or physiotherapy records being provided by the applicant, and they relied on the applicant’s subjective recounting of his symptoms and his recollection of medical and rehabilitation visits.

65Had the records been available, they would have shown that the applicant’s history would also have included, among other issues:

a. “trauma to left ribs – likely 7th & 8th rib fractures – normal left shoulder”²⁴;

b. surgery for retinopathy in October 2013 for which he as “excused from work” until January 2014;²⁵

c. left knee cellulitis ongoing from before the subject accident, which caused enough pain that the applicant required prescription pain medication; and

d. a fall against a bathtub in early December 2013²⁶ that resulted in neck stiff but full range of motion in left shoulder.

66The records also show that in a note dated October 15, 2013 Dr. Varma states that the applicant missed an appointment with “Teresa” [unknown party] as he was in a small car accident [emphasis added]. It seems logical to me that if this reference to a small car accident referred to the subject accident, the doctor would have indicated that. This unknown “small car accident” is not referenced anywhere, yet caused the applicant to miss an appointment. This note raises the question as to whether this is in fact another motor vehicle accident that has not been disclosed.

67The applicant’s records show a history of symptoms from before the motor vehicle accident (cellulitis and knee pain) to long after the second motor vehicle accident in April 2015 (headaches, shoulder and back pain). The applicant has shown however, that he has been able to secure employment during these periods.

68The reassessment for headaches and back pain done by Dr. Sharma of Minerva Comprehensive Pain management program on November 17, 2014, took place only nine days before the applicant signed an employment contract.

69The applicant has complained of neck and shoulder pain including headaches and low back pain since the subject accident. However, the documents also show that he has pain that is severe enough to warrant 40 tablets of oxycocet in August 24, 2015 and 60 tablets of Tramadol in September 30, 2015. Despite his symptoms and prescriptions, the applicant was still able to be employed as a superintendent with both “S” and “M”.

70In the applicant’s submissions he states several times that TD paid IRBs and did not raise any issues previously. I am not sure what the purpose of these statements is. Insurers adjust claims on an ongoing basis. Issues are raised as new evidence is presented. The payment of a benefit for a time-period or an amount, does not forever bind the insurer and the applicant to the obligation to continue the payment.

71The applicant references the EMG report of Dr. Dale Williams on June 3, 2015. The applicant states in his submission that Dr. Williams was unsure if diabetes was the sole reason for the “demylinating and axonal polyneuropathy”. Dr. Williams also states that the “applicant’s history is complicated by a severe motor vehicle collision in early April 2015, in which he sustained multiple fractures…”. “[The] polyneuropathy … is consistent with a length-dependent neuropathy, namely diabetes, for which applicant has poor control.” [emphasis added].

72Dr. Williams’ report is more supportive of TD’s position than the applicant’s. I also find that the applicant’s failure to include Dr. Williams’ reference to the April 2015 accident could be construed as purposefully misleading. The applicant has not acknowledged this accident in his submissions and has failed to provide any documents, although ordered to do so.

73The applicant cites the case of Burgess and Pembridge²⁷ (“Burgess”) in support of his position. In Burgess, a young woman suffered a concussion as well as soft tissue injuries when an article she was transporting in her car hit her in the head as a result of a motor vehicle accident. The similarities between Burgess and the case before me are superficial: both involve a motor vehicle accident and both parties experienced shoulder and neck pain and headaches. Ms. Burgess suffered cognitive impairments, had to be retrained in order to obtain employment and was found to be completely unable to engage in any employment for five years. [emphasis added] I agree with the respondent that Burgess has no bearing on the facts of this case.

74The second case, Republic, cited by the applicant involves a 47 year old woman who was injured in a motor vehicle accident. Diagnostic tests revealed a torn shoulder and a slipped disc. Having suffered these injuries, she could not continue her employment as a bus driver. Other than the similar location of the injuries, I do not find that Republic is relevant, and I have not given it any weight.

75I do not have any persuasive documentation or expert reports from the applicant showing that during the first “window”, he was substantially unable to perform the essential tasks of his pre-accident employment.

76For all of the evidence discussed above I do not find the applicant credible. I also find that if he was able to work as a superintendent for both “S” and “M” while he complained of the same or more serious symptoms as he did prior to April 16, 2014, then on a balance of probabilities, he was not substantially unable to perform the essential tasks of his employment after that date.

EXPENSES

77The applicant requested an order for his expenses in his initial submissions, but did not address the issue again. Neither party made submissions on this issue. I am assuming that the applicant was equating the terms “expenses” and “costs”.

78Under Tribunal rule 19, costs are only awarded where a party believes that another party in a proceeding has acted unreasonably, frivolously, vexatiously, or in bad faith, and the request may be made in writing with submissions.

79As this issue was not addressed by the parties, I make no order for expenses.

CONCLUSIONS

80I find that:

a. The application to the Tribunal is not statute barred.

b. The applicant is not entitled to IRBs.

c. The applicant is not entitled to interest as there are no overdue payments of a benefit.

d. There is no order for expenses.

ORDER

81Pursuant to the authority vested in it under the provisions of the Insurance Act, the Tribunal dismisses application 16-001308/AABS.

Released: August 29, 2017

Ruth Gottfried, Adjudicator

Footnotes

1. 1The entitlement dates in dispute have been incorrectly stated in previous reports and orders as September 2013 – April 2014. That, in fact, is the period for which the applicant received IRBs. It is the period after April 2014 that is in dispute.
2. 2An issue raised by the respondent in its initial submissions
3. 3An issue raised in the applicant’s initial submissions
4. 456. (1) A mediation proceeding or evaluation under section 280 or 280.1 of the Act or a court proceeding or arbitration under clause 281 (1) (a) or (b) of the Act in respect of a benefit shall be commenced within two years after the insurer’s refusal to pay the amount claimed. O. Reg. 34/10, s. 56 (1).
5. 516-002606 v North Blenheim Mutual Insurance Company, 2017 CanLII 33690 (ON LAT), http://canlii.ca/t/h4381, paragraph 22 and 16-002336 v North Blenheim Mutual Insurance Company, 2017 CanLII 33674 (ON LAT), http://canlii.ca/t/h4380, paragraph 20
6. 6Supplementary Submissions of the Responding Party- Part 1 – transcript of teleconference hearing (“transcript”) – page 27, lines 16-19
7. 7Supplementary Submissions of the Responding Party – “Transcript” - page 27, lines 24-25
8. 8A person receiving an income replacement benefit may return to or start employment or self-employment at any time during the first 104 weeks for which he or she is receiving the benefit without affecting his or her entitlement to resume receiving any benefits to which he or she is entitled under this Part if, as a result of the accident, he or she is unable to continue the employment or self-employment. O. Reg. 34/10, s. 11.
9. 9Applicant’s response submissions – dated December 21, 2016
10. 10Applicant’s response submissions, paragraph 18
11. 11Transcript, page 48, lines 12 - 20
12. 12Applicant’s supplementary submissions, paragraph 8
13. 1316-000179 v Old Republic Insurance Company, 2016 CanLII 73692 (ON LAT), http://canlii.ca/t/gvd76
14. 14Job Site Analysis and Functional Abilities Evaluation assessments, dated February 18, 2014, Dennis Polygenis, physiotherapist
15. 15Job Site Analysis, Polygenis, page 4
16. 16Applicant’s initial submissions, paragraph 8.
17. 17Applicant’s initial submissions, paragraph 11
18. 18S.44 medical assessment dated March 14, 2014
19. 19See footnote 18
20. 20S.44 psychological assessment dated March 26, 2014
21. 21Functional Capacity Evaluation, March 24, 2014, assessor Dennis Polygenis, physiotherapist
22. 22Respondent’s brief, page 67
23. 23Consultation Note by Dr. Gwardjan, physiatrist dated February 10, 2014
24. 24December 18, 2013 – clinical note - Dr. Varma
25. 25Letter from Dr. Raj Devram, optometrist dated January 27, 2014
26. 26December 17, 2013 – clinical note - Dr. Varma
27. 27Burgess and Pembridge, FSCO File No.: A11-001160