B.W. v. Wawanesa Mutual Insurance Company, 2019 CanLII 130361

Citation: B.W. vs Wawanesa Mutual Insurance Company, 2019 ONLAT 18-004703/AABS

Tribunal File Number: 18-004703/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:

B.W.

Applicant

and

Wawanesa Mutual Insurance Company

Respondent

DECISION

PANEL:

Lindsay Lake, Adjudicator

APPEARANCES:

For the Applicant:

Kateryna Vlada, Paralegal

For the Respondent:

Paul Omeziri, Counsel

HEARD IN WRITING:

February 18, 2019

OVERVIEW

1The applicant, B.W., was injured in an automobile accident on February 16, 2016 (the “accident”) and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”) from Wawanesa Mutual Insurance Company (“Wawanesa”), the respondent.

2Wawanesa denied B.W.’s claims because it had determined that all of B.W.’s injuries fit the definition of “minor injury” as prescribed by s. 3(1) of the Schedule and, therefore, fall within the Minor Injury Guideline (the “MIG”).¹ Wawanesa also denied B.W.’s claim for a weekly income replacement benefit (IRB). As a result, B.W. submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”).

3The parties were unable to resolve their dispute at the case conference and the matter proceeded to a written hearing.

ISSUES IN DISPUTE

4The following issues are to be decided:

(i) Is B.W. entitled to a weekly IRB for the period of February 23, 2016 to date and ongoing, which Wawanesa denied on March 1, 2017?

(ii) If the answer to issue (i) above is “yes,” then what is the amount of weekly IRBs that B.W. is entitled to receive?

(iii) Did B.W. sustain predominately minor injuries as defined under the Schedule?

(iv) If the answer to issue (iii) above is “no,” then I must determine the following issues:

(a) Is B.W. entitled to a medical benefit in the amount of $4,782.80 for chiropractic services recommended by Polyclinic Rehabilitation Institute in a treatment plan dated August 2, 2016, and denied by Wawanesa on September 8, 2016?

(b) Is B.W. entitled to a medical benefit in the amount of $2,198.85 for psychological services recommended by Dr. Kleinman in a treatment plan dated August 18, 2017, and denied by Wawanesa on August 31, 2017?

(v) Is B.W. entitled to interest on any overdue payment of benefits?

PROCEDURAL ISSUE: Missing Documents

5After reviewing the parties’ submissions and evidence, I discovered that the two treatment plans in dispute were not filed with the Tribunal despite being referred to by B.W. in her submissions.

6As a result, I issued an Order on November 4, 2019 requesting submissions from both parties on whether I should allow B.W. to file the missing treatment plans as evidence for this written hearing given the Tribunal’s Reconsideration Decision in J.R. v. Certas Home and Insurance Company.² In that decision, Executive Chair Lamoureux highlighted the Tribunal’s obligation to ask parties to submit information that it believes a party meant to rely upon as evidence in a hearing.

7Wawanesa made no submissions in accordance with my November 4, 2019 Order.

8For the following reasons, I order that the missing treatment plans form part of the evidence in this hearing.

9As part of her response to my November 4, 2019 Order, B.W. questioned my request for submissions from the parties on whether I should allow her to file the missing treatment plans as evidence. Her concern arose because Wawanesa was permitted to refile its supporting documents following the Tribunal’s request without the requirement for submissions. That is to say, why Wawanesa was allowed to refile certain documents without question, B.W. queried why the parties were required to argue whether she should be permitted to file the missing treatment plans.

10The two scenarios are wholly different. With respect to Wawanesa’s documents, an issue arose with the initial electronic submission resulting in Wawanesa’s documents not being uploaded by the Tribunal and, hence, the need for Wawanesa to resubmit them. On the other hand, the disputed treatment plans were never filed with the Tribunal. My request for submissions on the missing treatment plans was consistent with the direction set out in J.R. v. Certas when the Tribunal is faced with missing information that it believes a party meant to rely upon as evidence in a hearing.

11Curiously, B.W. argues that she never intended to rely upon the missing treatment plans as evidence for the hearing. I could not know that this was B.W.’s position prior to my November 4, 2019 Order. Furthermore, I highlight the following statement by Executive Chair Lamoureux’s statement in J.R. v. Certas:

Just as an insurer reviews a complete OCF-18 in order to properly decide whether to fund the insured’s request, the Tribunal generally requires the same document in order to properly understand both the insured’s request and the insurer’s response. Put simply, the Tribunal cannot fairly adjudicate an application in most cases without a complete copy of the very document giving rise to the parties’ dispute.³

12Therefore, an additional purpose of my request for the missing documents was to ensure that I had a complete copy of the treatment plans in dispute before me to allow me to properly understand the insured’s request and the insurer’s response. Regardless of whether or not B.W. intended to rely upon the treatment plans, I find that the missing treatment plans are evidence necessary for my full and satisfactory understanding of the issues in dispute and are the very documents giving rise to two of the issues between the parties in this matter. Therefore, I order that the missing treatment plans shall form part of the evidence in this hearing.

RESULT

13I find that:

(i) B.W. is not entitled to IRBs for the period of February 23, 2016 to date and ongoing. Therefore, the issue of quantum is moot;

(ii) B.W. did not sustain predominately minor injuries as defined under the Schedule and, therefore, she is removed from the MIG;

(iii) B.W. is not entitled to the treatment plan dated August 2, 2016 in the amount of $4,782.80; and

(iv) B.W. is entitled to $1,847.46 of the total amount of the August 31, 2017 treatment plan with interest in accordance with s. 51 of the Schedule.

ANALYSIS

Income Replacement Benefits (IRBs)

14B.W. is seeking IRBs for the period of 104 weeks within the accident and also for the period of 104 weeks after the accident and ongoing.

15Based on the evidence before me, I find that B.W. is not entitled to IRBs for the first period – i.e., from February 23, 2016 to February 16, 2018 – and, therefore, the issue of quantum is moot. Further, because B.W. is not entitled to IRBs within 104 weeks of the accident, I find that B.W. is not eligible for IRBs for any period following 104-weeks post-accident.

Entitlement to IRBs within 104 weeks of the accident (February 23, 2016 to February 16, 2018)

16An insured person is eligible to receive IRBs if the applicant was employed at the time of the accident and, as a result of the accident, he or she suffers a substantial inability to perform the essential tasks of his or her pre-accident employment within 104 weeks after the accident.⁴

17If the applicant was not employed at the time of the accident, he or she is still eligible to receive IRBs if the applicant was employed for at least 26 weeks during the 52 weeks prior to the accident or was receiving benefits under the Employment Insurance Act⁵ at the time of the accident.⁶

18B.W. bears the burden of proving on a balance of probabilities that she is entitled to IRBs for the period from February 23, 2016 to February 16, 2018.

Was B.W. employed at the time of the accident?

19B.W. submitted that, on February 8, 2016, two weeks prior to the accident, she began working at [a staffing and recruiting agency] as a general labourer.⁷ B.W. submitted as evidence an Employer’s Confirmation Form (OCF-2) dated March 11, 2016. The OCF-2 indicated that B.W. worked for two weeks prior to the accident with [a staffing and recruiting agency] and that her gross income was $360.00. B.W. submitted no other evidence to confirm her pre-accident employment.

20Wawanesa argued that B.W. was not employed at the time of the accident and, to that end, relied on the following:

(i) B.W.’s Application for Accident Benefits (OCF-1) dated March 11, 2016, which lists her most recent employer as [a manufacturing company], not [a staffing and recruiting agency] as stated in her submissions. The OCF-1 indicates that B.W. worked for [a manufacturing company] from February 9, 2016 with a gross income of $250.00;

(ii) A letter from B.W.’s representative, NI Lawyers, to [a manufacturing company] dated July 23, 2018 which requested a complete copy of B.W.’s employment file was marked “does not work here;”

(iii) Email correspondence dated February 4, 2019 from [P. J.], Director of Human Resources at [a manufacturing company], which states that the company has no record of B.W. working for [a manufacturing company] in 2016;

(iv) Email correspondence dated February 4, 2019 from [F. S.] of [a staffing and recruiting agency], which states that [a staffing and recruiting agency] has no payroll records concerning B.W.;

(v) Written correspondence dated November 8, 2018 from [a staffing and recruiting agency] stating that no payroll records of B.W. were located in response to a request from NI Lawyers for a copy of B.W.’s complete employment file;

(vi) B.W.’s Income Tax Return for the 2016 taxation year, which shows no reported employment income; and

(vii) A York Region EBIR Client Assessment Form dated December 16, 2016, which formed part of B.W.’s Ontario Works file, in which B.W. declared her income for the period ending December 16, 2016 as “NIL.”

21No reply submissions were filed by B.W. and, therefore, she offered no explanation or submissions on Wawanesa’s position that B.W. was not employed at the time of the accident.

22I find that B.W. has failed to prove on a balance of probabilities that she was employed at the time of the accident as I place more weight on the evidence submitted by Wawanesa than on the March 11, 2016 OCF-2 submitted by B.W. The evidence submitted by Wawanesa is consistent in that no employment income was reported by B.W. not only on her Income Tax Return, but also in her Ontario Works file, and that there were no employment files or payroll records from either [a staffing and recruiting agency] or [a manufacturing company]. B.W. also failed to clarify the discrepancies between her stated pre-accident employers and failed to submit as evidence any other documents that would support her position that she was employed.

23I also find that B.W. made no submissions that, if she was found to not be employed at the time of the accident, that she was otherwise entitled to IRBs because she was employed for at least 26 weeks during the 52 weeks prior to the accident or was receiving benefits under the Employment Insurance Act at the time of the accident. In fact, the evidence supports that she was not employed for at least 26 weeks during the 52 weeks prior to the accident as her Income Tax Return for the 2015 taxation year also reported no employment income.

24Given my finding that B.W. was not employed or met any of the other criteria for eligibility for IRBs during the period from February 23, 2016 to February 16, 2018 for the reasons set out above, I find that B.W. has failed to prove on a balance of probabilities that she is entitled to IRBs within 104 weeks of the accident. As a result, the issue of determining IRB quantum is moot.

Entitlement to IRBs beyond 104 weeks of the accident (February 17, 2018 to date and ongoing)

25One’s entitlement to an IRB in the post-104 period is predicated on his or her eligibility for an IRB in the period before. Put another way, if one does not qualify for an IRB during the first 104 weeks, then he or she does not qualify for one later.⁸

26As a result of my finding that B.W. was not eligible for IRBs within 104 weeks of the accident, I find that B.W. is not eligible for IRBs for any period following 104-weeks post-accident.

Did B.W. sustain a predominately minor injury?

The Minor Injury Guideline (“MIG”)

27The MIG establishes a framework available to injured persons who sustain a minor injury as a result of an accident. A “minor injury” is defined in s. 3(1) 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 defined in the Schedule.

28The onus is on B.W. to show that her injuries fall outside of the MIG.⁹

Physical Injuries

29B.W. argues that her physical injuries do not fall within the definition of a “minor injury” as set out in the Schedule. Specifically, B.W. argues that she sustained a severe head injury, concussion, hearing loss, chronic headaches, post-traumatic headaches and dizziness.

30Wawanesa argues that B.W. sustained only soft tissue injuries as a result of the accident and, therefore, such injuries would fall within the MIG. Wawanesa also submitted that B.W. provided no medical opinion to support her position regarding her removal from the MIG.

31I find that B.W. has proven on a balance of probabilities that she suffered a closed head injury, a concussion and resulting post-concussion headaches as a result of the accident for the following reasons:

(i) B.W. was diagnosed with a concussion on March 5, 2016 by her family doctor, Dr. Usama Sarsam, who referred her for an MRI to assess her “moderate concussion.” Dr. Sarsam also diagnosed B.W. with post-concussion headaches on December 14, 2016;

(ii) B.W. was again diagnosed with a concussion on May 19, 2016 by Dr. Warren Goldstein, neurologist, along with post-traumatic headaches;¹⁰

(iii) In February 2017, B.W. was still reporting daily headaches to Dr. Sarsam. Dr. Sarsam again referred B.W. to be assessed by a neurologist;

(iv) Dr. Joseph Bruni, neurologist, noted that B.W. had a history of a closed head injury and ongoing post-traumatic headaches in his June 9, 2017 Neurology Ambulatory Consult. While Dr. Bruni found that B.W. had a normal neurological examination and that her MRI did not demonstrate any significant clinically relevant findings, his recommendations included prescription medicine (Amitriptyline) and a referral for B.W. to a speciality headache clinic for ongoing assistance with her headache management;

(v) In his July 18, 2017 Neurological Consultation Report, Dr. Moises Maria, neurologist, noted that B.W. did “seem to have medication overuse headaches on a background of post-concussive headaches;”¹¹

(vi) B.W. saw Dr. Maria on at least two additional occasions. In an October 12, 2017 note, Dr. Maria prescribed B.W. Topiramate for both its headache prophylactic features and its anti-seizure treatment. In his February 15, 2018 note, Dr. Maria recommended no further use of the Topiramate as B.W. reported it had not improved her headaches;

(vii) Wawanesa provided no refuting medical evidence that B.W. did not sustain a concussion. In fact, several of the IEs supported a finding that B.W. sustained a closed head injury, concussion and headaches as a result of the accident. For example, in his October 31, 2016 Insurer’s Examination (IE) Orthopaedic Examination Report, Dr. Irving Grosfield, orthopaedic surgeon, diagnosed B.W. with a closed head injury, concussion and headaches as a result of the accident despite his acknowledgement that this was not his area of expertise.¹² Dr. Grosfield maintained his diagnoses of B.W. with a closed head injury, concussion and headaches in his February 15, 2017 IE Orthopaedic Surgery Examination Report and noted that B.W. continued to complain of constant headaches;

(viii) The February 15, 2017 IE Neurological Examination Report by Dr. Jason Lazarou, neurologist, also supports a finding that B.W. sustained a concussion as a result of the accident. Dr. Lazarou opined that B.W.’s headaches “appear to be a consequence of a concussion style head injury and thus would be best described post-concussion chronic migraine complicated by medication overuse headaches;”¹³ and

(ix) While I agree with Wawanesa that Dr. Arnold Rubenstien, psychologist, failed to reveal any objectively identifiable impairment that might fall outside of the MIG, his opinion was only regarding psychological impairments. At no time does Dr. Rubenstein provide an opinion as to whether or not B.W. sustained a concussion as a result of the accident.

32In consequence of my finding that B.W. sustained a concussion as a result of the accident, B.W.’s injuries are outside of the MIG. The MIG only relates to “minor injuries” as defined in s. 3(1) of the Schedule. This definition does not include concussions. As a result, B.W.’s symptoms and issues arising from her concussion, such as her post-concussion headaches, cannot be characterized as sequelae to a minor injury. As a result, B.W. has proven on a balance of probabilities that the injuries she sustained in the accident are outside of the MIG.

33Sections 14 and 15 of the Schedule provide that the insurer shall pay for medical benefits to, or on behalf of, an applicant so long as the applicant sustains an impairment as a result of an accident and the medical benefit is a reasonable and necessary expense incurred by the applicant.

34B.W. bears the onus of proving her entitlement to the disputed treatment plans are both reasonable and necessary on a balance of probabilities.¹⁴

35For the following reasons, I find that B.W. is not entitled to the August 2, 2016 treatment plan but is entitled to $1,847.46 of the total amount of the August 31, 2017 treatment plan with interest in accordance with s. 51 of the Schedule.

Chiropractic Services

36Although the issue in dispute was set out in the Tribunal’s September 13, 2018 Order as a treatment plan for chiropractic services, the treatment plan dated August 2, 2016 sought funding for the following treatment:

(i) An initial chiropractic assessment;

(ii) 18 sessions of chiropractic treatment;

(iii) 18 sessions of massage therapy;

(iv) 12 sessions of acupuncture;

(v) 6 sessions of Biofeedback (passive and active); and

(vi) 1 session of health counselling.

37This treatment plan was completed by Dr. Vladimir Levitin, chiropractor, and the injury and sequela information portion of the OCF-18 lists the following: concussion; postconcussional syndrome; chronic post-traumatic headache; seizures post MVA; whiplash associated disorder [WAD 2] with complaint of neck pain with musculoskeletal signs; radiculopathy (cervical spine); internal derangement of knee (bilaterally); and sprain and strain of thoracic spine. The goals of the treatment plan are pain reduction, increased range of motion, increase in strength and return to activities of normal living.

38On September 8, 2016, Wawanesa denied this treatment plan and notified B.W. of her required attendance at a s. 44 assessment. Wawanesa ultimately denied this treatment plan on November 10, 2016 following an Insurer’s Examination (IE) with Dr. Grosfield.

39I find that B.W. has failed to prove on a balance of probabilities that the treatment plan dated August 2, 2016 was reasonable and necessary for the following reasons:

(i) Although B.W. relies upon the CNRs of Dr. Sarsam, at no time does Dr. Sarsam make a recommendation for any of the treatment modalities contained in this treatment plan. Dr. Sarsam only made one recommendation for therapy, which was on March 5, 2016, and it was for physiotherapy;

(ii) B.W. relied upon the CNRs from Etobicoke General Hospital which show that she attended the emergency department on March 16, 2016, one-month post-accident, complaining of severe headaches. However, no recommendation for therapy was made at this time;

(iii) B.W. also relied upon Dr. Goldstein’s May 19, 2016 report but his report does not recommend any of the treatment modalities that make up this treatment plan in dispute and, instead, recommended physiotherapy along with other natural remedies and medicine for B.W.’s headaches and seizures;

(iv) I place weight on Dr. Grosfield’s October 31, 2016 Independent Insurer’s Orthopaedic Examination Report wherein he opines that the treatment plan in dispute is not reasonable and necessary. In addition to his finding that, from a musculoskeletal perspective, B.W. required no further treatment for her cervical and lumbar spine soft tissue injuries, Dr. Grosfield also reported that B.W.’s headaches prevented her from continuing with physical therapy on two previous attempts; and

(v) While B.W. submitted the decision of 17-002624 v. Aviva Insurance Canada,¹⁵ B.W. made no submissions on how the finding in this matter should be applied to my determination of the reasonableness and necessity of this treatment plan. Additionally, the facts in 17-002624 are distinguishable as it does not appear that the applicant in that matter sustained a concussion and the reasons given for the termination of treatment that the applicant attended was due to the insurer denying funding and not as a result of limitations flowing from any head injuries.

40For all of the reasons set out above, B.W. is not entitled to this treatment plan.

Psychological Services

41Although the issue in dispute was characterized in the Tribunal’s September 13, 2018 Order as a treatment plan for psychological services, the OCF-18 dated August 18, 2017 in the amount of $2,193.85 sought funding for a psychological assessment.

42The treatment plan states that the psychological assessment would encompass a clinical interview and psychological testing to identify the extent of B.W.’s symptoms and to determine if there is a diagnosis, complete a report and a completion of an OCF18 for further treatment. The OCF-18 in dispute was completed by Dr. Valery Kleiman, psychologist, and listed adjustment disorders in the injury and sequelae information portion of the treatment plan. The goals of the OCF-18 were to reduce or completely eliminate anxiety/depressive symptoms, to improve emotional status and sleep patterns, to optimize B.W.’s ability to cope with pain and stress, to identify impairments to help achieve maximum recovery and to return to activities of normal living.

43Wawanesa denied this treatment plan on August 31, 2017 and provided notice to B.W. of her required attendance at a s. 44 assessment. The reasons provided by Wawanesa for the denial were based on a February 2017 s. 44 assessment of B.W. following which Dr. Arnold Rubenstein, psychologist, found that B.W. compromised the validity of the objective psychological testing due to symptom amplification. Further, Wawanesa stated that there was no new objective evidence that B.W. met criteria for any diagnosis under the DSM-IV and, given the time that had passed since the accident, it required the s. 44 assessment to determine if the proposed assessment was reasonable and necessary. In its submissions, Wawanesa also relied upon Dr. Rubenstein’s comments that the treatment plan was requesting fees in excess of the amounts indicated in the Financial Services Commission of Ontario (“FSCO”) Guidelines.

44I find that B.W. has proven on a balance of probabilities that the treatment plan for the psychological assessment is reasonable and necessary. As early as April 6, 2016, B.W. was prescribed prescription medicine (Elavil) from Dr. Sarsam to treat her anxiety from the accident.¹⁶ Dr. Sarsam prescribed Cymbalta to B.W. in December 2016 and again in April 2017 after B.W. attended his office with complaints of stress, anxiety, distress and “feeling low.” Further, Dr. Sarsam mentioned B.W.’s anxiety in his April 15, 2017 Medical Referral Form and B.W. attended with Dr. Sarsam again on April 21, 2017 after having suffered an anxiety attack. Dr. Goldstein also noted that B.W.’s mood appeared to be affected by her concussion and recommended that she see a psychiatrist in his May 16, 2016 report.

45B.W. also submitted three pages of a 12-page September 8, 2017 psychological report by Dr. Kleiman. Dr. Kleiman appears to diagnose B.W. with Somatic Symptom Disorder and Specific Phobia (passenger related). I am unable to give weight to this report, however, as it was not submitted in its entirety. Nonetheless, I find that based on Dr. Sarsam’s and Dr. Goldstein’s evidence alone, B.W. is entitled to the psychological assessment as there were enough signs and symptoms at the time that the treatment plan was submitted that it was reasonable to conduct an assessment to determine if B.W. was suffering from a psychological condition.

46Moreover, I place little weight on the findings of Dr. Rubenstein in his Independent Insurer’s Psychology Examination Reports dated February 15, 2017 and October 3, 2017. Although in both reports Dr. Rubenstein finds that B.W. has not sustained any diagnosable psychological impairment as a direct result of the accident, he speaks in detail about the invalidity of B.W.’s test scores in both reports. Therefore, I disagree with his finding that B.W. did not sustain any diagnosable psychological impairment as a result of the accident; rather, his report clearly shows that because of the invalidity of B.W.’s testing, Dr. Rubenstein was unable to determine if B.W. sustained any diagnosable psychological impairment as a result of the accident.

47Finally, Wawanesa relies upon Dr. Rubenstein’s statement that the fees in the disputed treatment plan exceed the FSCO Guideline. No further submissions were made on this issue and no rely submissions were received from B.W. in response.

48FSCO’s Professional Services Guideline (the “Guideline”)¹⁷ sets out the maximum hourly rates for professional services. The maximum hourly rate for psychologists in non-catastrophic impairment matters is $149.61. The only amount on the disputed treatment plan charged at an hourly rate is the amount sought for “planning, service.” The treatment plan reflects that this proposed service is for one hour of time at $496.00 per hour. I agree with Wawanesa that this amount exceeds the permitted maximum hourly rate set by the Guideline and, therefore, is reduced to $149.61. Following this amendment, the total cost of the treatment plan is $1,847.46, which does not exceed the $2,000.00 maximum as set out in the Schedule for any one assessment.¹⁸ Absent any further submissions on the reasonableness of the fees set out in the treatment plan from Wawanesa, B.W. is entitled to the treatment plan in the amount of $1,847.46, plus interest in accordance with s. 51 of the Schedule.

Interest

49As I have found that B.W. is entitled to $1,847.46 of the total amount of the August 18, 2017 treatment plan for a psychological assessment, interest is payable on this amount in accordance with s. 51 of the Schedule.

CONCLUSION

50For the reasons outlined above, I find:

(i) B.W. is not entitled to weekly IRBs for the period of February 23, 2016 to date and ongoing; and

(ii) B.W. did not sustain predominately minor injuries as defined under the Schedule and, therefore, is removed from the MIG;

(iii) B.W. is not entitled to the August 2, 2016 treatment plan; and

(iv) B.W. is entitled to $1,847.46 of the total amount of the August 31, 2017 treatment plan with interest in accordance with s. 51 of the Schedule.

Footnotes

1. 1Minor Injury Guideline, Superintendent’s Guideline 01/14, issued pursuant to s. 268.3 (1.1) of the Insurance Act.
2. 22018 CanLII 13161 (ON LAT) (“J.R. v. Certas”).
3. 3Ibid. at para. 21.
4. 4S. 5(1) of the Schedule.
5. 5S.C. 1996, c. 23.
6. 6S. 5(1)ii of the Schedule.
7. 7Applicant’s Submissions, para. 16.
8. 8See the Reconsideration Decision of D.W. v. The Co-operators, 2018 CanLII 8092 (ON LAT) at para. 17.
9. 9Scarlett v. Belair Insurance, 2015 ONSC 3635 (Div. Ct.), para. 24.
10. 10Applicant’s materials, tab 23.
11. 11Applicant’s materials, tab 16.
12. 12Hearing Brief of the Respondent, tab 27a, page 6.
13. 13Hearing Brief of the Respondent, tab 27c, page 5.
14. 14Supra note 9 at paras. 20-24.
15. 152018 CanLII 13183 (ON LAT) (“17-002624”).
16. 16April 6, 2016 Medical Referral Form completed by Dr. Sarsam.
17. 17September 2014, Superintendent’s Guideline No. 03/14.
18. 18S. 25(5)(a).