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:
M.C.
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
PANEL:
Melody Maleki-Yazdi, Adjudicator
Kimberly Parish, Adjudicator
APPEARANCES:
For the Applicant:
Murad Huseynov, Paralegal
Stefanie Pereira, Counsel
For the Respondent:
James Schmidt, Counsel
Interpreter:
[R.D.] (Portuguese)
HEARD:
In person on: January 21 and 22, 2019
OVERVIEW
1M.C. (“the applicant”) was injured in an automobile accident (“the accident”) on August 15, 2017 and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 20101 (the ''Schedule''). She applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) when her claims for benefits were denied by the respondent.
2The respondent denied the applicant’s claims for additional medical benefits because it was determined that all of the applicant’s injuries fit the definition of “minor injury” prescribed by section 3(1) of the Schedule and, therefore, fall within the Minor Injury Guideline2 (“the MIG”). Further, income replacement benefits were denied by the respondent and are also being claimed by the applicant in this hearing.
ISSUES
3The following issues are in dispute for this hearing:
i. Are the applicant’s injuries predominantly minor injuries as defined in the Schedule and therefore subject to treatment within the MIG?
ii. If the applicant’s injuries are not within the MIG, then the Tribunal must determine the following issues:
(i) Is the applicant entitled to receive a medical benefit in the amount of $2,723.44 for chiropractic treatment, massage therapy treatment and acupuncture recommended by New Wave Health in a treatment plan submitted on March 15, 2018, and denied by the respondent on March 27, 2018?
(ii) Is the applicant entitled to receive a medical benefit in the amount of $3,916.76 for chiropractic treatment, massage therapy treatment and acupuncture recommended by New Wave Health in a treatment plan submitted on August 21, 2017, and denied by the respondent on August 31, 2017?
(iii) Is the applicant entitled to receive a medical benefit in the amount of $2,730.22 for chiropractic treatment, massage therapy treatment and acupuncture recommended by New Wave Health in a treatment plan submitted on September 20, 2017, and denied by the respondent on October 25, 2017?
(iv) Is the applicant entitled to receive payment for the cost of an examination in the amount of $1,650.00 for a chronic pain assessment recommended by New Wave Health in a treatment plan submitted on January 26, 2018, and denied by the respondent on February 6, 2018?
(v) Is the applicant entitled to receive the cost of an examination in the amount of $2,200.00 for a psychological assessment in a treatment plan recommended by Toronto Central Diagnostics in a treatment plan submitted on October 19, 2017, and denied by the respondent on October 30, 2017?
iii. Is the applicant entitled to receive an income replacement benefit in the amount of $400.00 per week for the period from March 19, 2018 to date and ongoing?
iv. Is the applicant entitled to an award under Ontario Regulation 664 because the respondent unreasonably withheld or delayed the payment of benefits?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The Tribunal finds that the applicant’s injuries are outside of the MIG due to chronic pain.
5The applicant is entitled to the following medical benefits:
(i) $2,723.44 for chiropractic treatment, massage therapy treatment and acupuncture recommended by New Wave Health in a treatment plan submitted on March 15, 2018, and denied by the respondent on March 27, 2018.
(ii) $3,916.76 for chiropractic treatment, massage therapy treatment and acupuncture recommended by New Wave Health in a treatment plan submitted on August 21, 2017, and denied by the respondent on August 31, 2017.
(iii) $1,650.00 for a chronic pain assessment recommended by New Wave Health in a treatment plan submitted on January 26, 2018, and denied by the respondent on February 6, 2018.
6The applicant is not entitled to $2,730.22 for physiotherapy, massage and chiropractic services recommended by New Wave Health in a treatment plan submitted on September 20, 2017, and denied by the respondent on October 25, 2017.
7The applicant is not entitled to the cost of examination in the amount of $2,200.00 for a psychological assessment in a treatment plan recommended by Toronto Central Diagnostics in a treatment plan submitted on October 19, 2017, and denied by the respondent on October 30, 2017.
8The applicant is entitled to income replacement benefits at the weekly rate of $400.00 per week from March 19, 2018 to date and ongoing.
9The applicant is not entitled to an award under Regulation 664.
10The applicant is entitled to interest in accordance with section 51 of the Schedule.
ANALYSIS
The applicant’s left shoulder impairment
11As a result of the accident, the applicant sustained the following injuries to the following areas: right shoulder, right arm, right side of ribs, right hip, right thigh, right side of neck. She also experiences anxiety when traveling in a car and has difficulty sleeping.
12The respondent has raised the issue of causation. Its position is that the issues with the applicant’s left shoulder predated this accident and that there is no causal link between the accident and the applicant’s left shoulder issues. The respondent made no submissions on the appropriate test to be applied to determine causation. The applicant’s position is that the accident exacerbated her left shoulder pain. Prior to the accident, the left shoulder pain did not functionally impair her and she was able to work. The applicant submitted that the “but for” test is the appropriate test for determining causation. The Tribunal finds the applicant has established she meets the test for causation under the “but for” test and that the applicant’s current left shoulder impairment was exacerbated as a result of the subject accident.
13The reasons noted below establish that “but for” the accident the issues with the applicant’s left shoulder would not have been exacerbated:
i. The clinical notes and records (“CNRs”) of Dr. Jennifer Black (the applicant’s family physician) dated May 26, 2017, noted left shoulder pain and there is nothing else noted within the CNRs relating to the left shoulder prior to the accident. Following the accident, Dr. Black’s CNR dated February 15, 2018, referenced left shoulder and arm pain, and noted that the applicant is using the left arm more because of right arm pain. The note dated March 5, 2018, indicates that the applicant has left shoulder pain that is secondary to overuse of the right arm. The applicant sustained injuries to her right arm and right shoulder in the accident, and stated she compensated for the lack of being able to use her right arm by using her left arm more frequently. This has contributed to the pain experienced with her left shoulder. The Tribunal is persuaded by the applicant’s testimony and the medical documentation which supports that she compensated for the pain in her right arm, which was injured in the accident, by overusing her left arm/shoulder. The applicant worked as a professional cleaner in which she was responsible for cleaning two buildings. She performed duties which included mopping floors and stairs, carrying a heavy mopping bucket filled with water up and down the stairs, carrying and lifting large industrial garbage bins, and distributing salt on the pavement during the winter months. To perform these activities she would have needed the use of her bilateral shoulders, arms, and hands. The applicant submits she has overcompensated by using her left arm and left shoulder as her right arm and right shoulder were injured in the accident and it is the applicant’s submission that this has led to a partial tear in her left shoulder.
ii. Following the accident, on February 24, 2018, the applicant had an ultrasound of her left shoulder. This supports that Dr. Black wanted to investigate if there was anything further going on with the applicant’s left shoulder since the accident. The ultrasound indicates that there is a partial thickness tear of the supraspinatus tendon.
iii. Dr. Roya Salehoun (chiropractor), the applicant’s own assessor, assessed the applicant on June 7, 2018, and opined that the applicant can benefit from further consideration in regard to her right shoulder tear as her left side is being overused.
iv. Dr. Abdullah Al Ahmeri (physiatrist), the applicant’s own assessor, conducted a physical examination of the applicant on July 27, 2018. The applicant reported to Dr. Al Ahmeri that she is feeling more pain on the left shoulder and cannot work because of this pain. Dr. Al Ahmeri noted that, on physical examination, there was limitation in the range of motion around the applicant’s shoulder.
v. Furthermore, the applicant testified that although she had pain in her left arm before the accident, she did not take time off of work as a result of this pain. Now, she cannot work or perform her household duties as a result of the pain.
Does the applicant suffer from chronic pain?
14An insured can be removed from the MIG for chronic pain. The Tribunal agrees with the reasoning in T.S. v. Aviva General Insurance Canada3, which was submitted by the applicant, that a finding of chronic pain takes one out of the MIG.
15The Tribunal finds that the applicant suffers from chronic pain that would take her out of the MIG based on the following medical evidence:
i. The Tribunal accepts that this applicant experiences severe, persistent and constant pain in her bilateral shoulders and neck regions. The medical evidence produced for the hearing is consistent with the applicant’s testimony and the Tribunal finds the applicant to be credible. On December 8, 2017 (approximately 4 months after the accident), Dr. Black referred to the applicant’s pain, predominantly on the right side of her body, as chronic pain. On June 4, 2018 (approximately 10 months after the accident), Dr. Dinesh Kumbhare (physiatrist) examined the applicant and opined that she has chronic pain in her neck and shoulder region. During her assessment with Mr. Remik Zakrzewski (occupational therapist) on August 17, 2018 (approximately one year after the accident), the applicant reported constant bilateral shoulder pain that was more severe than her constant neck and trapezius pain.
ii. The applicant’s pain affects her life. The applicant testified that she has not returned to work as a cleaner since the accident due to her immense bilateral shoulder pain and weak strength in both of her arms. Furthermore, the applicant testified that she cannot complete her household chores. The applicant told Dr. Nina Belyakova (psychologist) during her assessment on April 4, 2018, that her pain is aggravated when performing activities requiring lifting, bending, climbing stairs, prolonged walking, sitting, and standing. She also has some difficulties performing self-care tasks. She performs them with modification and requires additional time in performing such activities due to bilateral shoulder pain.
iii. Furthermore, the applicant reported to a number of assessors that her sleep is disturbed as a result of her pain. She told Mr. Zakrzewski that she is frequently awakened by pain and discomfort. She told Dr. Belyakova that she has difficulty sleeping and that she wakes up due to pain on average three times per night.
Are the three treatment plans for chiropractic treatment, massage therapy, and acupuncture reasonable and necessary?
16The Tribunal finds the applicant has met her burden of proof, on a balance of probabilities, that two of the proposed treatment plans in the amounts of $2,723.44 and $3,916.76 are reasonable and necessary. The goals of the two proposed treatment plans align with the assessors’ proposed treatments and with the applicant’s level of impairment to provide pain relief, strengthening, and increasing her level of functionability. The applicant is not entitled to the treatment plan in the amount of $2,730.22 because it is a duplication of service.
17In testimony, the applicant indicated that physical therapy helped her and that after she stopped going the pain in her right shoulder got worse. The Tribunal finds the two proposed treatment plans in the amounts of $2,723.44 and $3,916.76, which include a combination of chiropractic treatment, massage therapy, and acupuncture, would be beneficial in helping to relieve the applicant’s pain, improving her overall strength to her areas of impairment, and increase her level of function.
18The treatment plan dated January 24, 2018 (submitted to the respondent on March 15, 2018), in the amount of $2,723.44 recommends chiropractic treatment, massage therapy, and acupuncture with the goals of pain reduction, increase in strength, continue to improve pain-free functional ability/endurance, and return to activities of normal living.
19The treatment plan dated August 16, 2017 (submitted to the respondent on August 21, 2017), in the amount of $3,916.76 recommends chiropractic treatment, massage therapy, and acupuncture with the goals of pain reduction, increased range of motion, and return to activities of normal living.
20The treatment plan dated and submitted on September 20, 2017, in the amount of $2,730.22 recommends chiropractic treatment, massage therapy, and acupuncture with the goals of pain reduction, increase in strength, increased range of motion, and return to activities of normal living. The Tribunal finds that this treatment plan is a duplication of service as it proposed the same treatment and goals as the treatment plan submitted approximately one month prior on August 21, 2017, in the amount of $3,916.76 and therefore, this plan is not reasonable and necessary.
Is the chronic pain assessment reasonable and necessary?
21The Tribunal finds the chronic pain assessment recommended by Dr. Michael Gofeld (chronic pain specialist) is reasonable and necessary, and the applicant is entitled to this treatment plan. The goals of the chronic pain assessment include: reviewing and documenting the applicant’s functional status and psychosocial risk factors associated with the injury, including, but not limited to, changes in functional status, psychosocial issues, and other risk factors or barriers to recovery. Given the applicant’s functional limitations which have occurred since the accident almost two years ago, the objective goals of this assessment are reasonable and necessary in improving the applicant’s level of functioning and reducing factors which may be barriers to her recovery.
Is the psychological assessment reasonable and necessary?
22The Tribunal finds the treatment plan for a psychological assessment is not reasonable and necessary because it is a duplication of service as the applicant underwent a psychological assessment with her own assessor, Dr. Belyakova, who issued a report dated April 19, 2018. Dr. Belyakova concluded the applicant sustained a psychological impairment as a result of the accident. The applicant is not entitled to this treatment plan.
23Dr. Black’s CNR dated March 5, 2018, noted the applicant’s low mood, depression and flat affect, and that the applicant should receive a psychological assessment secondary to the motor vehicle accident. Subsequently, the applicant was assessed by Dr. Belyakova on April 4, 2018, and the report issued diagnosed the applicant with Adjustment Disorder with Mixed Anxiety and Depressed Mood as a result of the accident.
24Dr. Tatiana Dumitrascu (psychologist) conducted an insurer’s examination (“IE”) on November 23, 2017, and a report dated December 11, 2017, was produced. The assessment concluded the applicant does not suffer from a psychological disorder as a result of the accident and no psychological interventions are required. She completed an addendum report dated May 22, 2018, where her opinion remained the same. The addendum report included a review of new documents provided, including the updated CNRs of Dr. Black, and the IE assessment reports of Dr. Jacqueline Smith Auguste (orthopaedic surgeon) and Ms. Deborah Westbrook (physiotherapist).
25The applicant testified there was an interpretation issue with the psychological assessment conducted by Dr. Dumitrascu. The applicant is a Portuguese-speaking individual from Portugal. However, the applicant testified that the interpreter at the assessment was a Portuguese-speaking individual from Brazil. The applicant submits that the interpreter did not interpret her words correctly. In the context of assessments, if an insured person does not receive proper interpretation and cannot effectively communicate with the assessor, it can affect the legitimacy of the opinion of the assessor. The Tribunal has considered the psychological IE reports conducted by Dr. Dumitrascu but have assigned little weight to the reports due to the interpretation issue.
26The treatment plan in dispute for a psychological assessment is recommended by Dr. Eugene Hewchuk and is dated September 27, 2017 (submitted to the respondent on October 19, 2017). The goals of the psychological assessment are pain reduction, return to pre-accident level of psychological functioning, and return to activities of normal living.
27As discussed above, the applicant already completed a psychological assessment with Dr. Belyakova, the applicant’s own assessor. Dr. Belyakova’s assessment establishes that the applicant experiences psychological issues as a result of the accident.
28The applicant has not provided any evidence as to why a second psychological assessment is needed. In the absence of any evidence supporting the need for a second assessment, the applicant is not entitled to this treatment plan as the Tribunal finds it is a duplication of service.
Is the applicant entitled to income replacement benefits?
29The Tribunal finds that the applicant has a substantial inability to perform the essential tasks of her employment and is therefore entitled to Income Replacement Benefits (“IRBs”) at the rate of $400.00 per week from March 19, 2018 to date and ongoing. Section 5(1) of the Schedule provides, in part, that an insurer shall pay an IRB to an insured who sustains an impairment as a result of an accident if the insured person, as a result of and within 104 weeks after the accident, suffers a substantial inability to perform the essential tasks of her employment.
30The Tribunal relies on its finding that the applicant suffers from physical impairments from this accident which have caused her to suffer from chronic pain rendering her unable to return to her pre-accident employment.
31The applicant submits that she is entitled to IRBs because she has a substantial inability to perform the essential tasks of her pre-accident employment as a cleaner and no modified or light duties are available to her through her pre-accident employer. The applicant submits that cleaning is not an easy task and that her work duties are far more strenuous than indicated in the respondent’s assessments.
32The respondent submits that the applicant does not meet the test for IRBs because it agrees with the opinion of its assessors, Dr. Auguste (orthopaedic surgeon) and Ms. Westbrook (physiotherapist), who completed a multidisciplinary assessment dated March 2, 2018, and who concluded that the applicant does not meet the pre-104 week IRB test. The respondent submits that there was no evidence from the applicant’s employer about whether there were accommodations available. Although this information would have been helpful, the Tribunal finds that the applicant would have great difficulty maintaining her employment as a cleaner of two apartment buildings with her current physical impairments and the Tribunal is persuaded by the applicant’s testimony that the lack of strength in her hands made it difficult for her to grasp and hold items and generally perform the essential tasks of her employment.
33There is also a discrepancy between the parties about whether the applicant’s job is classified as light physical, or a heavier labour job.
34Prior to the accident, the applicant worked six days per week as a cleaner for two buildings. The applicant’s testimony and interviews with assessors indicate that her employment duties involved dusting, mopping, scrubbing, sweeping, and vacuuming of various surfaces. Her duties also involved carrying, lifting and emptying of items, carrying a heavy mopping bucket filled with water up and down the stairs, carrying and lifting large industrial garbage bins, and distributing salt on the pavement during the winter months. She cleaned doors, floors, washrooms, a pool area, and a parking garage. The applicant stated that she worked alone and quickly while working in the two buildings. The applicant stated that she stopped working as a cleaner after the accident because she could not perform these duties due to the limited range of motion in her shoulders and lack of strength in both of her arms following the accident.
35In support of her claim for IRBs, the applicant relies on a functional capacity assessment report by Dr. Salehoun (chiropractor) dated June 7, 2018, and a worksite assessment completed by Mr. Zakrzewski (occupational therapist) who issued a report dated August 17, 2018.
36Dr. Salehoun’s functional capacity evaluation concluded that the applicant has limitations in her cervical region, right shoulder, and lumbar ranges of motion. She also has limitations and insufficient functional tolerances, including but not limited to, grip strength, pinch strength, static lifting, pushing, pulling, dynamic lifting, sitting, standing, walking, carrying, stooping, reaching, handling, and fine finger movement. Dr. Salehoun further concluded that the applicant will have difficulty with housekeeping tasks requiring heavy lifting, pushing and pulling, prolonged sitting and standing, reaching forward and reaching up, grip strength, and pinch strength.
37Mr. Zakrzewski’s worksite assessment report concluded that the applicant had significant pre-accident physical work demands which she performed within her full-time hours. Mr. Zakrzewski opined that due to the physical demands of the applicant’s occupation along with her ongoing restrictions and functional abilities, she is unable to return to her pre-accident work duties.
38The respondent relies on the three assessments conducted by Dr. Auguste and Ms. Westbrook in support of why the applicant is not entitled to IRBs. Dr. Auguste’s orthopaedic surgeon’s report is dated March 2, 2018, and Ms. Westbrook’s jobsite analysis and functional capacity evaluation are dated March 2, 2018. Significantly, Ms. Westbrook did not visit the applicant’s worksite, so an actual physical jobsite analysis was not conducted, but her report noted that the applicant provided little information about her employer, other than her employer’s last name. Her report noted that a Portuguese interpreter was present for the assessment.
39Dr. Auguste’s IE report concluded that the applicant does not suffer a substantial inability to perform the essential tasks of her pre-accident work as a Light Duty Cleaner as a result of her accident-related injuries. Dr. Auguste opined that there is no compelling evidence which supports the applicant’s subjective reporting of her lack of participation in some of her housekeeping and home maintenance activities, which include mopping and vacuuming, which are very similar to those required at her two cleaning jobs. Dr. Auguste found no medical evidence restricting her from lifting from floor to waist level, push/pull up to 20 pounds, and the lifting of 1 pound overhead as required for her job.
40Ms. Westbrook’s jobsite analysis concluded that the applicant’s pre-accident occupation as a Light Duty Cleaner is classified as being the light level of physical demands.
41Ms. Westbrook’s functional capacity evaluation concluded that the applicant is capable of performing physical work at least at the sedentary level of physical demands for an 8-hour work shift. She noted that due to the applicant’s self-limitation on all six of the dynamic strength tasks, her actual abilities may be greater.
42The applicant testified that being a cleaner is not a light job. The applicant submits that her job should be classified as more strenuous and physical than either the sedentary or light level of physical demands. The respondent submits that Dr. Salehoun, the applicant’s own assessor, categorizes the overall physical demand level of the job as light. The applicant testified that pain has limited her ability to clean her own house since the accident. She cannot take items from the cabinets because pain prevents her from fully extending her arms. She testified that she was unable to lift a pot filled with water because she does not have the strength and subsequently dropped the pot of boiling water while lifting it and scalded her arm.
43In Dr. Salehoun’s report and in Dr. Al Ahmeri’s (physiatrist) CNRs, these functional impairments include limitations with her shoulders’ ranges of motion, and also with her grip strength, pinch strength, static lifting, pushing, pulling, dynamic lifting, sitting, standing, walking, carrying, stooping, reaching, handling, and fine finger movement.
44The Tribunal agrees with Ms. Westbrook that the applicant is suited for sedentary work rather than more labour-intensive work. However, based upon the applicant’s testimony which described her job duties in extensive detail and her inability to perform her household chores which were heavier duties, the Tribunal does not agree with the classification reached by Ms. Westbrook and Dr. Salehoun that her job was a light duty job. Further, the applicant’s evidence has been corroborated by Dr. Zakrzewski’s worksite assessment report which concluded the applicant had significant pre-accident physical work demands. The Tribunal finds her job was physically demanding. As a result of her ongoing impairments, which include her lack of strength in both hands which made grasping items difficult and her chronic pain, the applicant is unable to perform the essential tasks of her pre-accident employment.
45It is the finding of this Tribunal that the applicant has a substantial inability to perform the essential tasks of her employment and is therefore entitled to IRBs at the rate of $400.00 per week from March 19, 2018 to date and ongoing.
Is the applicant entitled to an award under Regulation 664?
46Pursuant to section 10 of Ontario Regulation 664, if an insurer has unreasonably withheld or delayed payments, the Tribunal may award a lump sum of up to 50 percent of the amount to which the insured was entitled at the time of the award, together with interest on all amounts then owing.
47On the facts and evidence before the Tribunal, it finds that an award is not warranted.
48First, as discussed above, the applicant argues that an award is justified as a result of the respondent’s conduct with regard to the language interpretation issue and errors made by Dr. Auguste. The applicant submits there was an interpretation issue with the psychological IE assessment conducted with Dr. Dumitrascu and the respondent did not take any action to remedy this by scheduling another psychological assessment with a different interpreter.
49It does not appear that the applicant raised the issue with the respondent after the assessment. Her failure to raise the issue may have led the respondent to believe that the applicant had received adequate interpretation services during the IE assessment. There is no evidence that suggests that the respondent was unreasonably withholding payment or delaying payment solely on the basis of this assessment.
50Further, the applicant submits that the respondent failed to assess the applicant’s claims on an ongoing basis as new evidence was ignored or not considered. Specifically, the respondent’s IE assessor, Dr. Auguste, has not seen any of Dr. Black’s clinical notes and records beyond August 31, 2017. Furthermore, the applicant’s position is that Dr. Auguste is not impartial. The applicant sent a letter dated April 30, 2018, to West Park Assessment Centre which raised concerns relating to Dr. Auguste’s impartiality and credibility. The applicant indicated that as a result of a breach of trust, she did not want to be further assessed by Dr. Auguste.
51In response, the respondent wrote a letter dated May 2, 2018, and indicated that Dr. Auguste would not be completing an addendum in relation to the clinical notes and records received.
52The Tribunal finds, as a result of the applicant advising the respondent she no longer wished to be assessed by Dr. Auguste due to concerns regarding impartiality, this led to the respondent requesting Dr. Auguste not to review the applicant’s updated CNRs. The respondent took an adequate and reasonable step to rectify a possible problem with the IE process. In the Tribunal’s view, this does not support the applicant’s argument that the respondent was unreasonably withholding payment or delaying payment to the applicant.
CONCLUSION
53The applicant is not subject to the MIG funding limit of $3,500.00 due to the Tribunal finding that she suffers from chronic pain that takes her outside of the MIG.
54The applicant is entitled to the treatment plans in the amounts of $2,723.44 and $3,916.76. The applicant is also entitled to the chronic pain assessment in the amount of $1,650.00.
55The applicant is not entitled to payment for the treatment plan in the amount of $2,730.22.
56The applicant is not entitled to the psychological assessment in the amount of $2,200.00.
57The applicant is entitled to income replacement benefits at the weekly rate of $400.00 per week from March 19, 2018 to date and ongoing.
58The applicant is not entitled to an award under Regulation 664.
59The applicant is entitled to interest in accordance with section 51 of the Schedule.
Released: July 19, 2019
Melody Maleki-Yazdi
Adjudicator
Kimberly Parish
Adjudicator
Footnotes
- O. Reg. 34/10.
- Minor Injury Guideline, Superintendent’s Guideline 01/14, issued pursuant to s. 268.3 (1.1) of the Insurance Act.
- T.S. v. Aviva General Insurance Canada, 2018 CanLII 83520 (ON LAT).