Released Date: 06/09/2020
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.J.L.
Applicant
and
Aviva General Insurance
Respondent
DECISION
ADJUDICATOR:
Sandeep Johal
APPEARANCES:
For the Applicant:
Julia Zhiyuan Hou
For the Respondent:
Michael J.P. McChesney
Heard:
By way of written submissions
OVERVIEW
1The applicant was injured in an automobile accident on December 11, 2016 and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 20101 (the ''Schedule'').
2The applicant was the driver of a vehicle making a left hand turn when she was struck by another vehicle in a T-bone fashion. As a result, the applicant submits she sustained injuries to her neck, right shoulder and back.
3The applicant applied for medical benefits that the respondent denied on the basis that her injuries fell under the Minor Injury Guideline (the “MIG”). The applicant disagreed with this decision and submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for dispute resolution.
ISSUES TO BE DECIDED
4The following are the issues to be decided:
i. Did the applicant sustain predominantly minor injuries as defined under in s. 3 of the Schedule, subject to treatment within the $3,500 monetary limit of the MIG?
ii. If the answer to issue (i) is no, then:
i. Is the applicant entitled to receive a medical benefit in the amount of $1,525 for chiropractic treatment, recommended by CK Chiropractic, in a treatment plan submitted April 26, 2017, and denied by the respondent on June 12, 2017?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5Based on the totality of the evidence before me, I find:
i. The applicant’s injuries are predominantly minor injuries as defined under the MIG. As a result of the monetary limit of the MIG being exhausted, there is no need to determine the reasonableness and necessity of the treatment plan in dispute; and,
i. As there are no benefits outstanding, there is no interest that is payable.
ANALYSIS
Applicability of the Minor Injury Guideline
6The MIG establishes a framework for the treatment of minor injuries. The term “minor injury” is defined in s. 3(1) of the Schedule as “one or more of a sprain, strain, 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 s. 3(1). Section 18(1) limits recovery for medical and rehabilitation benefits for such injuries to $3,500.
7The applicant bears the onus to establish her entitlement to coverage beyond the $3,500 cap for minor injuries on a balance of probabilities.2
8For the following reasons, I find that the applicant has not persuaded me on a balance of probabilities that her degenerative disc changes and central canal stenosis were caused by the accident as opposed to something that has occurred naturally with age.
9Furthermore, I find that the applicant has not satisfied her onus