Siow v. Allstate Insurance Company of Canada, 2021 CanLII 33696

Citation: Siow v. Allstate Insurance Company of Canada, 2021 ONLAT 20-004763/AABS

Released Date: 04/22/2021

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:

Ryan Chi-Wing Siow

Applicant

and

Allstate Insurance Company of Canada

Respondent

DECISION

ADJUDICATOR: Theresa McGee, Vice-Chair

APPEARANCES:

For the Applicant: Mary Tran, Paralegal

For the Respondent: Jaime Naumis, Counsel

HEARD: By way of written submissions

REASONS FOR DECISION

OVERVIEW

1The applicant, Ryan Chi-Wing Siow, was involved in an automobile accident on March 12, 2018, and sought benefits from the respondent, Allstate Insurance Company of Canada, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010¹ (the “Schedule”).

2The respondent determined that the applicant’s injuries fell within the Minor Injury Guideline and denied him medical benefits outside the $3,500.00 funding limit available under s. 18(1) of the Schedule. The applicant then applied to the Licence Appeal Tribunal (“Tribunal”) for resolution of the dispute.

ISSUES

3The issues to decided are:

a. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline?

b. Is the applicant entitled to $3,090.09 for chiropractic treatment, recommended by Life Point Medical Inc. in a treatment plan (OCF-18) dated June 25, 2018?

c. Is the applicant entitled to $4,164.59 for psychological treatment, recommended by Life Point Medical Inc. in a treatment plan dated October 3, 2018?

d. Is the applicant entitled to $3,020.36 for chiropractic treatment, recommended by Life Point Medical Inc. in a treatment plan dated December 17, 2018?

e. Is the applicant entitled to the assessments recommended by Life Point Medical Inc. as follows:

i. $1,845.72 for a psychological assessment, in a treatment plan (plan) dated May 24, 2018; and

ii. $1,699.51 for a functional abilities’ evaluation, in a plan dated November 27, 2018?

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

RESULT

4The applicant has failed to discharge his onus of proving entitlement to benefits outside the Minor Injury Guideline. It is therefore unnecessary to determine whether the specific benefits in dispute are reasonable and necessary as a result of the accident. Since no benefits are owing, no interest is payable. The application is dismissed.

ANALYSIS

5The applicant bears the onus of establishing, on a balance of probabilities, that he is entitled to the medical benefits he seeks. To do so, he must show that his accident-related injuries are more than predominantly minor injuries. Section 3 of the Schedule defines a “minor injury” 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.”

6Under s. 18(1) of the Schedule and in accordance with the Minor Injury Guideline, the funding available for the treatment of minor injuries is $3,500.00. In the applicant’s case, this funding has been exhausted. If the applicant cannot demonstrate he sustained injuries that were not predominantly minor, the analysis will end. It will not be necessary to examine whether the specific benefits that are in dispute meet the test for reasonableness and necessity under s. 15(1) of the Schedule.

7The applicant submits that he should not be subject to the Minor Injury Guideline because he sustained a psychological impairment in the accident, and psychological injuries and impairments exceed the definition of a minor injury. He also refers in his submissions to a referral he received to a chronic pain specialist. Although chronic pain is not a focus of his submissions, I will briefly speak to the evidence of chronic pain.

8The applicant has tendered little in the way of medical evidence in support of his application. He has provided the clinical notes and records of Dr. Jackson Poon and Dr. Drue Mandel, both family physicians. Between the two physicians, notes exist from only a handful of visits ranging from July 27, 2018 to August 31, 2020.

9At the applicant’s July 27, 2018 visit to Dr. Poon, his first after the accident, there is no mention of the accident or of any related injuries or complaints. There are no further records from Dr. Poon in