Release date: 05/26/2021
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:
Chunpreet Chohan
Applicant
and
Aviva General Insurance
Respondent
DECISION
ADJUDICATOR: Brian Norris
APPEARANCES:
For the Applicant: Daniella Cohen, Paralegal
For the Respondent: Nabila Majizadeh, Counsel
HEARD: By way of written submissions
OVERVIEW
1Chunpreet Chohan (“the Applicant”) was injured in an automobile accident on June 14, 2017 and sought benefits from Aviva General Insurance (“the respondent”) pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010, O. Reg. 34/10 (the “Schedule”). The respondent refused to pay for certain benefits and the Applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The disputed claims in this hearing are:
I. Is the Applicant entitled to a medical benefit in the amount of $3,948.91 for physiotherapy, recommended by Inline Rehab in a Treatment Plan submitted December 28, 2017 and denied on March 12, 2018?
II. Is the Applicant entitled to a medical benefit in the amount of $1,315.02 for chiropractic treatment, recommended by Inline Rehab in a Treatment Plan submitted March 28, 2018 and denied on April 28, 2018?
III. Is the Applicant entitled to a medical benefit in the amount of $3,191.25 for physio recommended by Inline Rehab in a Treatment Plan submitted May 31, 2018 and denied on June 8, 2018?
IV. Is the Applicant entitled to interest on any overdue payment of benefits?
RESULT
3The Applicant is unsuccessful on all claims.
BACKGROUND
4The Applicant was the occupant of the passenger-side rear-seat in a minivan which was struck on the passenger side by another vehicle. She sought no medical assistance at the scene of the accident but went to a walk-in clinic the following day. She went to see her regular family physician, Dr. H. Lai, about one month following the accident and complained of knee, back, left shoulder and wrist pain. Dr. Lai found that she sustained a back and wrist strain and referred her to physiotherapy and for a wrist x-ray, which showed a normal wrist. The accident had no measurable impact on her attendance at school and she was able to return to work at a fast food restaurant and found new employment about one month following the accident.
5The Applicant started physical treatment at Inline Rehab (“Inline”) on June 26, 2017. She was later determined to have sustained a psychological injury as a result of the accident and, as a result, was removed from the Minor Injury Guideline (“MIG”). Around the same time and thereafter, the Applicant applied for funding for three additional physical treatment plans, which are listed in dispute above. However, despite her removal from the MIG, the respondent denied funding for the disputed treatment plans.
THE DISPUTED TREATMENT PLANS
6The Applicant claims entitlement to all three disputed treatment plans for the same reasons. She submits that she has reported her injuries to her family physician, treatment facility, and Insurer’s Examination assessors and has been prescribed various medications, referred to physiotherapy and undergone several imaging examinations. She further submits that pain relief is a legitimate treatment goal and that her physical impairments, or possibly her ongoing pain, contributes to her psychological conditioning. She discusses some pre-existing injuries, implying that they prevent her from achieving maximal recovery. Lastly, she suggests that the treatment facilitates her reintegration into her family, community, and labour market.
7The respondent submits that there is no contemporaneous medical evidence to support the Applicant’s request for further physiotherapy and chiropractic treatment. It submits that the Applicant saw her family physician only once for accident-related injuries and questions the validity of some of the Applicant’s submissions.
ANALYSIS
8I find on the evidence that the disputed treatment plans are not reasonable and necessary for the Applicant’s accident-related injuries.
9I find no evidence showing that the pre-existing conditions highlighted by the Applicant, which are minor, would preclude her recovery. There are three visits with Dr. Lai in the spring of 2016 where the Applicant reported psychological symptoms. There is no evidence that those symptoms had any impact on the Applicant’s recovery from her physical sprain and strain injuries. Likewise, the Applicant also sustained a lumbar strain in the spring of 2016 when she fell while dog walking. There is no evidence to show that this injury had any impact on the Applicant’s recovery from her physical injuries.
10I find no contemporaneous compelling evidence to support ongoing physiotherapy or chiropractic treatment. The CNRs from Inline Rehab are uncompelling. The Applicant provides no specific reference to any entries in the records and there is no remarkable information in them which would entitle her to ongoing physiotherapy and chiropractic treatment. The disability certificate dated July 10, 2016 by Dr. N. Barnes, chiropractor, is also uncompelling because it predicts a 9-to-12-week disability period and suggests no pre-existing injury would hinder her recovery. The Applicant made no accident-related complaints to Dr. Lai after July 13, 2017. During a visit on October 16, 2017, the Applicant complained of hip pain for the last five days. The pain duration and lack of reference to the subject accident leads me to conclude that the hip pain is not accident related. Visits also occurred on April 13, May 16, 2018, and August 2020, with no mention of the subject accident.
11The insurer’s examination report by Dr. L. Weisleder, orthopaedic surgeon, dated March 7, 2018, supports no further facility-based treatment. Dr. Weisleder assessed the Applicant and, although testing found some range of motion impairment in her neck and shoulders, concluded that she reached maximal medical recovery and was appropriately assessed and treated for her strain injuries. The fact that Dr. Weisleder acknowledges a range of motion impairment on examination fails to upset the balance of the medical record. I cannot find that the disputed treatment plans are reasonable and necessary based solely on that issue without any contemporaneous compelling evidence to the contrary.
12The Applicant provides no evidence of an inability to reintegrate into the community. The Applicant leads no evidence to suggest that her physical injuries prevent her from participating in the community. As noted above, while the IE report determined that she had some range of motion impairment, the balance of her medical records show no evidence of an ongoing physical disability that prevents her from participating in the community. In fact, the evidence suggests that the Applicant has reintegrated into her community well following the accident. She found new employment a month following the accident, and has since completed school, and started preparing for law school admissions exams, all following the accident. It is not reasonable and necessary to fund ongoing treatment for pain relief and/or reintegration into the community when there is insufficient evidence to support such claims.
INTEREST
13Interest is payable on overdue payments, pursuant to section 51 of the Schedule. The Applicant is not entitled to the disputed treatment plans and thus, no payments went overdue and no interest is payable.
CONCLUSION
14The Applicant sustained psychological and soft-tissue injuries as a result of the accident. She received treatment for her physical injuries following the accident and has provided no compelling evidence that further physiotherapy and chiropractic treatment is reasonable and necessary for her accident-related injuries. No interest is payable as no payments went overdue.
Date of Issue: May 26, 2021
______________________
Brian Norris, Adjudicator