Licence Appeal Tribunal File Number: 20-009414/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:
Shuang Qiang Huang
Applicant
and
Certas Home and Auto Insurance Company
Respondent
DECISION
VICE-CHAIR:
Julian DiBattista
APPEARANCES:
For the Applicant:
Philip Kai Kwong Yeung, Paralegal
For the Respondent:
Michael J. Lippa, Counsel
HEARD:
By Way of Written Submissions
BACKGROUND
1The applicant was involved in an automobile accident on August 10, 2018 and sought benefits pursuant to the Statutory Accident Benefits Schedule Effective September 1, 2010 (including amendments effective June 1, 2016)(“Schedule”). The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).
2The respondent denied the applicant’s claims, including a psychological assessment, because it had determined that the applicant’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 (“MIG”).1 As a result, the applicant submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (“Tribunal”).
Issues in Dispute
3The following issues are in dispute:
(i) 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 MIG?
(ii) Is the applicant entitled to the amount of $200.00 ($1,300.00 less $1,100.00 approved) for chiropractic services set out in OCF-18 dated December 13, 2018 at Vcare Rehab Centre?
(iii) Is the applicant entitled to the amount of $2,200.00 for a psychological assessment set out in OCF-18 dated December 10, 2018 at Somatic Assessments & Treatment Clinic?
(iv) Is the applicant entitled to the amount of $3,701.88 for psychological services set out in OCF-18 dated January 27, 2021 at Somatic Assessments & Treatment Clinic?
(v) Is the applicant entitled to interest on any overdue payment of benefits?
Result
3I find that:
i. The applicant’s injuries are predominantly minor and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline;
ii. The OCF-18 for chiropractic treatment is not reasonable and necessary as the $3,500.00 MIG treatment limit has been reached;
iii. The applicant is not entitled to $2,200.00 for a psychological assessment, as the assessment is not reasonable and necessary, given the $3,500.00 MIG treatment limit has been reached;
iv. The applicant is not entitled to $3,701.88 for psychological services as the treatment is not reasonable and necessary, given the $3,500.00 treatment limit has been reached;
v. No interest is payable.
Analysis
4The 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