Licence Appeal Tribunal File Number: 20-005669/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:
Chen Chen Shih
Applicant
and
Economical Insurance
Respondent
DECISION [AND ORDER]
ADJUDICATOR: Rakesh Sharma
APPEARANCES:
For the Applicant: Daniaal Sibtain, Counsel
For the Respondent: Alexander V. Dos Reis, Counsel
HEARD BY WAY OF WRITTEN SUBMISSIONS
REASONS FOR DECISION
BACKGROUND
1Chen Chen Shi (the “applicant”) was involved in an automobile accident on April 20, 2017 and sought benefits pursuant to the O.Reg.34/10: Statutory Accident Benefits Schedule “Schedule” effective September 1, 2010 (including amendments effective June 1, 2016).
2The applicant was a seat belted driver of a Toyota Corolla that was hit by a third party vehicle on the driver side door in a near T bone collision. The air bags deployed. Police and EMS attended the scene. The applicant was taken to the Lakeridge Hospital and discharged same day. The applicant followed up with the family doctor on April 21, 2017, who recommended physiotherapy and gave medication to help with sleep.
3Economical Insurance Company (the “respondent”) denied certain benefits claimed by the applicant. The applicant submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).to dispute the denial of the benefits.
ISSUES IN DISPUTE
4The issues in dispute to be decided are:
I. Are the applicant’s injuries predominantly minor injuries as defined in section 3 of the “Schedule” and therefore subject to the medical and rehabilitation benefits not exceeding $3,500.00 and under the Minor Injury Guideline “MIG”?
II. Is the applicant entitled to a medical benefit in the amount of $1,299.35 for physiotherapy services recommended by All Good Wellness and Health Centre (“All Good”) in a treatment plan dated February 22, 2018 and denied on May 2, 2018?
III. Is the applicant entitled to payment of Income Replacement Benefits in the amount of $400.00 per week from September 1, 2017 to date and ongoing?
IV. Is the applicant entitled to an award for unreasonably withheld or delayed payments under section 10 of R.R.O 1990, Regulation 664?
V. Is the applicant entitled to interest on an overdue benefit amounts?
RESULT
5The applicant sustained predominantly minor injury as defined under the “Schedule” and therefore remains in the Minor Injury Guideline “MIG” and subject to medical and rehabilitation benefits not exceeding $3,500.00.
6Since the applicant remains in the “MIG” it is not necessary to decide whether the treatment plan (OCF-18) for $1,299.35 for physiotherapy services recommended by All Good Wellness and Health Centre (“All Good”) dated February 22, 2018 and denied on May 2, 2018 is reasonable and necessary.
7The applicant is not eligible for income replacement benefits in the amount of $400 per week from September 1, 2017 to date and ongoing, as the applicant did not sustain an impairment as a result of the accident and suffered a substantial inability as a result of and within 104 weeks of the accident to perform the essential tasks of that employment.
8The applicant is not entitled to an award as there are no unreasonably withheld or delayed payments.
9No interest is payable as there are no overdue benefit amounts
Are the applicant’s injuries predominantly minor injury as defined in section 3 of the “Schedule” and therefore under the Minor Injury Guideline “MIG”?
LAW
10The “MIG” establishes a treatment framework to an injured person who sustains predominantly a minor injury as a result of the accident. Section 3(1) of the “Schedule” states that “minor injury” means one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration, or subluxation and included any clinically associated sequelae to such an injury.
11Section 18.(1) states the monetary limits regarding medical and rehabilitation benefits in respect of an impairment that is predominantly a minor injury shall not exceed $3,500.
12Section 38 (3) (i)(A) that the applicant’s impairment is not predominantly a minor injury.
13“Impairment” is defined in s.3(1) of the “Schedule” as a loss or abnormality of psychological, physiological or anatomical structure or function.
The applicant in order to be removed from the “MIG” has the burden to prove on the balance of probabilities:
I. The impairment sustained by the applicant as a result of the accident was predominantly not a minor injury as defined under section 3 of the “Schedule”.
Did the applicant sustain physical injuries that were predominantly not minor injuries?
Physical Injuries:
14The applicant asserts to be removed from “MIG” on the following basis:
a. Dr. Lai’s clinical notes from as late as October 2017, 6 months post – accident, report ongoing pain in the shoulder, arms and back.
b. In January of 2018, nearly 9 months post – accident, physiotherapist Ms. Peneda reported in a Disability Certificate (OCF-3) that the applicant would benefit from a referral to chronic pain specialist
c. In March 2020, nearly 3 years post- accident, the applicant’s family doctor noted that the applicant continued to experience pain in the shoulder, arms and low back. A referral was made to Physiatrist Dr. Wong who diagnosed the applicant with fibromyalgia, a disorder characterized by widespread chronic pain accompanied by fatigue, sleep, cognitive and mood.
15The respondent’s in-person insurer examination report dated February 14, 2018 of Dr. Dilkas, physiatrist to determine if the “MIG” applies to the applicant, found the applicant has sustained cervical sprain/ strain which could be classified as Whiplash Associated Disorder Type II “WAD”. These injuries fall within the definition of minor injury under the “Schedule”.
16The applicant does not dispute the conclusions of Dr. Dilkas report dated February 14, 2018 that the physical injuries of the applicant fall within the definition of minor injury under the “Schedule”.
17The applicant instead contests her case for removal from “MIG” on the basis under para [12] above.
18The first argument of the applicant for removal from the ‘MIG” is that Dr. Lai note of October 25, 2017 states MSK pain Back and left arm, and recommended ice/warm compression, physiotherapy, chiropractic and acupuncture treatment.
19Review of the family doctors cnr’s of Dr. Lai and Dr. Yuen revealed that the applicant saw Dr. Lai after October 25, 2017 on November 6, 2017. The said note does not mention about the MSK pain Back and left arm. The applicant did not see the family doctor almost for a year after November 6, 2017. The next time the applicant saw her family doctor Yuen was on November 14, 2018. The applicant has seen Dr. Yuen from November 14, 2018 until July 15, 2020 approximately 19 times and the notes do not mention any accident related injuries
20I prefer over Dr Lai note dated October 25, 2017, the in -person insurer examination report of Dr. Dilkas dated February 14, 2018 that was scheduled in response to a treatment plan (OCF-18) dated September 27, 2017 for $1,927.55 from All Good Wellness and Health for physical therapy. The report of Dr. Dilkas concluded that the injuries fall within the definition of minor injury under the “Schedule”.
21The second argument of the applicant for removal from the “MIG” is that in January of 2018, nearly 9 months post-accident, physiotherapist Ms. Peneda reported in a Disability Certificate (OCF3) dated January 5, 2018 that the Applicant would benefit from a referral to chronic pain specialist.
22I find, the disability certificate was submitted in respect of entitlement to specified benefit of income replacement benefit ”IRB”/ non-earner benefit “NEB” and not for continuing the treatment of the injuries as a result of the accident. Ms. Peneda subsequent to the said (OCF3) completed a treatment plan(OCF18- issue in dispute under para [4]II above) dated February 22, 2018, submitted on April 22, 2018 for physiotherapy services for $1,299.35. The injuries under part 6 of the plan were stated to be “ WAD II with neck pain and MSK sign, sprain/strain of thoracic spine and sprain/strain of elbow”. The plan does not suggest a referral to chronic pain specialist.
23The third argument of the applicant for removal from the “MIG” is that in March 2020, nearly 3 years post-accident, the Applicant’s family doctor noted that the applicant continued to experience pain in the shoulder, arms and low back. A referral was made to physiatrist Dr. Wong, who diagnosed the applicant with fibromyalgia, a disorder characterized by widespread chronic pain accompanied by fatigue, sleep, cognitive and mood.
24Review of the family doctors cnr’s of Dr. Lai and Dr. Yuen revealed that the applicant saw Dr. Lai for the last time on November 6, 2017. The applicant did not see the family doctor almost for a year after November 6, 2017. The next time the applicant saw her family doctor Yuen was on November 14, 2018. The applicant has seen Dr. yuen from November 14, 2018 until July 15, 2020 approximately 19 times and the notes do not mention any accident related injuries.
25I find, the referral to Dr. Joseph Wong by family doctor Yuen in the note dated March 2, 2020 was not related to the applicant’s complaint from the injuries arising out of the accident. The referral was due to the applicant’s complaint of “puffy forearms because moved house and doing household chores”.
26The note dated March 17, 2020 of Dr. Joseph Wong, Physiatrist lists the subjective complaints of the applicant as “diffuse pain located in her right shoulder) both hands and the lower back for the past year-and a-half, frequent insomnia problems. The note under Physical Examination states “ Range of motion of the neck and back is normal. Reflexes were 2+ bilaterally, muscle strength was 5/5. All the fibromyalgia points were diffusely tender. The note under Impression stated “ Fibromyalgia” and under recommendation for treatment “ prescribed paxil 20 mg. imovane 7.5 mg and Tylenol extra strength”.
27I find, the notes for Dr. Yuen from November 14, 2018 until March 2, 2020 do not mention about the applicant suffering from diffuse pain.
28I find, the progress report dated April 6, 2020 of Dr. Wong states “fibromyalgia” “Recovered”, as the arrow from “fibromyalgia” points to the checked box “ Recovered”. There are no more symptoms, no tender areas, upper extremity right normal. The note dated March 17, 2020 and April 6, 2020 of Dr. Wong do not mention about any accident related injuries.
29Based on the above analysis, I find, the respondent arguments as convincing, to prefer the insurer assessor Dr. Dilkas report dated February 14, 2018 over the diagnosis of “fibromyalgia” by Dr. Wong in his note dated April 6, 2020. There is a complaint gap of about 2 years from the treatment. Dr. Wong did not review any medical records during the assessment process and the diagnosis is based on the applicant self reporting. The causal connection between the diagnosis and the accident is not established. The applicant does not meet any of the factors that merit removal from the “MIG” in respect of chronic pain symptoms. The OCF3 and OCF18 submitted by the applicant stated soft tissue injuries. The applicant during the insurer examination by Dr. Dilkas, physiatrist reported on going neck pain with a severity of 4-5/10. Dr. Dilkas concluded that the applicant sustained sprain/strain and no ongoing objective impairment.
30Based on the evaluation of the evidence on record, I find, the applicant sustained physical minor injuries as concluded in the insurer examination report dated February 14, 2018 of Dr. Dilkas, physiatrist.
Did the applicant sustain psychological injury, in order to be removed from the “MIG” ?
Psychological Injury:
31The applicant relied upon the cnr’s of family doctor Lai, to prove that the applicant sustained a psychological injury arising out of the accident and it was not a minor injury. Dr. Lai’s notes dated May 1, 2017, June 12, 2017 and October 25, 2017 diagnosed the applicant with insomnia, stress, vehicular anxiety, and depressed mood.
32The applicant also relied upon a reference in the insurer examination report dated February 14, 2018 of Dr. Dilkas, physiatrist the report mentions that the applicant during the assessment reported psychological symptoms including very low mood, low energy, decreased sleep, decreased appetite, decreased interest, and tension while driving. Dr. Dilkas recommended a psychology assessment to determine if these symptoms excluded the applicant from the “MIG”.
33The applicant in the written submissions states that while the respondent did arrange an insurer examination with psychologist Dr. Cheryl Bradbury, it was for an opinion on the applicant’s entitlement to Income Replacement Benefits and/or Non-Earner Benefits. Contrary to the suggestion of Dr. Dilkas, the respondent did not ask Dr. Bradbury to provide an opinion on whether the Applicant’s psychological symptoms excluded her from treatment under the MIG.
34Review of notes of family doctor Lai on May 1, 2017, June 12, 2017 and October 25, 2017 revealed applicant having memory issues and sleep disorder, insomnia, stress, anxiety seeing vehicles, depressed mood and mood disorder. The notes mention possible causes as recent events, behavioral/ lifestyle and to follow up with emotion and specialist referral. The note of October 25, 2017 mentions half tablet of zopiclone and follow up with sleep study. The last note of Dr. Lai dated November 6, 2017 does not document about insomnia and mood disorder.
35I find, Dr. Lai did not refer the applicant to a psychologist/ psychiatrist for further assessment necessitated by the symptoms to determine a diagnosable psychological impairment that required treatment. The cnr’s of family doctor Yuen dated April 21, 2017, May 3, 2017 and from November 14, 2020 until July 15, 2020 do not mention any psychological symptoms arising out of the accident.
36Dr. Bradbury, psychologist insurer examination report dated April 5,2018 found that the applicant’s difficulties “are mild and subclinical in nature and do not meet DSM-5 diagnostic criteria for any significant accident related psychological impairment/sequelae at this time”. This assessment was to determine eligibility for Income replacement benefit/ non- earner benefit. However, the report did not find any accident related psychological impairment/ sequelae. Further Dr. Bradbury concluded that the applicant did not suffer from any substantive post-accident psychological impairment from which recovery would be required.
37I take notice of the applicant’s reply submissions to assign little weight to the conclusions drawn in Dr. Bradbury’s report as the conclusions were inconsistent with the results from the psychometric measures administered during the assessment.
38However, I disagree with the applicant’s contention for the lack of any corresponding opinion of the applicant’s psychologist about the inconsistent results in the report of Dr. Bradbury.
39Therefore, I find the applicant did not sustain a psychological injury as a result of the accident.
40I find, the applicant was unable to prove on the balance of probabilities that the applicant sustained physical injuries that were predominantly not minor and sustained a psychological injury arising out of the accident in order to be removed from the “MIG”.
41Based on the evaluation of the evidence on record, I find, the applicant sustained minor injury and remains under the Minor Injury Guideline “MIG” and subject to $3,500 for medical and rehabilitation benefits.
Is the applicant entitled to a medical benefit in the amount of $1,299.35 for physiotherapy services recommended by All Good Wellness and Health Centre (“All Good”) in a treatment plan dated February 22, 2018 and denied on May 2, 2018
42The applicant remains in Minor Injury Guideline (MIG) and subject to a limit of $3,500 for medical and rehabilitation benefits. Therefore, the analysis whether the said treatment plan is reasonable and necessary for rehabilitation of the applicant beyond the “MIG” limit is not required.
Is the applicant entitled to payment of Income Replacement Benefits “IRB” in the amount of $400.00 per week from September 1, 2017 to date and ongoing?
LAW:
43The disputed weekly income replacement benefit from September 1, 2017 to date and ongoing, initially falls within 104 weeks of the accident, therefore the applicable eligibility test is under section 5(1)1.i
I. The applicant sustains an impairment as a result of the accident.
II. The applicant was employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffers a substantial inability to perform the essential tasks of that employment.
III. “Impairment” is defined in s.3(1) of the “Schedule” as a loss or abnormality of psychological, physiological or anatomical structure or function.
Essential task of the applicant’s employment at the time of accident.
44The applicant argued that the essential tasks of the employment at the time of accident were different than the tasks mentioned in the insurer examination reports of the respondent. The applicant affidavit dated July 9, 2021 filed as a litigation document stated the duties that were substantially different than the duties stated in the insurer examination reports of the respondent. The affidavit listed the following duties at the Golden Pine Chinese Food Restaurant :
Cleaning the floors and tables, (sweeping, mopping, wiping tables;
Ordering, carrying, stocking/ shelving inventory (up to 30 pounds);
Purchasing and carrying ingredients;
Serving and clearing tables;
Preparing ingredients for cooking;
A chef was also employed who was responsible for cooking.
45The applicant stated the inability to sweep and mop floors, carry and stock inventory especially heavy items that weigh approximately 20 to 30 pounds and serve customers.
46During the cross-examination the applicant clarified that “Admin” in Employment confirmation form (OCF2) means “you have to do everything”. As regards the job of working at reception for approximately 8 to 9 years at the time of accident mentioned in the insurer examination report of Dr. Steven Dilkas, Physiatrist the applicant stated that the Dr. Steven Dilkas did not ask the applicant what she did in the restaurant
47The respondent has conducted five insurer examinations to determine the applicant’s eligibility for an income replacement benefit. The said reports mention about the essential tasks of the employment. These reports were provided to the applicant by an explanation of benefit dated April 17, 2018.
48The in-person insurer examination physiatry report dated April 5, 2018 of Dr. Steven Dilkas states that the applicant worked at a restaurant and reception answering the phone for approximately eight to nine years at the time of the subject accident. The applicant owned the business.
49The in -person insurer examination psychology report dated April 5, 2018 of Dr. Cheryl Bradbury indicates that at the time of the accident the applicant was self employed operating her small take out restaurant the Golden Pine Chinese Food Restaurant.
50The National Occupation Classification Report (NOC) dated April 5, 2018 of Mr. Cruz, kinesiologist, classified the occupation of the applicant based on job description mentioned in the following documents:
Independent Physiatry Evaluation dated January 31, 2018 and completed by Dr. Steven M. Dilkas (Physical & Medicine Rehabilitation), indicated that, “Ms. Shih worked at a restaurant in reception answer the phone for approximately eight to nine years at the time of the accident.”
Application for Accident Benefits (OCF-1) dated May 04, 2017 and completed by the applicant, Chen-Chen Shih, indicated that at the time of the index accident Ms. Shih was employed as the “Owner” of “Golden Pine Chinese Restaurant”.
Disability Certificate (OCF-3) dated January 05, 2018 and completed by Norlyn Peneda (Physiotherapist) from All Good Wellness, indicated that at the time of the index accident Ms. Shih was employed as a “Restaurant Server”.
Treatment and Assessment Plan (OCF-18) dated April 21, 2017 and completed by Dr. Ian Kai (Chiropractor) from North Toronto Rehabilitation and Physiotherapy, indicated under Part 8 that, the applicant “is a fast food restaurant owner and is unable to work at this time due to her injuries.”
Employer’s Confirmation Form (OCF-2) dated November 16, 2017 and completed by Chen Seu Dor (Director) from Golden Pine Chinese Restaurant, indicated that at the time of the index accident Ms. Shih was employed full-time as a “Manager”, and was required to perform “Admin” duties.
51The paper review insurer examination National Occupation Classification Report (NOC) dated April 5, 2018 by Mr. Alexys Kyle Cruz, kinesiologist concluded that based on the available medical documentation, Ms. Shih’s position as a manager of the Golden Pine Chinese Restaurant most closely resembles the unit group category of NOC #0631 - Restaurant and Food Service Managers. The strength required in performing the work activities of an occupation classified within the unit group #0631 can be classified within the limited strength category. Based on the National Occupational Classification Career Handbook (Second Edition, 2006) work activities within the limited strength category involve handling loads (such as pulling, pushing, lifting and/or moving objects) up to 5 kg (11 lbs).
52The in-home functional assessment report dated April 5, 2018 completed by the insurer examination assessor Mr. Stewart Tsuji. occupational therapist (O.T.) indicates that the applicant was the owner and manager of the Golden Pine Chinese Food Restaurant in Courtice, Ontario, and has been employed since 2016, before which she worked for 6 years in Alliston, Ontario. The applicant returned to work two weeks after the accident but mostly to check in. She reported that she worked for another 2 weeks until her chef offered to purchase her business.
53The functional abilities evaluation report dated April 5, 2018 of insurer examination assessor Ms. Sherri Corriero; physiotherapist indicates that the applicant has been working in restaurants in different locations for approximately eight to nine years. The applicant owned a restaurant at the time of the accident and the chef took it over after the accident. The applicant was mostly at the front answering the phone, working at the counter and cash register, if there were not a lot of customers, the applicant would help in the kitchen cutting vegetables and other food preparation.
54The applicant submitted a disability certificate (OCF-3) dated January 5, 2018 indicating eligibility to income replacement benefit (IRB). The Part 1 of the disability certificate stated the applicant works as “restaurant server” Under Part 6, it stated that the applicant can not work anymore. The disability certificate does not elaborate upon the essential tasks of the “restaurant server”.
55The employment confirmation form (OCF-2) dated November 16, 2017 completed by the applicant states under job description that the applicant worked full time as “Admin”. Job title as “Manager” from December 5, 2008 until April 20, 2017 at Golden Pine Chinese Food Restaurant. It does not state the essential task of job under “Admin” or “Manager”.
56I find, it is hard to accept the clarification provided by the applicant in the cross-examination about the word “Admin” meaning in a small restaurant “ you have to do everything” . The applicant had the opportunity to elaborate upon the tasks under “Admin” and “Restaurant Server” at the time of completion of the (OCF-2) and (OCF-3), during the course of in-person insurer examinations conducted in April 2018 in the presence of an interpreter, upon receipt of the insurer examination report forwarded under explanation of benefit dated April 17, 2018.
57I find, the applicant had ample opportunities to clarify to the respondent the alleged discrepancies about the essential tasks of the employment for a timely review/ reassessment by the respondent of its position regarding the IRB eligibility. The applicant remained silent about the alleged discrepancy regarding essential task of employment, chose to suffer financial stress until filing of an affidavit in July 2021 stating the essential tasks of the employment to pursue income replacement benefit.
58Therefore, in order to determine the essential tasks of the applicant’s employment at the time of accident, I prefer to rely upon the information regarding the essential tasks of the employment provided by the applicant in the documents submitted by her in the course of claiming the income replacement benefits especially the employment confirmation form (OCF-2) dated November 16, 2017 stating “Admin” duties of the applicant and a disability certificate (OCF-3) dated January 5, 2018 stating employed as “Restaurant Server” and the information provided to the insurer assessors during the course of completing the in-person examinations to determine eligibility to the “IRB”. Based on the information by the applicant, the respondent completed the insurer examinations to determine the eligibility of the applicant to “IRB”.
59Based on the evaluation of the evidence on record, I find, the essential tasks of the applicant as mentioned in the OCF-2, OCF-3 and as stated in the insurer examination reports to be correct.
Did the applicant sustain an impairment as a result of the accident and within 104 weeks after the accident, suffers a substantial inability as a result of the accident to perform essential task of that employment?
60The applicant in the affidavit dated July 9, 2021 under para 14 affirms that “as a result of my injuries from the accident, primarily the pain in my right arm and hand, which is my dominant hand, I was unable to perform the physical elements of my employment”.
61The applicant did not comment upon the conclusions drawn by the insurer examiners in their reports stating that the applicant does not suffer from substantial inability to complete the essential tasks of the employment. These reports were provided to the applicant under explanation of benefit dated April 17, 2018.
62According to insurer assessor Dr. Steven Dilkas, physiatrist report dated April 5, 2018 " based upon my assessment of Ms. Shih and review of the provided documentation, from a musculoskeletal perspective, I do not find that she suffers a substantial inability to perform the essential tasks of her pre-accident employment”.
63According to insurer assessor Dr. Bradbury, psychologist report dated April 5, 2018 " it would be the considered opinion of the evaluator that Ms. Shih has not sustained a substantial psychological inability to engage in her pre-accident employment responsibilities.
64According to insurer assessor Ms. Corriero, physiotherapist report dated April 5, 2018 “you demonstrated overall strength is considered limited to light strength category”.
65According to insurer assessor Mr. Cruz, report dated April 5, 2018 kinesiologist “the strength required in performing your pre-accident employment can be classified within the limited strength category”.
66According to insurer assessor Mr. Tsuji, OT report dated April 5, 2018 " no physical impairment was identified, although her primary barrier resuming her pre-MVA activities was noted to be physical deconditioning secondary to an overall withdrawal from her pre-MVA routines and a lack of any structured home exercise program."
67In addition to the conclusions drawn by the insurer assessor in their reports, I also rely upon the information regarding the injuries sustained by the applicant in the documents submitted by the applicant in the course of claiming the income replacement benefits especially the disability certificate (OCF-3) dated January 5, 2018 .
68The applicant’s completed disability certificate (OCF-3) dated January 5, 2018 under Part 6 “Disability and Tests information “states that the applicant is substantially unable to perform the essential tasks of the employment at the time of the accident as a result of and within 104 weeks of the accident. Under explanation it is stated “ patient can not complete restful sleep, the pain will wake her up every 2-3 hours. She can not work anymore or do household work or do groceries”. Under Part 5 “Injury and Sequelae Information” it states “WAD2, sprain/ strain of thoracic spine and lumbar spine”. Under the type of work the form states “ restaurant server”.
69The explanation in OCF-3 does not specify the type and area of pain interfering with restful sleep that results in the applicant’s inability perform the essential tasks of her employment at the time of the accident. There is no reference to the pain in right arm and hand.
70The cnr’s of Dr. Lai, family doctor, dated May 1, 2017, June 12, 2017 October 25, 2017 and November 6, 2017 do not state pain/ weakness in right hand and arm. The cnr’s of the applicant’s other family doctor, Dr. Yuen from April 21, 2017 until July 15, 2020 do not state any accident related injury.
71Therefore, I agree with the above-mentioned insurer examination reports concluding that the applicant did not sustain an impairment as a result of the accident and within 104 weeks after the accident, suffers a substantial inability as a result of the accident to complete essential task of that employment.
72Based on the evaluation of the evidence on record, I find, the applicant ineligible to receive the income replacement benefit as the applicant did not sustain an impairment as a result of the accident that resulted within 104 weeks after the accident into the applicant suffering a substantial inability to perform the essential tasks of that employment. Since the applicant is ineligible for the income replacement benefit, it is not necessary to determine the weekly amount of the income replacement benefit.
Is the applicant entitled to an award for unreasonably withheld or delayed payments under [section 10](https://www.canlii.org/en/on/laws/regu/rro-1990-reg-664/latest/rro-1990-reg-664.html#sec10_smooth) of [R.R.O 1990, Regulation 664](https://www.canlii.org/en/on/laws/regu/rro-1990-reg-664/latest/rro-1990-reg-664.html)?
73The applicant is not entitled to an award as there are no unreasonably withheld or delayed payments.
Is the applicant entitled to interest on an overdue benefit amounts?
74No interest is payable as there are no overdue benefit amounts.
ORDER
75The applicant sustained predominantly minor injuries as defined under the “Schedule” and therefore remains in “MIG” and subject to the limit on medical and rehabilitation benefits not exceeding $3,500.00.
76The applicant remains in the “MIG” therefore an analysis to decide whether the treatment plan the amount of $1,299.35 for physiotherapy recommended by All Good Wellness and Health Centre dated February 22, 2018 is reasonable and necessary for the rehabilitation of the applicant is not required.
77The applicant is not eligible for an income replacement benefit as the applicant did not sustain an impairment as a result of the accident and as a result of and within 104 did not suffer substantial inability to perform the essential tasks of that employment.
78The applicant is not entitled to an award as there are no unreasonably withheld or delayed payments.
79No interest is payable as there are no overdue benefit amounts.
Released: March 3, 2022
Rakesh Sharma
Adjudicator```