Raees v. Aviva Insurance Canada, 2022 CanLII 78894

Licence Appeal Tribunal

Citation: Raees v. Aviva Insurance Canada, 2022 ONLAT 20-011738/AABS

Licence Appeal Tribunal File Number: 20-011738/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:

Muhammad Raees

Applicant

and

Aviva Insurance Canada

Respondent

DECISION

ADJUDICATOR: Brett Todd

APPEARANCES:

For the Applicant: Joshua Gautreau, Counsel

For the Respondent: J.C. Rioux, Counsel

HEARD BY WAY OF WRITTEN SUBMISSIONS

BACKGROUND

1Muhammad Raees (the “applicant”) was injured in an automobile accident on May 17, 2019 and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”)¹ from Aviva Insurance Canada (the “respondent”).

2The applicant was driving passengers for Uber when another vehicle struck the passenger side of his vehicle.² Emergency services attended the scene. The applicant visited Dr. R. El-Zaharna, family physician, in the days after the accident, where he reported experiencing right-side neck pain, left shoulder pain, right elbow pain, and low back pain.³ The applicant reported being involved in a previous automobile accident on November 11, 2017.⁴ Following that accident, he was diagnosed with sprain/strain injuries affecting the cervical spine, bilateral trapezii, lumbar spine, right elbow, bilateral wrists, bilateral knees, and ankles.⁵

3The applicant initiated a claim for medical benefits. He was initially treated in accordance with the Minor Injury Guideline (the “MIG”), as the respondent had determined that the applicant’s injuries fit the definition of “minor injury” as prescribed by s. 3(1) of the Schedule.⁶ The applicant was removed from the MIG in a letter dated September 12, 2019 and approved for further treatment.⁷

4A number of insurer examinations (“IEs”) were conducted in 2020,⁸ resulting in the termination of an attendant care benefit (“ACB”) and the denial of other claims by the applicant, including the chronic pain assessment and two treatment plans at issue here. The applicant then submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”).

ISSUES IN DISPUTE

5The following issues are to be decided:

(i) Is the applicant entitled to $312.81 ($3,447.63 less $3,134.82 approved) for chiropractic, physiotherapy, and massage treatment, proposed by Scarborough Health and Wellness in a treatment plan (“OCF-18”) dated February 12, 2020?

(ii) Is the applicant entitled to $3,234.77 for chiropractic treatment, proposed by Scarborough Health and Wellness in an OCF-18 dated September 16, 2020?

(iii) Is the applicant entitled to $2,255.49 for a chronic pain assessment, proposed by Paramount Medical Assessment in an OCF-18 dated May 19, 2020?

(iv) Is the applicant entitled to interest on any overdue payment of benefits?

6Two issues listed in the case conference report and order were withdrawn prior to the hearing. These involved an OCF-18 proposed by Paramount Medical Assessment for assistive devices in the amount of $2,763.82 and an OCF-18 proposed by Paramount Medical Assessment for a functional abilities assessment in the amount of $2,256.39, both denied on January 14, 2020.⁹

7The applicant also introduced in his written reply submissions a claim for an award pursuant to Regulation 664 and costs pursuant to Rule 19 of the Tribunal’s Common Rules of Licence Appeal Tribunal, Animal Care Review Board, and Fire Safety Commission (the “Rules”). Neither of these were previously listed as issues in dispute, and the respondent has not had the opportunity to provide submissions further to these issues. While Rule 19 costs may be argued “at any time before the decision or order is released” and that the Tribunal may issue a Regulation 664 award in certain circumstances, I find it is unfair to the respondent for the applicant to introduce and argue these new issues in his reply. Being mindful of Rule 3.1(a) of the Rules and s. 23(1) of the Statutory Powers Procedure Act, I decline to add these issues to the dispute and consequently do not adjudicate them.

RESULT

8I find that the applicant is entitled to the following:

(i) The unapproved portion of the February 12, 2020 OCF-18 ($312.81);

(ii) The September 16, 2020 OCF-18 ($3,234.77);

(iii) The May 19, 2020 OCF-18 for a chronic pain assessment ($2,255.49); and

(iv) Interest according to s. 51 of the Schedule.

ANALYSIS

The Treatment Plans

9Section 38(8) of the Schedule provides that the insurer shall give the insured person a notice identifying the goods, services, assessments, and examinations that the insurer does not agree to pay for in any treatment and assessment plan. This notice must be provided within 10 business days of the insurer receiving the treatment and assessment plan. Medical and all other reasons must be cited in this notice explaining why the insurer considers these items (or the proposed costs of them) to not be reasonable and necessary.

10Section 38(11) 2. provides that failure to give notice in accordance with s. 38(8) in connection with a treatment and assessment plan means that the insurer shall pay for all goods, services, assessments, and examination described in the related treatment and assessment plan.

11For the reasons below, I am persuaded by the applicant that the respondent’s denial failed to comply with s. 38(8) of the Schedule. The consequences of s. 38(11) 2. apply.¹⁰ As a result, the applicant is entitled to the unpaid part of that treatment plan, plus interest, in accordance with s. 51 of the Schedule. I also find that the applicant has met his onus regarding the September 16, 2020 OCF-18, and as a result is entitled to that treatment plan, plus interest in accordance with s. 51 of the Schedule.

February 12, 2020 OCF-18

12The February 12, 2020 OCF-18 was completed by A. Nalli, chiropractor, of the Scarborough Health and Wellness Centre.¹¹

13The treatment plan noted injuries and sequelae resulting from the subject accident, including whiplash associated disorder, finger dislocation, sprain and strain of the interphalangeal finger joint, shoulder muscle strain, elbow contusion, localized swelling mass and lump (head), headache, sleep disorders, nightmares, other anxiety disorders, dizziness and giddiness, and irritability and anger. It also referred to the injuries affecting the applicant’s ability to carry out tasks of employment and the activities of normal life. The treatment plan also mentioned the applicant’s prior motor vehicle accident in 2017, which exacerbated issues with a “deformed” index finger, apparently from childhood. This finger was subsequently re-injured in the subject accident. Further injuries were sustained to his wrists, shoulders, neck, and back.¹²

14Goals of this treatment plan were pain reduction, an increase in strength, and an increased range of motion, along with functional objectives of returning to pre-accident work duties and a return to the activities of normal living.¹³

15I note that there is an error in the applicant’s written submissions regarding this OCF-18. Instead of the plan in question, an OCF-18 from the same clinic dated August 12, 2019 has been mistakenly inserted here.¹⁴ (A dispute over this issue was included in the original list of items in dispute, but was withdrawn by the applicant at the case conference.¹⁵) Regardless, I was still able to review the February 12, 2020 OCF-18 at dispute here as it was included in the respondent’s submissions.¹⁶

16The applicant’s position on the partial denial of this OCF-18 rests almost entirely on the respondent’s not providing specific reasons in its denial letter. I am persuaded by the applicant’s argument, as the partial approval letter does not contain any information regarding why part of the original treatment and assessment plan was denied. It simply notes the amount approved at $3,134.82 and the amount claimed at $3,447.63, with no explanation as to the rationale behind the differences.¹⁷

17The respondent’s submissions for this hearing are also silent on why this portion of the OCF-18 was denied. The respondent simply states that “the applicant has not given a reason why the remaining $312.81 would be payable.”¹⁸ This alone is insufficient rationale, and it comes far too late in the process to meet the conditions imposed by s. 38(8), regardless. This also underscores the necessity of s. 38(8), in that the applicant could not provide a “reason” here given the lack of information from the respondent as to why part of the plan was denied.

18I find that the applicant has proven that the respondent did not provide a proper denial in compliance with s. 38(8), which then triggers the consequences imposed by s. 38(11) 2. I find that the applicant is entitled to the remaining $312.81 portion of the February 12, 2020 OCF-18, plus interest in accordance with s. 51 of the Schedule.

September 16, 2020 OCF-18

19The September 16, 2020 OCF-18 was also completed by A. Nalli, chiropractor, of the Scarborough Health and Wellness Centre.¹⁹

20The treatment plan was identical to the February 12, 2020 OCF-18 described above. It noted the same injuries and sequelae. It also mentioned the applicant’s prior motor vehicle accident in 2017, the historic issues involving the “deformed” finger, and how the subject accident caused injuries to his wrists, shoulders, neck, and back.²⁰

21Goals of this treatment plan were the same as in the February 12, 2020 OCF-18 noted above.²¹

22It is well established that objective medical supporting evidence is vital in determining whether any proposed treatment plan is reasonable and necessary. Without this objective medical evidence, a treatment plan on its own is not enough to establish entitlement to it and its benefits.

23In this case, there are competing medical opinions roughly contemporaneous with the September 16, 2020 OCF-18. The applicant relies largely on a chronic pain medical assessment by Dr. I. Wilderman conducted on July 22, 2020 that diagnosed “a chronic pain disorder that prevents him from partaking in daily activity as he did prior to the accident.”²² Dr. Wilderman further diagnosed the applicant with chronic pain syndrome, post-concussion syndrome, chronic whiplash associated disorder, mechanical lower back pain, lumbago, bilateral sacroiliac joint dysfunction, post-traumatic osteoarthritis, post-traumatic chronic headaches, bilateral rotator cuff syndrome, bilateral myofascial pain syndrome of rhomboid region, medial epicondylitis on the right, lateral epicondylitis on the right, dizziness, depression, anxiety, and post-traumatic stress disorder.²³ The report cited pre-existing conditions as aggravating factors, most notably injuries from the prior accident in 2017 and a finger issue dating to childhood.

24Dr. Wilderman’s report recommended a multidisciplinary chronic pain treatment program, as he stated that the applicant had not yet reached maximum medical recovery. This program would include the treatment noted in the September 12, 2020 OCF-18, such as chiropractic and physiotherapy, along with sessions of psychotherapy and cognitive-behavioural therapy.²⁴ This report also includes observations by the applicant that he experienced continued pain relief during the physical and chiropractic treatment sessions conducted at Scarborough Health and Wellness, but that this subsided after these plans were no longer funded by the respondent.²⁵

25While the Dr. Wilderman report is the most fulsome regarding the clinical notes and records provided by the applicant, this is actually the culmination of a number of assessments that reveal a continuation of the applicant’s symptoms through 2019 and 2020. They form a chain of evidence that serve as a foundation for the results and recommendations in the Dr. Wilderman report.

26In an accident follow-up appointment with Dr. El-Zaharna on May 28, 2019, the family physician diagnosed the applicant with lumbar strain, neck whiplash, concussion, and musculoskeletal pain.²⁶ The initial disability certificate (“OCF-3”) completed by Scarborough Health and Wellness on May 22, 2019 noted psychological issues, citing the applicant complaining of sleep disorders, nightmares, anxiety, dizziness and giddiness, and irritability and anger.²⁷

27Although A. Nalli, the health practitioner who prepared the OCF-3, is a chiropractor and not a psychologist or psychiatrist, I assign considerable weight to this diagnosis as it was supported by a psychological assessment by Dr. R. Silverman, psychologist, dated October 5, 2019. Dr. Silverman diagnosed the applicant with “adjustment difficulties in connection with his post-accident situational stressors and lifestyle disruptions.”²⁸ Specific difficulties that the applicant reported included becoming easily frustrated and angry with others, particularly his wife, along with marital tension, and feelings of inadequacy as a provider for his wife and children. He also reported sleep difficulties due to ongoing physical pain and racing thoughts.²⁹ This report also included a recommendation that the applicant’s psychological impairments rendered the injuries he sustained in the subject accident as not “predominantly minor in nature” and requiring removal from the MIG for treatment.³⁰ As already noted, the respondent removed the applicant from the MIG at about this same time.

28Injuries sustained in the subject accident were cited in the Dr. Silverman report as the root cause behind these psychological stressors. These injuries resulted in constant neck pain described as “sharp” and “throbbing” that the applicant rated as a pain level of 8-9 out of 10; constant back pain also described as “sharp and throbbing” and rated by the applicant as a pain level of a 9 out of 10; constant bilateral shoulder pain that is more pronounced on the left side, with the left shoulder pain rated as a 9 out of 10 and the right as a 7 out of 10; intermittent pain in the left index finger that the applicant rated as a 6 out of 10 but had improved an estimated 20-30% since the accident; constant right elbow pain that the applicant rated as an 8 out of 10 that had improved an estimated 20% since the accident; and headaches occurring almost every day that the applicant rated at a pain level of 8-9 out of 10.³¹

29Although diagnosing physical symptoms is outside of Dr. Silverman’s area of expertise, I place some weight on this report as the issues align with those in the other clinical notes and records on the file. It adds to the overall evidence that the applicant was experiencing significant physical symptoms such as ongoing pain, that also impacted his mental state and overall quality of life. The comments by the applicant to Dr. Silverstein add to a pattern of evidence indicating that he was experiencing some relief from the pain caused by injuries in the subject accident during ongoing treatment. This is relevant to whether the treatment plan in dispute is reasonable and necessary pursuant to the Schedule.

30These clinical notes and records were not disputed by the respondent in 2019. On November 27, 2019, the respondent approved a Form 1 for ACB in the amount of $1,921.70 per month. This was paid until May 20, 2020.³²

31The respondent’s denial of the treatment plan in question rests largely on the report of Dr. P. Jugnundan, general practitioner, completed as part of a larger multidisciplinary assessment independent examination (“IE”) dated August 20, 2020. Dr. Jugnundan concluded that the applicant did not suffer from chronic pain, that he had not reached maximum medical improvement, and that he showed no evidence of any disability or impairment that prevented him from resuming employment duties and completing the tasks of everyday life.³³

32I note a number of internal contradictions in Dr. Jugnundan’s report that make me question his analysis. Specifically, this report was not in reference to the OCF-18 in question here, but to other OCF-18s (a claim for medical devices such as braces and a back pillow that was not incurred and was withdrawn from this appeal), plus ACB and income replacement benefit issues not in dispute here. Observations in the report include that the applicant was “pain-focused” and would make “pain-generated sounds” during the course of the examination.³⁴ The applicant demonstrated a decreased range of motion “on the basis of pain avoidance.”³⁵ Dr. Jugnundan noted “active resistance” to some range of motion testing, although this is not expanded upon in the conclusions of his report to fully explain if the applicant was not cooperating with the examination or was in fact experiencing pain.³⁶ In connection with the latter, the applicant also notes that such symptoms have caused him to stop playing sports, cut back on gym activities, and is somewhat reliant on his wife to help with him dressing and personal hygiene/care responsibilities.³⁷

33The above evidence strongly indicates that the applicant was experiencing pain and restricted movement at the time of this examination. The applicant further reported to Dr. Jugnundan that his wife had to regularly help him putting on shirts and to occasionally help him off the toilet.³⁸ This accords with the information provided by other health practitioners, including that in the OCF-18 at question here. As a result, I conclude that the applicant was having significant difficulties as a result of that pain, despite the conclusions of Dr. Jugnundan that gloss over these observations in his report.

34Furthermore, Dr. Jugnundan notes in his report that the applicant claimed that his “condition had improved” at the end of a section detailing the physical, massage, and chiropractic therapy being administered on an ongoing basis by Scarborough Health and Wellness.³⁹ The clear implication is that this treatment was achieving its goal. This makes it difficult for me to understand why Dr. Jugnundan came to the conclusions that he did in his report, or why the respondent used it as the basis of a denial of the OCF-18 at dispute here, particularly when Dr. Jugnundan also confirmed his belief in his report that the applicant had not reached maximum medical improvement.

35I favour the applicant’s argument, as well, regarding the direction of Dr. Jugnundan. In the report, Dr. Jugnundan’s advice to the applicant is to return to his family physician and continue with physical activity to continue improving his physical condition and move more toward maximum medical improvement.⁴⁰ This is exactly what the applicant did. He returned to Dr. El-Zaharna, who recommended ongoing physical therapy and to continue with the therapy that resulted in the OCF-18 disputed here.⁴¹ Granted, this direction from Dr. Jugnundan falls short of endorsing the specific treatment plan at question. But it indicates agreement when it comes to physical treatment being necessary for the applicant to continue recovering from his injuries. Furthermore, Dr. Jugnundan’s direction is not completely compatible with his conclusions, which were used as the basis for the respondent denying this treatment plan. Dr. Jugnundan’s evidence and conclusions do not line up.

36Another area of concern that I have with Dr. Jugnundan’s report is that he does not fully assess the applicant’s return to work. The preponderance of the evidence before me indicates that the applicant is driving again, which was his primary occupation before the subject accident, and that he secured a different job following the accident, driving for a cartage firm as opposed to carrying passengers. There is a clear dispute within the submissions regarding the applicant’s employment situation, with the applicant claiming he is working part-time hours and the respondent claiming that he works a full-time shift Monday to Friday.⁴² The latter seems to be based on a notation in an IE psychological assessment by Dr. A. Marino that the applicant told him he was working “full time, Mondays to Fridays, and works a night shift.”⁴³ This is, however, strongly denied by the applicant in his response submissions.⁴⁴

37I do not have enough information before me to make a full determination here as to the veracity of either claim. In the absence of something like employment records, which were not submitted by either party, I cannot make any determination on the employment issue. However, more thorough information has been provided by the applicant. As the applicant points out in his response submissions denying the full-time work status claimed in the respondent’s written submissions, the Wilderman report covers the job question much more thoroughly. That report notes that even though the applicant has returned to driving, it is as a part-time truck driver who just drives and does not participate in any loading or unloading. It also specifies that he changed his occupation from driving for Uber and Lyft in response to “considerable pain” that caused “a substantial and continuous impairment of his ability to perform his employment functions.”⁴⁵

38These expanded explanations provided by the applicant are persuasive, as greater context and background is provided into his work history and the impact that his injuries had on his employment. These arguments hold more weight than the Dr. Jugnundan report, which skims over the applicant’s work situation (and is echoed in the written submissions of the respondent⁴⁶). Dr. Jugnundan simply notes that the applicant has returned to driving, and uses this as reason enough to conclude that he is not experiencing significant issues that may require treatment.⁴⁷ Of course, simply getting behind the wheel again to earn a paycheque does not fully review the entire situation here. The added context from the applicant regarding the work situation lends further strength to the overall applicant position that he was experiencing ongoing issues requiring treatment and adds to the argument that the treatment plan in dispute here was both necessary and reasonable.

39I should note that I also reviewed the other IEs submitted by the respondent, but did not assign much weight to them for various reasons. The Dr. P. Ranalli neurology assessment focused largely on the neurological status of the applicant and dealt specifically with OCF-18s not in dispute here, so it was not fully relevant.⁴⁸ The Dr. Marino psychology assessment focused largely on an ACB issue not at dispute here,⁴⁹ and the R. Pritchett occupational therapy in-home assessment focused on this ACB matter along with OCF-18s not at dispute here.⁵⁰

40On the evidence, I find that the applicant has met his burden of proving that the proposed treatment plan is reasonable and necessary. The medical record indicates that the treatment was assisting the applicant with both pain relief and the overall relief of his symptoms. I find that the applicant is entitled to $3,234.77 in the September 16, 2020 OCF-18, plus interest in accordance with s. 51 of the Schedule.

The Chronic Pain Assessment

41In determining whether an assessment is reasonable and necessary, it must also be noted that assessments, by their nature, are speculative. The purpose of an assessment is to determine if a condition exists. Notwithstanding their speculative nature, the applicant still bears the onus of establishing on a balance of probabilities that an assessment is reasonable and necessary. To do so, the applicant must point to objective evidence that there are grounds to suspect he has the condition for which he seeks the assessment.

42The May 19, 2020 OCF-18 for a chronic pain assessment was completed by Dr. Wilderman, family physician, of the Wilderman Medical Clinic.⁵¹

43The goals of this assessment were pain reduction, an increase in strength, a return to the activities of normal living, and a return to modified work activities, along with the creation of a plan for multidisciplinary pain management to assist with the applicant’s symptoms and aid in the recovery process. Symptoms cited were nearly identical to those noted in the other two OCF-18s described above that are the subject of the other disputes.⁵²

44The applicant’s position here relies largely on the existing medical evidence as noted above in the sections addressing the two treatment plans in dispute.

45The respondent once more refers to the Dr. Jugnundan report in its reasons supporting the denial of the chronic pain assessment OCF-18. As I have already noted my concerns with this report, I will not go over the same ground as in the above sections covering my analysis there, as my reasoning for setting aside the conclusions of that report are virtually identical. All I will add here is to note that Dr. Jugnundan took the exact same approach when it came to dismissing the chronic pain assessment involving the applicant as he did his other observations, resulting in some significant contradictions between what he observed and noted in his report and his conclusions. Dr. Jugnundan dismisses any possibility of the applicant suffering from a chronic pain condition, despite his own report containing numerous observations (already described above) of the applicant experiencing pain, limited movement, lifestyle challenges, and even related psychological issues (also backed up by the Silverstein report cited above).

46I also note that Dr. Jugnundan offers a firm diagnosis that the applicant does not suffer from chronic pain, when it is clear from his own wording that the applicant’s situation remains at least somewhat open-ended. Granted, coming to the conclusion that the applicant has not reached maximum medical improvement does not exactly line up with supporting a diagnosis of chronic pain. But it certainly does open the door to questioning what methods of treatment would best be considered to address the applicant’s symptoms and move him to a maximum medical improvement status. One way of determining that would be a chronic pain assessment.

47The applicant makes precisely this point in both his written submissions and his reply submissions, underlining (literally) that the question here is not about whether or not the applicant is experiencing chronic pain, but if “there is any reason to investigate whether the applicant has chronic pain.” The applicant further argues that it would set an impossible standard for an applicant to have to have a chronic pain diagnosis in order to prove the need for a chronic pain assessment.⁵³

48Oddly, the respondent’s arguments focus on an actual chronic pain diagnosis, challenging the applicant with reference to the American Medical Association guidelines regarding chronic pain syndrome and the Tribunal decision in 17-007825 v. Aviva Insurance Canada.⁵⁴ While it may be a persuasive argument, I find it is inapplicable on this matter as the issue at dispute is not whether the applicant has chronic pain warranting treatment, but whether a chronic pain assessment is reasonable and necessary.

49Given the speculative nature of assessments, it is impossible to argue for their necessity through the assumption of a diagnosis, as the respondent appears to do with its reliance on Dr. Jugnundan’s conclusions. The applicant still bears the onus of establishing on a balance of probabilities that an assessment is reasonable and necessary. In other words, the applicant needs to show objective evidence that there are grounds to suspect that he has the condition for which he is seeking the assessment.

50I find that the applicant has satisfied that onus. Even in the absence of the Dr. Wilderman chronic pain assessment, the applicant has provided significant and persuasive medical evidence through the clinical notes and records from Dr. El-Zaharna, Dr. Silverman, and the treatment clinic to establish that he suffered significant, ongoing pain as a result of the subject accident. The respondent’s evidence supports this as well. As already cited above, the Dr. Jugnundan report notes ongoing pain, lack of mobility due to that pain, and significant issues affecting the applicant’s everyday life at home. It also features a diagnosis that the applicant had not yet reached maximum medical improvement status. All of this builds a strong case to investigate the applicant’s pain with an assessment, making such an assessment reasonable and necessary. It further meets the objectives of all such treatment plans when it comes to them having reasonable, identified goals, a way to advance those goals through recommended treatment, and have a reasonable cost in dollars and resources.

51On the evidence before me, I find that the applicant is entitled to $2,255.49 in the May 19, 2020 OCF-18 for a chronic pain assessment, plus interest in accordance with s. 51 of the Schedule.

CONCLUSION

52For the reasons outlined above, I find that the applicant is:

(i) Entitled to the unapproved portion of the February 12, 2020 OCF-18 ($312.81), plus interest in accordance with s. 51 of the Schedule;

(ii) Entitled to the September 16, 2020 OCF-18 ($3,234.77), plus interest in accordance with s. 51 of the Schedule; and

(iii) Entitled to the May 19, 2020 OCF-18 ($2,255.49) for a chronic pain assessment, plus interest in accordance with s. 51 of the Schedule.

Footnotes

1. 1O. Reg. 34/10.
2. 2Respondent’s Tabs, Tab 2, pages 23-26 67 (Motor Vehicle Collision Report). (NOTE: All page number citations refer to the pagination of the PDF documents submitted by both parties, not the pagination of individual documents within those PDFs.)
3. 3Applicant Written Submissions 1, page 5; tab 9, pages 106-107 (CNRs of Dr. R. El-Sharna).
4. 4Ibid. pages 4-5.
5. 5Ibid. Tab 8 (Physiatry Assessment of Dr. M. Ko, August 1, 2018).
6. 6Minor Injury Guideline, Superintendent’s Guideline 01/14, issued pursuant to s. 268.3 (1.1) of the Insurance Act.
7. 7Applicant Written Submissions 1, Tab 11, page 147 (OCF-18, September 12, 2019).
8. 8Respondent’s Tabs, Tabs 1, 3, and 4.
9. 9Applicant Written Submissions 1, page 9.
10. 10s. 38 (11) 1. would also apply here, if the respondent had not already removed the applicant from the MIG.
11. 11Respondent’s Tabs, Tab 8, pages 164-172 (OCF-18, February 12, 2020).
12. 12Respondent’s Tabs, Tab 8, pages 164-172 (OCF-18, February 12, 2020).
13. 13Ibid. Tab 8, page 168.
14. 14Applicant Written Submissions 2, Tab 17, pages 23-32 (OCF-18, August 12, 2019).
15. 15Case Conference Report and Order by Adjudicator Amanda Marshall (LAT 20-011738), page 2.
16. 16Respondent’s Tabs, Tab 8, pages 163-172 (OCF-18, February 12, 2020).
17. 17Applicant Written Submissions 2, Tab 17, page 20 (Aviva letter, February 21, 2020).
18. 18Respondent Written Submission, page 8.
19. 19Applicant Written Submissions 2, Tab 18, pages 38-47 (OCF-18, September 16, 2020).
20. 20Ibid. Tab 18, page 42.
21. 21Ibid. Tab 18, page 43.
22. 22Applicant Written Submissions 1, Tab 15, page 207 (Dr. Wilderman Medical Clinic Independent Medical Evaluation Report, July 22, 2020).
23. 23Applicant Written Submissions 2, Tab 15, page 8-9 (Dr. Wilderman Medical Clinic Independent Medical Evaluation Report, July 22, 2020).
24. 24Applicant Written Submissions 2, Tab 15, pages 8-11 (Dr. Wilderman Medical Clinic Independent Medical Evaluation Report, July 22, 2020).
25. 25Applicant Written Submissions 1, Tab 15, page 208.
26. 26Ibid. Tab 9, page 100 (CNRs of Dr. R. El-Zaharna).
27. 27Ibid. Tab 10, page 145 (OCF-3 filed by the applicant, May 22, 2019).
28. 28Ibid. Tab 12, page 167 (Dr. Silverman Psychological Assessment, October 5, 2019).
29. 29Applicant Written Submissions 1, Tab 12, pages 163-164 (Dr. Silverman Psychological Assessment, October 5, 2019).
30. 30Ibid. Tab 12, pages 168-169.
31. 31Ibid. Tab 12, pages 162-163.
32. 32Ibid. Tab 13, pages 170-175 (ACB Form 1, November 27, 2019).
33. 33Respondent’s Tabs, Tab 1, pages 4-12 (Dr. Jugnundan General Practitioner Report, August 20, 2020).
34. 34Ibid. Tab 1, page 7.
35. 35Ibid. Tab 1, page 10.
36. 36Ibid. Tab 1, page 7.
37. 37Ibid. Tab 1, page 6.
38. 38Ibid. Tab 1, page 6.
39. 39Ibid. Tab 1, page 5.
40. 40Respondent’s Tabs, Tab 1, page 9 (Dr. Jugnundan General Practitioner Report, August 20, 2020).
41. 41Applicant Written Submissions 1, Tab 9, page 100-138 (CNRs of Dr. El-Zaharna).
42. 42Respondent Written Submission, page 4.
43. 43Respondent’s Tabs, Tab 3, pages 30-38 (Dr. Marino Psychology Assessment, May 5, 2020).
44. 44Applicant Reply Submission, pages 4-5.
45. 45Applicant Written Submissions 2, Tab 15, page 3 (Dr. Wilderman Medical Clinic Independent Medical Evaluation Report, July 22, 2020).
46. 46Respondent Written Submission, page 8.
47. 47Respondent’s Tabs, Tab 1, page 11 (Dr. Jugnundan General Practitioner Report, August 20, 2020).
48. 48Ibid. Tab 1, pages 13-19 (Dr. Ranalli Neurology Assessment, August 20, 2020).
49. 49Ibid. Tab 3, pages 30-38 (Dr. Marino Psychology Assessment, May 5, 2020).
50. 50Ibid. Tab 3, pages 39-53 (R. Pritchett Occupational Therapy In-Home Assessment, May 5, 2020).
51. 51Respondent’s Tabs, Tab 6, pages 140-148 (OCF-18, May 19, 2020).
52. 52Ibid. Tab 6, pages 145, 148.
53. 53Applicant Reply Submission, page 4-5.
54. 5417-007825 v Aviva Insurance Canada, 2018 CanLII 98282 (ON LAT).