Ngai v. The Co-operators General Insurance Company, 2022 CanLII 81518

Citation: Ngai v. The Co-operators General Insurance Company, 2022 ONLAT 20-008103/AABS

Licence Appeal Tribunal File Number: 20-008103/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:

Tommy Ngai

Applicant

and

The Co-operators General Insurance Company

Respondent

DECISION

VICE-CHAIR:

Ian Maedel

APPEARANCES:

For the Applicant:

Yu Jiang, Paralegal

For the Respondent:

Amanda M. Lennox, Counsel

HEARD:

By Way of Written Submissions

BACKGROUND

1The applicant was involved in an automobile accident 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”).

2On June 9, 2018, the applicant was a seat belted driver of his motor vehicle when he collided with a pickup truck. His airbags deployed and he was ambulatory at the scene. He complained of neck pain, upper and lower back pain and was transported to hospital via ambulance. X-rays revealed no visible fractures, subluxations, or dislocations in his cervical and lumbar spine.¹ He was released from hospital on the same date and visited his family physician six days later.

ISSUES

3The issues to be decided are:

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 Minor Injury Guideline?

ii. Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from June 24, 2019 to date and ongoing?

iii. Is the applicant entitled to $200.00 for chiropractic services recommended by Point Grey Physio in a treatment plan (“OCF-18”) dated September 7, 2018?

iv. Is the applicant entitled to $1,892.20 for chiropractic services recommended by Point Grey Physio in an OCF-18 dated November 2, 2018?

v. Is the applicant entitled to $189.02 for medication submitted December 21, 2018?

vi. Is the applicant entitled to $2,200.00 for a psychological assessment recommended by Somatic Assessments & Treatment Clinic in an OCF-18 dated April 14, 2019?

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

RESULT

4I find that the applicant’s psychological impairment is not a predominantly minor injury and he is not subject to treatment within the Minor Injury Guideline. The applicant is not entitled to an income replacement benefit, nor are the OCF-18s for chiropractic treatment reasonable or necessary.

5The applicant is entitled to partial payment of the OCF-6 in the amount of $142.90 and to the cost of a psychological assessment in the amount of $2,200.00. The applicant is further entitled to interest on both of these outstanding amounts pursuant to s. 51 of the Schedule.

ANALYSIS

The Minor Injury Guideline

6The Minor Injury Guideline (“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 and includes any clinically associated sequelae to such an injury.” The terms, “strain,” “sprain,” “subluxation,” and “whiplash associated disorder” are defined in the Schedule.

7Section 18(1) of the Schedule limits funding for medical and rehabilitation benefits for predominantly minor injuries to a cap of $3,500.00. An applicant may receive payment for treatment beyond the $3,500.00 limit if they can demonstrate that a pre-existing condition, documented by a medical practitioner, prevents maximal medical recovery under the MIG or, if they provide evidence of a psychological impairment or chronic pain with a functional impairment.

8It is the applicant’s burden to establish entitlement to coverage beyond the $3,500.00 cap on a balance of probabilities.²

9In the current matter, the applicant has already exhausted the $3,500.00 MIG treatment limit.

Physical Impairments and the MIG

10I am not satisfied the applicant has established on a balance of probabilities that he sustained physical injuries as a result of the accident that would warrant his removal from the MIG.

11The applicant relies on two Disability Certificates (“OCF-3s”). The first, filed by Dr. G. Palantzas, chiropractor on June 29, 2018, indicates the applicant suffered injury to muscle and tendon at neck level, dislocation, strain of joints and ligaments of thorax, lumbar spine, pelvis, shoulder girdle, knee, hip, sprain and strain of ribs, sternum and sacroiliac joint, radiculopathy, rotator cuff syndrome, injury to the muscle and tendon at hip and thigh, headache, dizziness, malaise, fatigue, slowness, and poor responsiveness.³

12The second OCF-3, also filed by Dr. Palantzas on June 21, 2019, listed the same physical injuries and sequelae.⁴ Both listed the anticipated duration of the impairments as more than 12 weeks.

13The applicant also relies on the clinical notes and records of his Family Physician, Dr. Heung-Wing Li. The applicant first visited Dr. Li, six days post-accident on June 15, 2018, where it was noted that the applicant was suffering from neck pain, including stiffness, mild headache, tenderness to the paraspinal muscles, trapezius, and back. However, normal range of motion was noted. The doctor diagnosed the applicant with back sprain/strain, whiplash injury (acute). He prescribed naproxen, and baclofen and referred the applicant for physiotherapy treatment.⁵

14The X-rays taken on the date of the accident revealed no visible fractures, subluxations, or dislocations in his cervical and lumbar spine.⁶ However, X-rays taken on August 13, 2018, approximately two-months post-accident, revealed degenerative disc disease in the applicant’s lower back at vertebrae L3, L4, L5, and S1. It was further noted there was disc space narrowing and marginal osteophyte formation and a mild loss of height suggesting a mild compression fracture at L1.⁷

15Dr. Li’s clinical notes and records reveal reports of back pain nine times between June 15, 2018 and August 28, 2020. However, this back pain was only linked to the accident on two occasions, on June 15, 2018 and October 11, 2019. Similarly, neck pain related to the accident was only noted once, on June 15, 2018.

16By January 15, 2019, the applicant was noted to have normal posture, gait and balance, was able to touch his toes, range of motion was noted as normal, with mild tenderness in paraspinal muscles and lower back.⁸ Notes of back pain were accompanied by references to standing and lifting as part of his employment.⁹ The sole reference to lower back pain linked to the accident on October 11, 2019 indicated he was suffering pain since the accident and due to lifting at work.¹⁰

17The respondent relies on the Insurers Examination (“IE”) Report of Dr. R. Zabieliauskas, Physiatrist, dated January 14, 2019. While the applicant self-reported a decrease in the range of motion in the neck, tenderness in the paraspinal musculature with spasm, and back pain, Dr. Zabieliauskas noted no overt signs of discomfort during the medical interview. Upon physical examination the doctor noted some tenderness in the trapezius, good range of motion in the neck on all planes and of all upper extremity joints, some tenderness to palpation over lower spinous processes and pain in the lower lumbar zone beyond 50-60% forward flexion.¹¹

18Dr. Zabieliauskas concluded that the applicant suffered soft tissue injuries or strains as a result of the accident that should have healed in the ensuing two to three months, and certainly within six months post-accident. While the applicant may be experiencing some residual pain, Dr. Zabieliauskas found there was no ongoing physical impairment or physical disability attributable to the subject motor vehicle accident.¹²

19Although not otherwise required, the applicant has not provided any s. 25 Assessment Reports regarding his alleged physical impairments. The clinical notes and records of Dr. Li detail reports of pain in the approximate two-year post-accident period. However, few of these reports of pain are explicitly linked to the accident. Similarly, it is clear that the applicant is suffering from degenerative disc disease and osteoarthritis, which combined with his employment as a welder (long periods of standing and lifting) may be a significant source of his physical pain. I am not otherwise persuaded that the accident was a necessary cause of this physical pain.

20Dr. Zabieliauskas was the only medical professional that provided an assessment report with regard to the applicant’s alleged physical impairments. I place significant weight upon his conclusions that the applicant suffered soft tissue injuries as a result of the accident, and that any residual pain was sequelae of these sprains and strains.

21Given the strength of Dr. Zabieliauskas’ report, the lack of a responding s. 25 report, and the sporadic reporting of accident-related pain to Dr. Li, I cannot otherwise conclude that the applicant’s physical impairments were caused by the accident. The sprains and strains outlined in the documents should have been resolved within six months. I am satisfied that any residual pain are sequelae of these minor injuries as outlined in s. 3 of the Schedule. As a result, I am persuaded that the applicant’s injuries fall within the treatment limits of the MIG.

Chronic Pain and the MIG

22The applicant must demonstrate on a balance of probabilities that his functionality has been affected in order to be removed from the MIG. In this matter, I have been provided insufficient evidence to indicate the applicant’s accident-related injuries have had a detrimental impact on his functionality.

23The applicant refers to the American Medical Association Guides (“AMA Guides”)¹³ in attempting to establish the applicant suffers chronic pain as a result of the accident in this case. The AMA Guides state that at least three of the following criteria must be met for a diagnosis:

(i) Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances;

(ii) Excessive dependence on health care providers, spouse, or family;

(iii) Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain;

(iv) Withdrawal from social milieu, including work, recreation, or other social contacts;

(v) Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs; and

(vi) Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.

16These criteria can provide helpful guidance as an interpretative tool for understanding how pain affects an individual’s functional capacity.

17The only potential criterion that may apply to the applicant is the potential development of psychosocial sequelae post-accident, specifically anxiety and fear related to driving. While the applicant continued to operate a motor vehicle in order to travel to work, the clinical notes and records are replete with references to driving phobia. This will be addressed below as part of the psychological analysis.

18Based on the evidence adduced, and in consideration of the AMA Guides criteria, I find the applicant has failed to demonstrate on a balance of probabilities that his injuries fall beyond the treatment limits of the MIG. Simply put, more is required to establish to what extent a chronic condition, be it a syndrome or chronicity of symptoms affects functionality. Although he may satisfy one of the criteria in the AMA Guides, the applicant has not provided sufficient medical evidence to establish that his functionality is impaired and chronic pain is the cause of the disability.

Psychological Impairment and the MIG

19Psychological impairments, if established, fall outside the MIG, because such impairments are not included in the prescribed definition of “minor injuries.” Base on the evidence provided, I am satisfied that the applicant’s psychological impairments place him outside of the treatment limits of the MIG.

20I place weight upon the Psychological Assessment Report provided by Dr. Sharleen McDowall, psychologist and Mandy Fang, Masters of Social Work, dated November 24, 2020. This report included the applicant’s self-reports of fear while driving, anxiety when observing other vehicles following his, hypervigilance while driving, and flashbacks of the accident.¹⁴ This report provided the only objective psychometric testing tendered in evidence. These professionals conducted the Beck Depression Inventory II, Beck Anxiety Inventory, Patient Pain Profile, and the Impact of Event Scale – Revised. Following the clinical interview and testing, a Diagnostic and Statistical Manual of Mental Disorders (“DSM-V”) diagnosis of major depressive disorder with anxious distress, specific phobia (travel) was rendered in relation to the accident. Dr. McDowall and Ms. Fang indicated that the applicant’s psychological impairment was significant and compelling and recommended a course of fourteen cognitive behavioural sessions of treatment, followed by an in-vehicle practicum.¹⁵

21The findings of the s. 25 Psychological Assessment are bolstered by the Dr. Li’s clinical notes and records. The applicant reported nightmares or driving phobia 11 times between June 15, 2018, and August 28, 2020.¹⁶ This indicates a clear and consistent pattern of reporting of these psychological symptoms, which were not present in the pre-accident medical records. On January 31, 2019, Dr. Li also made a psychological referral related to the applicant’s phobia, insomnia, and depression.¹⁷

22The respondent relies on the Psychiatry IE Assessment conducted by Dr. R. Hines, psychiatrist in his report dated July 17, 2019. Following a review of the applicant’s medical history and a clinical interview, Dr. Hines concluded there was no objective evidence of any emotional or cognitive symptoms as described by the applicant. These symptoms in themselves were not reflective of a psychiatric illness or diagnosis.¹⁸

23The doctor indicated there was no mental health diagnosis or impairment as a result of the accident. Otherwise, any subjectively reported emotional symptoms would be predominantly considered a minor injury.¹⁹ However, conspicuously absent in this report was any indication that objective psychological testing was conducted, nor was there an indication of the specific tests administered. In my, view this is a fundamental weakness in the reliability of this report.

24While I do not dispute that Dr. McDowall and Ms. Fang’s report does not expressly state the medical documents reviewed, and largely reflect the applicant’s own self-reporting, it does provide a specific DSM-V diagnosis based on the objective psychological testing conducted. Given the evidence tendered, I am persuaded that the applicant does suffer from specific phobia (travel), particularly given the extensive references to driving phobia outlined in the clinical notes and records provided.

25Thus, I am persuaded that the applicant suffers a psychological impairment that would remove him from the treatment limit of the MIG.

Income Replacement Benefits (“IRBs”)

26The applicant is seeking IRBs for the period from June 24, 2019, to date and ongoing. I find the applicant is not entitled to IRBs for this period.

27The test for eligibility to receive IRBs within 104 weeks of the accident is set out in s. 5(1) of the Schedule. An insured person is eligible to receive IRBs if, as a result of the accident, they suffer a substantial inability to perform the essential tasks of their pre-accident employment within 104 weeks after the accident.

28The applicant bears the burden of proving on a balance of probabilities that he is entitled to IRBs for the period from June 24, 2019, to date and ongoing.

29Both OCF-3’s dated June 29, 2018, and June 21, 2019 indicate the applicant was substantially unable to perform the essential tasks of his employment at the time of the accident as a result of and within 104 weeks of the accident.²⁰

30Prior to the accident, the applicant was employed at Commercial Design Systems as a welder. He returned to work after one day post-accident. According to the applicant’s submissions, the essential duties of his employment included long periods of standing, upper body coordination, heavy lifting, concentration, and focus.

31However, the applicant failed to provide any objective evidence related to the essential tasks of his employment as a welder. The applicant indicated to Dr. Zabieliauskas that his employment consisted primarily of welding window frames. According to the Record of Employment provided, the applicant’s last date of employment with Commercial Design Systems was May 5, 2019.²¹

32The applicant submits he was then employed in September 2019 by F.A.B. Stainless Inc. as a welder. The applicant submits this position included lighter duties, but he earned a lesser wage than his previous employment. However, the applicant failed to provide any evidence of any accommodation or reduction in wages as a result of his physical impairments. In fact, the applicant failed to provide any employment file or evidence related to his employment at F.A.B. Stainless.

33Again, I find the IE Physiatry Report dated January 14, 2019, by Dr. Zabieliauskas persuasive. In examining the substantial inability test, Dr. Zabieliauskas noted the applicant continued to work as a welder on a full-time basis from 7:00 am to 4:30 pm, Monday to Friday, occasionally working an hour of overtime, or a six-hour overtime shift on Saturdays.²² Following a physical examination Dr. Zabieliauskas concluded the applicant was able to perform all the essential tasks of his employment as a welder without any physical restrictions or functional limitations.²³

34Dr. Zabieliauskas’ conclusions are supported by the surveillance conducted from September 30 to October 1, 2019. During this period the applicant was observed working at F.A.B. Stainless Inc. as welder. He was specifically observed seated in a chair welding and assisting pushing a large cylinder into the building.²⁴ The applicant was otherwise observed working without restriction or difficulty.

35Even if I had compelling evidence related to the essential tasks of the applicant’s pre-accident employment, Dr. Li’s clinical notes and records do not provide evidence of a substantial inability required to meet the test for IRBs. While these records do provide evidence the applicant may suffer some ongoing pain, the applicant has not established this pain is a result of the accident-related impairments, and he continues to work on a full-time basis as a welder. While I do accept that the applicant suffers from driving phobia as diagnosed by Dr. McDowall and Ms. Fang, he continues to drive to work five (or six) days a week.

36Based on the totality of the evidence adduced, I cannot otherwise conclude that the applicant has demonstrated he has substantial inability to perform the essential tasks of his pre-accident employment as a welder. Thus, he is ineligible to receive IRBs from June 24, 2019, to date and ongoing.

Chiropractic Treatment

37Given my findings above, with regard to the applicant’s physical impairments, I am not satisfied these two OCF-18s for chiropractic treatment are reasonable and necessary.

38Sections 14 and 15 of the Schedule provide that the insurer shall pay medical benefits to, or on behalf of, an applicant so long as the applicant sustains an impairment as a result of an accident and the medical benefit is a reasonable and necessary expense incurred by the applicant as a result of the accident.

39The applicant bears the onus of proving entitlement to the proposed treatment by proving both OCF-18s are reasonable and necessary on a balance of probabilities.²⁵

40Again, given the strength of Dr. Zabieliauskas’ report, the lack of a responding s. 25 report, and the sporadic reporting of accident-related pain to Dr. Li, I cannot otherwise conclude that the applicant’s physical impairments were caused by the accident. The sprains and strains outlined in the documents should have been resolved within six months. I am satisfied that any residual pain are sequelae of these minor injuries as outlined in s. 3 of the Schedule. As a result, I am not persuaded that these two treatment plans are reasonable and necessary pursuant to the Schedule.

Medication and Ambulance Expense

41The applicant is claiming expenses in the amount of $192.02 provided by way of an Expenses Claim Form (“OCF-6”) dated December 21, 2018. I am persuaded that some of these medications, and the ambulance charge are reasonable and necessary pursuant to s.15(1)(c) of the Schedule.

42I can determine that the respondent is liable to pay a prescription medication if:

a. the motor vehicle accident caused the impairment that necessitates the prescription medication;

b. the prescription medication is reasonable and necessary, and

c. a regulated health professional provides the prescription.²⁶

43The applicant provides three separate claims for medication from July 13, 2018, September 28, 2018, and December 14, 2018. There are total of ten prescription records detailing medication expenses in the amount of $147.02.

44I am persuaded that $97.90 in medication expenses are reasonable and necessary. Given that I have found the applicant is out of the treatment limits of the MIG due to a psychological diagnosis – specific phobia (travel) as a result of the accident. These medications are either anti-depressants or used to treat depression and anxiety, and they were prescribed by Dr. Li, the applicant’s family physician:

Auro-Mirtazapine – $9.40 – prescribed July 13, 2018

Cymbalta – $44.25 – prescribed September 28, 2018

Cymbalta – $44.25 – prescribed December 14, 2018.

45I do not find that the remainder of the medication expenses in the amount of $44.12 are reasonable and necessary pursuant to the Schedule. These medications are unrelated to the accident. They include an antifungal (Lamisil Terbinafine), a dental paste (Oracort), a bronchodilator (Orciprenaline), and Naproxen (a common NSAID).

46I am satisfied that the applicant is entitled to $45.00 for an ambulance expense on the date of the accident.

47Section 38(2) of the Schedule provides than an insurer is not liable to pay for a medical benefit if it was incurred before the insured submitted a treatment plan unless several exceptions are met. This includes 38(2)(b), an expense for an ambulance or other services provided on an emergency basis within five days of the accident.

48This expense is an exception to s. 38(2), as it was incurred on the date of loss directly following the accident. Given the applicant has now been placed outside of the treatment limits of the MIG, I am otherwise satisfied this expense is reasonable and necessary.

49In total, $142.90 is payable pursuant to the OCF-6 dated December 21, 2018.

Cost of a Psychological Assessment

50Given the applicant’s diagnosis of specific phobia (travel), provided by Dr. McDowall and Ms. Fang, and the repeated self-reporting of driving phobia to Dr. Li in the two years post-accident, I am persuaded the psychological assessment in the amount of $2,200.00 is reasonable and necessary.

51In 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 she has the condition for which he seeks the assessment.

52As stated above, I remain unpersuaded by the Psychological IE report provided by Dr. Hines, particularly because it did not include any specific reference to the objective psychological testing undertaken. Without any objective testing to undergird his diagnosis that the applicant does not have a mental health diagnosis or impairment as a result of the accident, I cannot otherwise place any weight upon this report.

53Conversely, the report provided by Dr. McDowall and Ms. Fang did include objective psychological testing results in support of their DSM-V diagnosis that includes specific phobia (travel) as a result of the accident.²⁷ Any weaknesses in this report, including whether these practitioners reviewed the previous clinical notes and records is otherwise bolstered by the pattern of reporting that emerged from Dr. Li’s clinical notes and records. These records revealed a consistent pattern of reported driving phobia at least ten times in the period between June 15, 2018 and August 28, 2020.²⁸ This is a pattern I cannot otherwise ignore, especially in light of the diagnosis rendered by Dr. McDowall and Ms. Fang.

54Given the persuasive evidence provided regarding the applicant’s driving phobia, I am satisfied the psychological assessment in the amount of $2,200.00 is reasonable and necessary.

Interest

55The applicant is entitled to interest on the psychological assessment expense in the amount of $2,200.00 and expenses outlined in the OCF-6 dated December 21, 2018, in the amount of $142.90. Interest on these amounts shall be paid in accordance with s. 51 of the Schedule.

ORDER

56I find that:

i. The applicant’s psychological impairment is not predominantly minor, nor subject to treatment within the $3,500.00 limit of the Minor Injury Guideline;

ii. The applicant is not entitled to an income replacement benefit in the amount of $400.00 per week from June 24, 2019 to date and ongoing;

iii. The OCF-18’s for chiropractic treatment dated September 7, 2018 and November 2, 2018 are not reasonable and necessary;

iv. The applicant is entitled to medication and an ambulance expense in the amount of $142.90 pursuant to the OCF-6 dated December 21, 2018;

v. The applicant is entitled to $2,200.00 for a psychological assessment as per the OCF-18 dated April 14, 2019;

vi. The applicant is entitled to interest on overdue payments of benefits pursuant to s. 51 of the Schedule.

Footnotes

1. 1Written Submissions of the Applicant, Records of North York General Hospital, June 9, 2018, Tab 2.
2. 2Scarlett v. Belair Insurance, 2015 ONSC 3635, para. 24 (Div. Ct.).
3. 3Written Submissions of the Applicant, Disability Certificate dated June 29, 2018, Tab 6.
4. 4Written Submissions of the Applicant, Disability Certificate dated June 21, 2019, Tab 12.
5. 5Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li June 15, 2018, Tab 3A.
6. 6Written Submissions of the Applicant, Records of North York General Hospital, June 9, 2018, Tab 2.
7. 7Written Submissions of the Applicant, Report of North Scarborough X-Ray and Ultrasound August 13, 2018, Tab 3A.
8. 8Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, January 15, 2019, Tab 3A.
9. 9Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, July 13, 2018, December 14, 2018, April 13, 2019, Tab 3A.
10. 10Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, October 11, 2019, Tab 3B.
11. 11Written Submissions of the Respondent, Physiatry Report of Dr. Raymond Zabieliauskas, January 14, 2019, Tab 10.
12. 12Ibid.
13. 13American Medical Association, Guides to the Evaluation of Permanent Impairment, 6th Edition, 2008, pp. 23-24.
14. 14Written Submissions of the Applicant, Psychological Assessment Report by Dr. Sharleen McDowall and Mandy Fang, November 24, 2020, Tab 1.
15. 15Ibid.
16. 16Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, Tabs 3A, 3B.
17. 17Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, January 31, 2019, Tab 3B.
18. 18Written Submissions of the Respondent, Psychiatry Assessment Report of Dr. Robert Hines, July 17, Tab 4.
19. 19Ibid.
20. 20Written Submissions of the Applicant, Disability Certificates, Tabs 6 and 12.
21. 21Written Submissions of the Applicant, Record of Employment, May 13, 2019, Tab 14.
22. 22Written Submissions of the Respondent, Physiatry Report of Dr. Raymond Zabieliauskas, January 14, 2019, Tab 10.
23. 23Ibid.
24. 24Written Submissions of the Respondent, Delta Investigations Report, October 7, 2019, Tab 12.
25. 25Scarlett v. Belair Insurance, 2015 ONSC 3635 at paras. 20-24.
26. 2616-001809/AABS v. CUMIS General Insurance, 2017 CanLII 19204 (ON LAT), para 29.
27. 27Written Submissions of the Applicant, Psychological Assessment Report by Dr. Sharleen McDowall and Mandy Fang, November 24, 2020, Tab 1.
28. 28Written Submissions of the Applicant, Clinical Notes and Records of Dr. Heung-Wing Li, Tabs 3A, 3B.