Gutta v. Economical Insurance, 2022 CanLII 87734

Citation: Gutta v. Economical Insurance, 2022 ONLAT 20-007347/AABS

Licence Appeal Tribunal File Number: 20-007347/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:

Anna Gutta

Applicant

and

Economical Insurance

Respondent

DECISION [AND ORDER]

ADJUDICATOR: Gregory Kung

APPEARANCES:

For the Applicant: Anna Gutta, Applicant Vaishali Chugh, Paralegal

For the Respondent: Jody Gleeson, Litigation Specialist Daniel Smith, Counsel

HEARD: By Way of Written Submissions

REASONS FOR DECISION [AND/OR ORDER]

BACKGROUND

1The applicant, Anna-Maria Gutta, was involved in an automobile accident on March 17, 2017, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016).

2The applicant was denied certain benefits by the respondent, Economical Mutual Insurance Company, and submitted an application to the License Appeal Tribunal – Automobile Accident Benefits Service (“Tribunal”).

ISSUES

3The following issues are to be decided:

(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 a medical benefit in the amount of $3,800.00 for physiotherapy treatment, recommended by Airport Rehab in a treatment plan (OCF-18) dated March 5, 2019?

(iii) Is the applicant entitled to a medical benefit in the amount of $3,175.84 for multi-disciplinary treatment, recommended by Airport Rehab in an OCF-18 dated September 1, 2020?

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

RESULT

4I find that the applicant sustained a minor injury as a result of the accident and is subject to the MIG.

5The applicant is not entitled to the March 5, 2019 and September 1, 2020 OCF-18s for physiotherapy and multidisciplinary treatment because the OCF-18s propose treatment outside of the MIG.

6No interest is payable.

ANALYSIS

The Minor Injury Guideline (MIG)

7The main consideration that the Tribunal must decide upon is whether the applicant sustained a minor injury as defined in the Schedule and is therefore subject to the MIG and the $3,500.00 finding limit for minor injuries.

8The 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.

9Section 18(1) limits recovery for medical and rehabilitation benefits for predominantly minor injuries to $3,500.00. An applicant may be entitled to medical benefits beyond the $3,500.00 cap 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 that they sustained an injury that falls outside of the minor injury definition. It is the applicant’s burden to establish entitlement to coverage beyond the $3,500.00 cap on a balance of probabilities.¹

10The Tribunal has also found that chronic pain syndrome would remove an injured person from the MIG, as this diagnosis is not included in the definition of “minor injury” in s. 3(1) of the Schedule.

Positions of the Parties

11On March 17, 2017, the applicant was involved in a motor-vehicle accident. She was transported to hospital. X-rays were completed and the findings noted, “no compression fractures of the thoracic spine, left knee alignment is satisfactory. No fracture or dislocation. No suprapatellar joint effusion…no acute abnormality in the thorax or left knee.”²

12Following the accident, the applicant saw Dr. Shobha Divakar, walk-in family physician. His medical notes comment on “mild swelling”³ on the left knee and a bruise. He remarked that “movements ok, not restricted.”⁴ He noted a superficial cut on the right middle finger without active bleeding or signs of fracture as well as a mild bruise on left breast and right infracavicular. He concluded by diagnosing the applicant with “MVA and multiple minor injuries.”⁵

13An MRI found the applicant to have minor grade 2 chondromalacia patella and mild pre-tibial pre-patellar bursitis, with the amount of joint fluid within normal range. Dr. Liu, radiologist, noted a “questionable partial ACL tear without bone contusion…no meniscual tear.⁶

14Based on this initial diagnosis, the applicant has appealed that these injuries sustained from her motor vehicle accident are not minor. She has indicated that she suffers from ongoing psychological injuries and chronic pain syndrome which is impacting her functionality. She believes that both her psychological injuries and chronic pain syndrome, which were a result from her accident, fall outside of the minor injury definition. It is her submission that these injuries are not included in the minor injury definition and thus, she should not be subject to the $3,500.00 funding limit on medical and rehabilitation benefits. She has submitted two treatment plans in dispute at the recommendation of her treating practitioner. She believes that these OCF-18s are reasonable and necessary based on the fact that the treatment

15The respondent submits that the applicant’s injuries do not take her out of the MIG. They believe that all evidence points to the applicant suffering soft tissue injuries and that the applicant has not been able to prove on a balance of probabilities that she suffers from chronic pain syndrome nor any psychological injuries which rise above mere sequalae from the predominant injury. The respondent submits that the applicant has failed to prove on a balance of probabilities that her injuries are not minor pursuant to s. 3(1) of the Schedule. The respondent argues that the applicant has been able to resume her pre-accident lifestyle including driving and that any pre-existing injuries that the applicant is claiming have not prevented the applicant from recovering from the current minor injuries.

16I find that the applicant has failed to meet her onus of proving on a balance of probabilities⁷ that she suffers from an injury that falls outside of the minor injury definition.

Chronic Pain and the MIG

17The applicant indicates that she developed a chronic pain condition and that chronic pain is an injury that is not included in the minor injury definition. The applicant argues that she was diagnosed with chronic left knee pain in January 2021 and that her injuries have had a direct impact on her functionality and mobility.

18The applicant must demonstrate on a balance of probabilities that her functionality has been affected by the pain from the current injuries in order to be removed from the MIG. In this matter, I have not been provided with evidence that overwhelmingly indicates the applicant’s accident-related injuries have had a detrimental impact on her functionality. More is required to establish to what extent a chronic pain condition, be it syndrome or “chronicity of symptoms”, affects functionality. This opinion must be supported by medical evidence that establishes an applicant’s functionality is impaired and that the chronic pain is the cause of the disability.

19The Tribunal has repeatedly adopted the approach of assessing an applicant’s claim of chronic pain against the six criteria described in the American Medical Association Guides (AMA Guides),⁸ which 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.

20I find that the applicant’s evidence fails to demonstrate that pain impacts her functionality. The applicant relies on Dr. Sofia Elahi, family physician, concluding through a phone consultation that she had “chronic left knee pain.”⁹ The applicant draws attention to communication between Dr. Anthony Galea, sports doctor, and Dr. Elahi in a letter dated May 5, 2021, referred to the applicant as having, “chronic and persistent pain.”¹⁰ She also relies on the submitted OCF-18s which describe her injuries as not falling within the MIG and that they are impacting her ability to carry out her activities of normal life.

21The applicant submits that she was also diagnosed by a chiropractor with chronic post-traumatic headaches above and beyond any other minor injuries and that his documentation confirms her functionality has been impaired. She attended Prime Physiotherapy & Rehab on October 26, 2017 and Dr. Murciano, chiropractor, noted in his OCF-3 that he believed the applicant had chronic post-traumatic headache, dating back to the accident.¹¹ Due to these injuries, Dr. Murciano also believed that the applicant would be substantially unable to perform the essential tasks of her employment at the time of the accident as a result of and within 104 weeks of the accident, adding that the applicant “cannot work out, has trouble with house chores” with an anticipated duration being 9-12 weeks.¹²

22The applicant relies on Anna Bajwa, physiotherapist, from Airport Rehab to describe her impaired functionality. Ms. Bajwa performed an assessment on the applicant on February 23, 2019, which provided the information to complete the March 5, 2019 OCF-18. Ms. Bajwa relayed the applicant’s self-report that she was still suffering from left knee pain with difficulty standing after sitting for a long period of time. Movements such as reaching, overhead movements, lifting, carrying, bending at the waist, lumbar loading and stooping were described as painful and aggravating. The applicant reported to Ms. Bajwa that she had difficulty with household chores and disturbed sleep from the pain. However, I note that assessments in February 2020 recorded “disturbed sleep…post MVA initially now improving” and completing all personal care tasks independently while a July 2020 assessment read that the applicant had “okay sleep” and was able to perform all house keeping and personal care tasks independently.¹³

23The applicant reported independence with her personal care tasks and day to day functionality. The respondent ordered a physiatry assessment at SOMA Medical Assessments. Dr. Seyed Hosseini, physiatrist, performed the assessment on January 3, 2018. The respondent relies heavily on this assessment. Dr. Hosseini’s assessment covers the applicant’s self-reporting on her activity levels and occupational ability. Based on the assessment, it clearly indicates that the applicant, “is independent in completing all of her personal care tasks…back to performing her household responsibilities…prior to the subject’s accident she was socially very active…Currently, she is back to these activities. She has returned to driving.”¹⁴

24In regard to her occupational history and comparing it to the evidence before me, it is obvious to me that the applicant’s functionality to work was not impacted by the injuries. To Dr. Hosseini, the applicant “reported remaining off work for one week…after the accident, she took on a second job… currently she is back to full time work on regular hours and duties.” The applicant shared with Dr. Hosseini that she was working full-time as a real-estate agent at the time of the accident and took a second job as a travel booking agent. She described both positions as “primarily working from home.”¹⁵ Yet, the applicant’s self-reporting on her employment appeared to change from assessment to assessment, as she reported to Dr. Murciano that she was not working at the time of the accident and did not work at least 26 weeks of the previous 52 weeks preceding the accident.¹⁶ She then reported to Dr. Murciano that she could return to work on modified hours and/or duties and required a knee brace when her job requires walking, but made no mention to him that she was back to working full-time hours. This is further confirmed by Ms. Bajwa who noted on February 23, 2019, that the applicant is working full-time, 7 days a week, without accessing Employment Insurance. In July 2020, the applicant indicated to Ms. Bajwa that she was not working pre-MVA.¹⁷ However, Ms. Bajwa further confirms in a February 2020 assessment that the applicant has “returned to full demands” for work.

25The evidence does not show that the applicant had any dependence on pain medication. Multiple assessment reports state that the applicant did not like taking oral medications or that she reported only taking it occasionally when needed. There is no mention of the applicant having to rely on others to perform daily tasks, nor did she withdraw from social milieu.

26I have contemplated the reconsideration decision of T.S. v. Aviva General Insurance Canada as part of my deliberations¹⁸ In that reconsideration decision, the Executive Chair held that the definition of minor injury in s. 3(1) of the Schedule does not encompass an impairment such as chronic pain.¹⁹ In response, the respondent highlighted the further description of chronic pain in T.S. v. Aviva by the Executive Chair as, “ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual's well-being.”²⁰ Though I may be inclined to believe that the applicant experiences some recurrent pain, I do not find that there is clinical evidence that this pain is affecting her functionality.

27While two clinicians have labelled the applicant as having chronic pain, I prefer the respondent’s evidence over the applicant’s. I also find that the evidence submitted by both the applicant and respondent overwhelmingly show that the applicant’s functionality has not been impaired by her injuries.

28As regards to the chronic headaches, I note there was no other mention of chronic headaches or headaches for that matter in any of the other medical evidence before me. Other than Dr. Murciano’s assessment, the applicant did not raise this as an issue to any other health practitioner in any of the documentation after 2017.

29When assessing these diagnoses, I do note that both of these diagnoses were made in 2021, nearly three years after the accident. There is no other medical evidence that supports a chronic pain syndrome diagnosis prior to 2021. In my view, Dr. Galea did not specifically diagnose the applicant with a chronic pain syndrome; he makes no diagnosis in any of his clinical notes. Granted, a diagnosis of chronic pain does not automatically take an applicant out of the MIG; an assessment of the applicant’s functionality must also be taken into consideration.

30The applicant has pointed to her self-reports of pain and impaired functionality in her OCF-3 and OCF-18s to support her claim of her complete inability to live a normal life. However, I have not found any compelling evidence to support this, as these documents are not consistent with concurrent medical evidence. Any suggestion that the applicant would be unable to work in her submitted OCF-3 was quickly dismissed when she secured a second job after the accident and resumed working a week after the accident. According to the evidence, she maintained full working capabilities and there is no evidence to suggest that she ever was unable to work due to her injuries. I note that Dr. Murciano himself, concluded that the applicant’s inability to perform housekeeping and home maintenance services that she normally would perform pre-accident would resolve in 9-12 weeks. He made no suggestion that the applicant’s injuries would be chronic in nature.

31Furthermore, clinical documentation shows that her pain was resolving and condition improving. According to Dr. Hosseini, the applicant, nearly 10 months after the accident, appears to have fully resumed her pre-accident lifestyle: taking care of any housekeeping, driving, and attending social outings with her friends, and “was observed to move independently with sufficient ease from the sitting to standing to supine positions and vice versa.”²¹ Dr. Hosseini noted in his assessment that during testing the applicant was able to move independently with sufficient ease from the sitting to standing to supine positions with a normal and non-antalgic gait.²² This objective medical evidence demonstrates the applicant’s functionality in her legs, which I give significant weight.

32Dr. Elahi has remarked on the applicant’s more recent condition and functionality. On January 20, 2021, Dr. Elahi had a phone consultation with the applicant to discuss results of the MRI. The applicant reported that “her knee feels better since she is not physically active anymore.”²³ On March 2, 2021, Dr. Elahi after discussing with the applicant about her X-rays and MRIs being negative for any significant injury, she noted in regard to the applicant that, “her pain has healed.”²⁴

33I prefer the notes from Dr. Hosseini, Ms. Bajwa and Dr. Elahi. They demonstrate that her occasional pain was treated with Advil when needed, occasional physiotherapy and icing. Furthermore, according to the evidence before me, the applicant was independent, resumed social activities and increased her workload and the pain in her leg did not require mobility aids or leave her with any inability to ambulate.

34While the applicant submits that her submitted evidence constitutes a chronic pain diagnosis, when assessing the totality of clinical evidence before me, I do not find that the applicant’s functionality has been impaired. Based on the evidence provided by both parties and in consideration of the AMA Guides criteria, I find the applicant has failed to demonstrate on a balance of probabilities that her injuries are outside of the MIG as a result of chronic pain. The applicant has not provided sufficient medical evidence to establish that she meets three or more of the AMA Guides criteria or that the intermittent pain that she is experiencing is not merely sequalae of her minor injuries.

Psychological Impairments and the MIG

35Psychological impairments, if established, fall outside the MIG, because such impairments are not included in the prescribed definition of a “minor injury.” The applicant has also submitted that she suffered from pre-existing conditions that cannot be treated within the MIG limits and would prevent maximum medical recovery.

36While, these two criteria are normally assessed separately, I have combined the two as the applicant submits that two previous vehicular accidents left her with psychological injuries that were unresolved creating a barrier in her recovery from the current injuries. She has not claimed that any physical injuries previously have prevented her recovery.

37I find that the applicant has not demonstrated that she sustained a psychological injury as a result of the accident nor had a pre-existing condition that would prevent maximal recovery if she is subject to the MIG limit.

38The applicant submits that she “has suffered significant psychological symptoms as a result of the accident.”²⁵ The applicant refers to an independent psychological assessment performed by Dr. John Lee, psychologist. Dr. Lee completed the assessment on January 9, 2018. There is no evidence of any psychotherapy, counselling, or assessment for any possible psychological impairment between the accident and this assessment and most importantly no mention of any psychological complaints in the evidence before me.

39I find Dr. Lee’s conclusion in his report dated January 19, 2018, regarding the applicant’s claim of pre-existing psychological injuries to be compelling. The applicant reported to Dr. Lee that following two prior motor vehicle accidents in 2009 and 2012, she experienced stress and vehicle anxiety but required no treatment and describes the applicant as generally coping with these symptoms. Since the 2017 accident, she described further stress with “[residual] vehicle anxiety and dealing with the impact of her accident on her weight and with regards to the bureaucracies of having an accident claim.”²⁶ She explained to Dr. Lee that previous stress never went away but was exacerbated by the current accident. She attempts to make the case in her submissions that these previous psychological impairments have prevented her from fully recovering from this accident and moreso have intensified her current psychological injuries.

40There are no prior mental health diagnoses and no medical records confirming the presence or extent of the applicant’s psychological injuries from previous motor vehicle accidents. However, I note that the applicant commented during the assessment that she expected her condition to improve over time with continued exposure to driving.²⁷ She denied any psychosis or having nightmares, and stated she had normal eating habits and a generally normal mood. She reported “no outstanding psychological or physical complaints,”²⁸ which was corroborated by Dr. Lee who noted that she had “no history of mental health diagnoses or chronic health conditions.”²⁹ Dr. Lee is clear in his conclusion that “the claimant’s pre-accident of elevated stress related to prior motor vehicle accidents is not considered to negatively impact her recovery.”³⁰

41I find Dr. Lee’s assessment of the applicant’s self-reporting to be integral when considering the applicant’s psychological impairment claim. Dr. Lee notes in his clinical observations that during the assessment the applicant became “teary-eyed”³¹ when self-reporting. The assessment notes that the applicant believed she does not need any formal psychological intervention, she “continually advised this assessor [Dr. Lee] that at this juncture, she did not feel she required psychological treatment.”³² Dr. Lee did not note any cognitive impairment, thought disorder, delusions, or hallucinations.

42Dr. Lee completed several psychological tests on the applicant. On the Pain Patient Profile (P-3), the applicant scored invalid scores due to omitted responses. For the Trauma Symptom Inventory (TSI-2-A) the applicant showed no significant elevation on any clinical scale, which indicated a relative absence of trauma-related psychological distress. The applicant also completed the Millon Clinical Multiaxial Inventory-III (MCMI-III). Her profile indicated a low self-disclosure rate with a moderate tendency to present positively. It showed elevation in “traits indicative of independent and highly self-assured individuals.”³³ Dr. Lee noted no significant elevations on any clinical scales, which indicated a relative absence of psychological distress that would reach clinical proportions.

43Dr. Lee concludes in his assessment that the applicant displays emotional adjustment symptoms that do not “reach the threshold for a diagnosable mental health disorder at this juncture.”³⁴ He adds that psychological testing revealed no clinically significant findings. As there is no proposed treatment plan for psychological services, Dr. Lee made no commentary on the two OCF-18s before the Tribunal.

44As the only clinician with expertise on psychological injuries or impairments, I find Dr. Lee’s psychological assessment report is uncontested. He concludes that the applicant has no psychological impairment from the accident or at least any that would take the applicant outside of the MIG. His further commentary that the applicant’s previous motor vehicle accidents and the applicant’s self-reported stress and anxiety have no impact on the applicant’s recovery from her injuries from this vehicle accident are helpful for analysis.

45Section 8(d) of the MIG states that additional funds up to a maximum of $400.00 are available to provide supplementary goods and additional services to support restoration of functioning and address barriers to recovery. These can include, “supportive interventions such as advice/education to deal with accident-related psycho-social issues, such as but not limited to: distress, difficulties coping with the effects of his/her injury; driving problems/stress.”³⁵

46I find Dr. Lee’s assessment persuasive where he believes she has adjustment symptoms that fall within the parameters of the MIG. “The claimant does exhibit residual adjustment symptoms that fall within the treatment parameters of the [MIG], as a result of the motor vehicle accident.”³⁶ While the applicant has never submitted any psychological treatment plans, Dr. Lee has suggested that “supportive interventions” that still fall under the MIG would be helpful for the applicant as he maintains a positive prognosis for the applicant. According to the applicant’s report of her psychological symptoms, I agree with Dr. Lee that they can be characterized as symptoms that remain sequalae of the minor injuries that the applicant sustained.

47I do not find that the fact that the applicant became “teary-eyed” during the psychological assessment to signify a significant psychological injury as the applicant claims. Dr. Lee is clear in his finding that “from the psychological perspective, the claimant does not suffer any sequelae that would exclude her treatment under the [MIG].” Based on the totality of the evidence related to alleged psychological impairments, I find the applicant has not demonstrated on a balance of probabilities that her accident-related impairments fall outside of the minor injury definition.

48There are two treatment plans at issue:

a. a treatment plan (OCF-18) dated March 5, 2019 for physiotherapy services proposed by Airport Rehab in the amount of $3800;

b. an OCF-18 dated September 1, 2020 for multi-disciplinary treatment proposed by Airport Rehab in the amount of $3175.84

49Both treatment plans suggest that the applicant’s injuries cannot be treated within the Minor Injury Guideline. Given that I have determined the applicant’s impairments are subject to the $3,500.00 funding limit on medical and rehabilitation benefits, an analysis of whether the OCF-18s in dispute are reasonable and necessary is unwarranted pursuant to the Schedule because they propose treatment beyond the funding limit, above and beyond what the respondent has already paid out to the applicant.

Interest

50As there are no overdue payment of benefits, the applicant is not entitled to interest pursuant to s. 51 of the Schedule.

CONCLUSION

51For the reasons outlined above, I find that:

i. The applicant has not met her burden of proving that she sustained an injury that is not included in the minor injury definition.

ii. The applicant is not entitled to the March 5, 2019 or September 1, 2020 OCF-18.

iii. The applicant is not entitled to interest on any overdue payment of benefits pursuant to s. 52 of the Schedule.

Released: September 20, 2022

__________________________

Gregory Kung

Adjudicator

Footnotes

1. 1Scarlett v. Belair Insurance, 2015 ONSC 3635, para. 24 (Div. Ct.).
2. 2Applicant Book of Documents, CNRs of Georgian Bay Hospital, March 14, 2017, Tab 1 pages 12-13
3. 3Applicant Book of Documents, CNRs of Dr. Shobha Divakar, March 17, 2017, Tab 2 page 30
4. 4Applicant Book of Documents, CNRs of Dr. Shobha Divakar, March 17, 2017, Tab 2 page 30
5. 5Applicant Book of Documents, CNRs of Dr. Shobha Divakar, March 17, 2017, Tab 2 page 31
6. 6Applicant Book of Documents, CNRs of Dr. Shobha Divakar, September 14, 2017, Tab 2 page 48
7. 7Scarlett v. Belair Insurance, 2015 ONSC 3635, para. 24 (Div. Ct.).
8. 8American Medical Association, Guides to the Evaluation of Permanent Impairment, 6th Edition, 2008, pages 23-24.
9. 9Applicant Book of Documents, CNRs of Dr. Sofia Elahi, March 15, 2021, Tab 4 page 75
10. 10Applicant Book of Documents, CNRs of Dr. Sofia Elahi, May 5, 2021, Tab 4 page 76
11. 11Written Submission of the Application, Disability Certificate OCF-3, October 26, 2017, Tab 6 Part 5
12. 12Written Submission of the Application, Disability Certificate OCF-3, October 26, 2017, Tab 6 Part 6
13. 13Written submission of the application, Airport Rehab Centre Entire Clinical Note, Tab 12
14. 14Applicant Book of Documents, S.44 assessment by Dr. Seyed Hosseini, January 19, 2018, Tab 7 page 110
15. 15Applicant Book of Documents, S.44 assessment by Dr. Seyed Hosseini, January 19, 2018, Tab 7 page 110
16. 16Written Submission of the Application, Disability Certificate OCF-3, October 26, 2017, Tab 6 Part 1
17. 17Written submission of the application, Airport Rehab Centre Entire Clinical Note, Tab 12
18. 182018 CanLII 83520 (ON LAT) (“T.S. v. Aviva”).
19. 19Ibid. at para. 20.
20. 20Ibid. at para. 23.
21. 21Applicant Book of Documents, S.44 assessment by Dr. Seyed Hosseini, January 19, 2018, Tab 7 page 111
22. 22Applicant Book of Documents, S.44 assessment by Dr. Seyed Hosseini, January 19, 2018, Tab 7 page 111
23. 23Applicant Book of Documents, CNRs of Dr. Sofia Elahi, January 20, 2021, Tab 4 page 73
24. 24Applicant Book of Documents, CNRs of Dr. Sofia Elahi, March 2, 2021, Tab 4 page 74
25. 25Written submission of the application, Tab 1 page 7
26. 26Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 122
27. 27Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 122
28. 28Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 123
29. 29Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 120
30. 30Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 127
31. 31Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 120
32. 32Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 120
33. 33Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 124
34. 34Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 126
35. 35“Minor Injury Guideline,” Superintendents Guideline, No. 01/14, page 11
36. 36Applicant Book of Documents, S.44 assessment by Dr. John Lee, January 19, 2018, Tab 8 page 126