Licence Appeal Tribunal File Number: 21-007210/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:
Sivagnnam Kiddidapillai
Applicant
and
Allstate Insurance
Respondent
DECISION
ADJUDICATOR:
Nishant Nayak
APPEARANCES:
For the Applicant:
Jeremy Magence, Counsel
For the Respondent:
April Snow, Counsel
HEARD BY WAY OF WRITTEN SUBMISSIONS
BACKGROUND
1Sivagnnam Kiddidapillai (“the applicant”) was involved in an automobile accident on September 20, 2018, and sought benefits from Allstate Insurance Company (“the respondent”), pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016), (“Schedule”).
2The respondent denied the applicant’s claims, because it determined that all of the applicant’s injuries fit the definition of a “minor injury” as prescribed by s. 3(1) of the Schedule and, therefore, are subject to the Minor Injury Guideline (“MIG”). As a result, the Applicant submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefits Service (“Tribunal”) for resolution of the dispute.
ISSUES IN DISPUTE
3The following issues are to be decided:
Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the MIG? (Note: The parties agree the MIG limits have been exhausted).
Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Dr. Akram-Pali, in a treatment plan/OCF-18 (“plan”), submitted on June 12, 2019, and denied on June 24, 2019?
Is the applicant entitled to $2,871.72 for chiropractic services, proposed by Pro Life Wellness, in a plan, submitted on June 28, 2019, and denied on July 11, 2019?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4I find that the applicant has not met his onus of proving that his accident-related impairments warrant removal from the MIG. As the MIG limits have been exhausted, it is unnecessary for me to consider the reasonableness or necessity of the disputed treatment plans. The applicant is also not entitled to interest and the application is dismissed.
Procedural Issue
5In the respondent’s reply submissions, it requests that the s. 25 report by Dr. Stacey Nolan, chiropractor, dated November 14, 2021, be excluded as evidence for this hearing. It asserts the applicant produced Dr. Nolan’s report with his initial submissions for this hearing on January 6, 2023, while the production exchange deadline ordered by the Tribunal was October 20, 2022.
6I acknowledge the respondent’s position that Dr. Nolan’s report was submitted late but I am not persuaded that there was any prejudice caused to the respondent as they had an opportunity to provide written submissions on the weight the Tribunal should assign to this report. Therefore, I am allowing Dr. Nolan’s report to be part of the applicant’s evidence.
ANALYSIS
The Minor Injury Guideline (MIG)
7The 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.”
8Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the applicant sustains an impairment that is predominantly a minor injury in accordance with the MIG.
9The 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