Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 21-004727/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:
Patrick Catli
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR: Harry Adamidis
APPEARANCES:
For the Applicant: Michael Yermus, Counsel
For the Respondent: Jessica Bacopulos, Counsel
HEARD: By written submissions
OVERVIEW
1Patrick Catli, the applicant, was involved in an automobile accident on October 10, 2019, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Aviva General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2Where more context is required, it is appropriate to include it in the overview section so that the reader has a better understanding of the background informing the dispute. This may include, for example, relevant timelines, novel circumstances, or unique procedural history. It is not necessary to rehash the mechanics of the accident unless it is pivotal to the issue.
ISSUES
3The issues in dispute 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 Minor Injury Guideline limit?
ii. Is the applicant entitled to $2,575.12 for chiropractic services, proposed by Downsview Health Inc. in a treatment plan which was denied on April 7, 2021?
iii. Is the applicant entitled to $1,242.56 for chiropractic services, proposed by Downsview Health Inc. in a treatment plan which was denied on April 7, 2021?
iv. Is the applicant entitled to $1,910.08 for chiropractic services, proposed by Downsview Health Inc. in a treatment plan which was denied on April 7, 2021?
v. Is the applicant entitled to $1,866.28 for chiropractic services, proposed by Downsview Health Inc. in a treatment plan which was denied on April 7, 2021?
vi. Is the applicant entitled to $1,234.24 for chiropractic services, proposed by Downsview Health Inc. in a treatment plan which was denied on April 7, 2021?
vii. Is the applicant entitled to $2,200.00 for goods and services, proposed by Oshawa Physiotherapy and Rehabilitation Centre in a treatment plan which was denied on April 7, 2021?
viii. Is the applicant entitled to $6,100.00 for goods and services, proposed by Oshawa Physiotherapy and Rehabilitation Centre in a treatment plan which was denied on April 7, 2021?
ix. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld delayed payments to the applicant?
x. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule.
5He is not entitled to the disputed treatment plans, interest, nor an award.
ANALYSIS
Minor injury guideline (MIG)
6I find that the applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule.
7Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury. Section 3(1) defines a “minor injury” as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
8An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, under s. 18(2), that they have a documented pre-existing injury or condition combined with compelling medical evidence stating that the condition precludes recovery if they are kept within the confines of the MIG. The Tribunal has also determined that chronic pain with functional impairment or a psychological condition may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
9The applicant submits that he should be removed from the MIG because he has been diagnosed with chronic pain syndrome.
10The respondent submits that the applicant only has musculoskeletal pain and he has