Singh v. Economical Insurance, 2023 CanLII 74633

Citation: Singh v. Economical Insurance, 2023 ONLAT 21-006118/AABS

Licence Appeal Tribunal File Number: 21-006118/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:

Daljinder Singh

Applicant

and

Economical Insurance

Respondent

DECISION

ADJUDICATOR: Kate Grieves

APPEARANCES:

For the Applicant: Waqas Amjad, Paralegal

For the Respondent: Suzanne Armstrong, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Daljinder Singh, the Applicant, was involved in an automobile accident on March 13, 2020, 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 Economical Insurance Company, the Respondent, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issues in dispute are:

1. Are the Applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to the Minor Injury Guideline (“MIG”) and the $3,500.00 funding limit on treatment?
2. Is the Applicant entitled to a medical benefit in the amount of $1,803.73 for physiotherapy services proposed by Complete Rehab centre in a treatment plan dated March 2, 2021?
3. Is the Applicant entitled to a medical benefit in the amount of $1,578.11 for physiotherapy services proposed by Complete Rehab centre in a treatment plan dated June 3, 2021?
4. Is the Applicant entitled to medical benefit in the amount of $2,460.00 for a psychological assessment proposed by Complete Rehab centre in a treatment plan dated April 30, 2020?
5. Is the Respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the Applicant?
6. Is the Applicant entitled to interest on overdue payment of benefits?

RESULT

3The Applicant sustained a minor injury as a result of the accident, as defined in section 3 of the Schedule. He is subject to the MIG and the $3,500.00 funding limit on treatment.

4The Applicant is not entitled to the treatment and assessment plans or expenses in dispute because they propose goods and services that are not included in the MIG and above the funding limit.

5No interest is payable, and the Respondent is not liable to pay an award under s. 10 of O.Reg. 664.

6The application is dismissed.

ANALYSIS

7The MIG establishes a treatment 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.” Under section 18 of the Schedule, injuries that are defined as minor are subject to a $3,500.00 funding limit on treatment.

8The onus is on the Applicant to demonstrate that he sustained an injury that is not included in the minor injury definition or that he has a pre-existing health condition that would preclude him from reaching maximal recovery if subject to the MIG and the $3,500.00 funding limit on treatment.

9The treatment and assessment plans in dispute propose treatment that falls outside the MIG. Thus, the Applicant’s entitlement to them is contingent on a finding that his injuries are not included in the minor injury definition. If so, the Applicant must then demonstrate that the treatment and assessment plans are reasonable and necessary on a balance of probabilities. With respect to his award claim, the onus is on the Applicant to demonstrate that the Respondent unreasonably withheld or delayed the payment of benefits.

The Minor Injury Guideline

10The Applicant submits that he suffers from psychological impairments that fall outside the definition of a minor injury. The Respondent submits that he has not met the burden of proving that the accident caused injuries that fall outside of the scope of the MIG. I agree with the Respondent and find that the Applicant has not met his onus to demonstrate entitlement to the benefits claimed.

11The Applicant’s submissions provide a summary of the medical evidence, without explanation or reference to any legal framework that sets out the criteria needed to prove the issues in dispute. An Applicant cannot simply submit evidence and leave it up to the Adjudicator to connect the dots