Prasad v. Sonnet Insurance Company, 2024 CanLII 43440

Citation: Prasad v. Sonnet Insurance Company, 2024 ONLAT 22-006059/AABS

Licence Appeal Tribunal File Number: 22-006059/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:

Srikant Prasad Applicant

and

Sonnet Insurance Company Respondent

DECISION

ADJUDICATOR: Lisa Holland

APPEARANCES:

For the Applicant: Srikant Prasad, Applicant Bianca Pirrotta-Iaccino, Paralegal

For the Respondent: Sonnet Insurance Company Sunjay Mistry, Paralegal

HEARD: By Way of Written Submissions

OVERVIEW

1Srikant Prasad, the applicant, was involved in an automobile accident on December 15, 2019, and sought medical and rehabilitation benefits from the respondent, Sonnet, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”).

2The applicant was denied the treatment and assessments in dispute on the basis that he sustained predominantly minor injuries that are treatable within the Minor Injury Guideline (“MIG”). The applicant disagreed and applied to the Licence Appeal Tribunal-Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

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 limit and in the MIG?

ii. Is the applicant entitled to $1,995.33 for a psychological assessment, proposed by Marco Chiodo of Brampton Civic Care Centre Inc. in a treatment plan (OCF-18) (“plan”) dated April 23, 2020?

iii. Is the applicant entitled to $2,829.37 for chiropractic services, proposed by Roger Singh of Brampton Civic Care Centre Inc. in a plan dated June 29, 2020?

iv. Is the applicant entitled to $2,483.79 for chiropractic services, proposed by Reshma Shetty of Brampton Civic Care Centre Inc. in a plan dated September 9, 2020?

v. Is the applicant entitled to $2,245.55 for chiropractic services, proposed by Aliya Salayeva of Brampton Civic Care Centre Inc. in a plan dated November 13, 2020?

vi. Is the applicant entitled to $2,200.00 for a chronic pain assessment, proposed by Dr. Igor Wilderman of Ontario Independent Assessment Centre Inc. in a plan dated October 23, 2020?

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

RESULT

4The applicant has failed to demonstrate that removal from the MIG is warranted. He has not provided sufficient medical evidence that his accident-related injuries fall outside the MIG. The respondent indicates that $50.06 remain under the MIG limit. It is not necessary to consider whether the plans for chiropractic services, psychological assessment and chronic pain assessment are reasonable and necessary. As a result, there is no entitlement to interest.

5The application is dismissed.

ANALYSIS

The applicant has failed to demonstrate that he suffers from accident-related injuries that warrant removal from the MIG

6Section 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 in accordance with the MIG. 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.” An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG. In all cases, the burden of proof lies with the applicant.

7The applicant submits that he should be removed from the MIG based on his accident-related physical and psychological injuries which prevent his recovery under the MIG limits:

a. His post-accident provisional diagnosis of adjustment disorder

b. His post-accident diagnosis of anxiety, depression and bipolar disorder

c. His post-accident prescription medications for anxiety

d. His post-accident physical pain

8To this end, the applicant relies on his OCF-3 Disability Certificate, the findings of a psychological screening interview from Brampton Civic Care Centre, clinical notes and records of Cornerstone Medical Clinic and Excellent Care Medical Centre and treatment records.

9The applicant relies on the OCF-3 dated December 23, 2019 which indicates he suffers from whiplash disorder and strain and sprains of the spine, ribs, sternum and shoulders, contusion of the abdominal wall, headache and problems related to his psychosocial circumstances. A psychological screening report by Marco Chiodo dated April 23, 2020 indicates that the applicant returned to work one week after the accident. He was off work after the pandemic started in March 2020. He is also stressed by his wife not returning to Canada from India. Mr. Chiodo indicates in the treatment plan dated April 23, 2020 that COVID is a barrier to the applicant’s psychological recovery.

10The applicant does not refer to any pre-existing conditions that would prevent him from maximum recovery under the MIG limit. He refers to the clinical notes and records of Cornerstone Medical Clinic which identifies a pre-accident history of anxiety and panic attacks. The applicant also refers to the clinical notes and records of Dr. Elraheb of Excellent Care Medical Centre beginning on October 27, 2020. The applicant was referred for cardiology consultations both before and after the accident for anxiety related symptoms.

11The applicant submits that his doctors’ clinical notes and records are preferred medical evidence to the insurer examination reports. The applicant submits that he was diagnosed with anxiety, depression and bipolar disorder as a result of the accident. In March 2021, Dr. Elraheb indicated the applicant has recently become overwhelmed. Dr. Elraheb diagnosed delusional disorder, prescribed medications and referred him to a psychiatrist. However, Dr. Elraheb does not diagnose any accident-related physical or psychological injuries.

12In response, Sonnet points to a s. 44 Insurer Examinations by Dr. D’Souza and Dr. Clewes to support its position. Dr. Mark D’Souza, a chronic pain specialist indicates the applicant was struggling after he was laid off in April 2020 due to COVID. Dr. D’Souza found no residual physical injuries and recommended a psychological assessment. Dr. Janet Clewes a psychologist indicates in her report dated June 16, 2021 that the applicant has anxiety as a result of his family losing their restaurant business and his wife never returning from India. He was laid off after the pandemic and he has experienced difficulty looking for work. Dr. Clewes found no evidence that the applicant has anxiety or other psychological symptoms as a result of the accident.

13The applicant submits that his accident-related injuries warrant removal from the MIG. However, there is no medical evidence that the applicant sustained physical or psychological injuries arising out of the accident which require treatment beyond the MIG limit.

14A Disability Certificate completed by chiropractor, Dr. Aliya Salayeva on December 23, 2019 indicates that the applicant is expected to return to his pre-accident vocational and housekeeping activities within 9-12 weeks. There is no further evidence in support of accident-related physical or psychological conditions prolonging the applicant’s recovery. The evidence suggests that the applicant developed increasing symptoms of anxiety and depression after losing his job after COVID and his divorce in 2021. His subsequent diagnoses of delusional disorder and bipolar disorder in March 2021 have not been linked to the accident by his physicians.

15While the applicant points to his post-accident diagnoses of anxiety, depression and bipolar disorder, his treating physicians do not provide a diagnosis of an accident-related psychological injury. Dr. Clewes indicates that the applicant admitted his pre-accident anxiety and current anxiety is caused by his wife leaving him. The applicant confirmed that he has returned to driving without anxiety. He further indicated his physical pain symptoms have resolved.

16The applicant has not provided any supporting medical evidence of a chronic pain diagnosis. The clinical notes and records of his treating physicians do not mention any complaints of chronic pain or functional limitations as a result of the accident. There is no medical evidence to contradict the findings of Dr. D’Souza that the applicant sustained uncomplicated soft tissue injuries with no residual functional impairment. The applicant has not demonstrated that his accident-related injuries fall outside the MIG.

Are the treatment plans payable?

17Here, the applicant seeks payment for plans in the amounts of $2,829.37. $2,483.79 and $2,245.55 for chiropractic services; a plan in the amount of $1,995.33 for a psychological assessment and a plan in the amount of $2,200.00 for a chronic pain assessment at Brampton Civic Care Centre.

18Since the applicant has not demonstrated that his accident-related injuries warrant removal from the MIG, it is not necessary to consider whether the plans are reasonable and necessary.

Interest

19Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since the applicant was not successful on removal from the MIG or the plans for chiropractic services, psychological and chronic pain assessments, no benefits are owing and interest does not apply.

ORDER

20The applicant has failed to demonstrate that removal from the MIG is warranted. There is no medical evidence in support of an accident-related psychological injury or chronic pain syndrome. Therefore, it is not necessary to consider whether the plans for chiropractic services, chronic pain assessment and psychological assessment are reasonable and necessary and interest does not apply. The application is dismissed.