Licence Appeal Tribunal File Number: 24-009459/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:
Jaspreet Dhaliwal
Applicant
and
Pembridge Insurance Company
Respondent
AMENDED DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: Jasmine Patel, Counsel
For the Respondent: Tom Yen Sara Azghadi, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Jaspreet Dhaliwal, the applicant, was involved in an automobile accident on September 8, 2022, 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, Pembridge Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The 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 $3,50.00 Minor Injury Guideline (“MIG”) limit?
ii. Is the applicant entitled to $3,540.45 for chiropractic and massage therapy services, proposed by Inline Rehabilitation Centre in a treatment plan/OCF-18 (“plan”) dated February 1, 2024?
iii. Is the applicant entitled to $3,416.68 for psychological services, proposed by Inline Rehabilitation Centre in a plan dated October 5, 2023?
iv. Is the applicant entitled to $4,217.71 for chiropractic and massage therapy services, proposed by Inline Rehabilitation Centre in a plan dated March 16, 2023?
v. Is the applicant entitled to $56.41 ($1,293.11 less $1,236.70 approved) for physiotherapy services, proposed by Inline Rehabilitation Centre in a treatment plan dated January 3, 2023?
vi. Is the applicant entitled to $1,920.52 for a psychological assessment, proposed by Inline Rehabilitation Centre in a plan dated January 12, 2023?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant sustained a minor injury as a result of the accident. She is subject to the MIG and the $3,500.00 finding limit for a minor injury.
4As the applicant is in the MIG, it is not necessary to consider if the treatment and assessment plans in dispute are reasonable and necessary.
5The applicant is not entitled to interest.
ANALYSIS
Minor Injury Guideline (“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. 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.”
7An 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.
8The applicant argues that she should be removed from the MIG based on a psychological condition. The respondent disagrees.
9For the following reasons, I find that the applicant sustained a minor injury as a result of the accident.
Psychological Condition
10I find, on a balance of probabilities, that the applicant should not be removed from the MIG based on an accident-related psychological condition.
11The applicant relies on the psychological assessment report of Sabrina Simmons, M.A., and Dr. Valery Kleinman, psychologist, dated May 17, 2023. Ms. Simmons and Dr. Kleinman diagnose the applicant with an adjustment disorder with mixed anxiety and depressed mood, and specific phobia (driving/passenger related). According to the applicant, a diagnosed psychological impairment precludes her from the MIG.
12The applicant also relies on the disability certificate/OCF-3 of Dr. Kevin Bar, chiropractor, dated October 6, 2022. Dr. Bar listed the applicant’s diagnoses as mild cognitive disorder, disorders of initiating and maintaining sleep, nausea, nervousness, and strains/sprains of the cervical/thoracic/lumbar spine and shoulder joint.
13The respondent submits that the applicant’s reliance on a single section 25 psychological assessment report is insufficient to justify her removal from the MIG. According to the respondent, the assessment was conducted virtually by Ms. Simmons, who is not a psychologist, and there is no indication that Dr. Kleinman was involved in the assessment or the preparation of the report. The respondent also submits that there is no indication that Ms. Simmons reviewed any of the applicant’s medical records, or that validity tests were administered.
14The respondent relies on the section 44 assessment reports of Dr. Rajka Soric, physiatrist, dated November 21, 2023, and Dr. Tatiana Dumitrascu, psychologist, dated December 12, 2023. The respondent argues that the applicant advised Dr. Soric that she had been the primary caregiver for newborn son since he was born on July 10, 2023. Dr. Dumitrascu also reported that the applicant complained of no significant emotional symptoms related to the accident, and in terms of vehicular anxiety, the applicant travelled as a passenger as needed and did not report any significant symptoms of anxiety. The respondent further submits that Dr. Dumitrascu’s psychometric validity testing found a tendency for symptom magnification, and based on her overall assessment, Dr. Dumitrascu concluded that the applicant did not meet the DSM-5 criteria for any psychological disorders.
15I find that it is not within the scope of practice for a chiropractor to diagnose a cognitive disorder or psychological condition. For that reason, I have given no weight to the disability certificate completed by Dr. Bar. I have also given limited weight to the psychological assessment of Ms. Simmons and Dr. Kleinman. I find that there is no indication as to what extent Dr. Kleiman was involved in the assessment, diagnoses, or recommendations that were made. There is also no mention in the report that the applicant was pregnant at the time of assessment, and I agree with the respondent that no validity measures were administered.
16With respect to a specific phobia (driving/passenger related) noted in Ms. Simmons and Dr. Kleiman’s report, the applicant reported to both Dr. Soric and Dr. Dumitrascu that she was able to travel as a passenger in a vehicle, and she reported to Dr. Dumitrascu that she did not feel comfortable driving with her newborn son in the vehicle “because she had been noticing many ‘crazy’ drivers on the roads”.
17I am persuaded by Dr. Dumitrascu’s psychological report which was conducted in-person by a psychologist, it involved the administration of validity measures, and Dr. Dumitrascu’s findings were consistent with emotional and cognitive symptom magnification that likely affected the applicant’s responses on all administered psychometric measures. According to Dr. Dumitrascu, the applicant did not suffer from clinically significant psychological symptomatology, and did not meet the diagnostic criteria for a psychological condition as a result of the accident. Again, Ms. Simmons and Dr. Kleinman did not apply any validity measures, and their findings were reliant on the applicant’s self-report. I find that this calls into question the reliability of their findings.
18For the reasons set out above, I find that the applicant has not proven on a balance of probabilities that she suffers from a psychological condition that would warrant removal from the MIG.
19Since I have found that the applicant’s accident-related injuries do not remove her from the MIG, it is not necessary for me to consider whether the treatment plans in dispute are reasonable and necessary. I find that the applicant is entitled to treatment up to the MIG limits.
Interest
20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no payments are outstanding, the applicant is not entitled to interest.
ORDER
21For the reasons stated above, I find:
i. The applicant’s accident-related injuries are predominantly minor, and she is therefore subject to treatment within the $3,500.00 limit of the MIG;
ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary; and
iii. No interest is payable.
Released: November 20, 2025
Tyler Moore
Vice-Chair