Daneluzzi v. Wawanesa Mutual Insurance Company, 2025 ONLAT 23-008461/AABS
Licence Appeal Tribunal File Number: 23-008461/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:
Nicole P Daneluzzi
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR: Sam Moini
APPEARANCES:
For the Applicant: Bianca Pirrotta-Iaccino, Paralegal
For the Respondent: Harkamal Hehar, Counsel
HEARD: In Writing
OVERVIEW
1Nicole Daneluzzi, the applicant, was involved in an automobile accident on August 8, 2021, 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, Wawanesa Mutual 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 $3,500.00 Minor Injury Guideline (MIG) limit?
ii. Is the applicant entitled to $2,949.34 ($3,157.39 less $208.05 approved) for chiropractic services, proposed by Alma Rehabilitation Inc. in an OCF-18/treatment plan (treatment plan) submitted November 25, 2021?
iii. Is the applicant entitled to $2,912.56 for chiropractic treatment proposed by Alma Rehabilitation Inc. in a treatment plan submitted May 25, 2022?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant sustained a minor injury as a result of the accident. She is subject to the MIG and the $3,500.00 funding limit for a minor injury which the parties have agreed has been exhausted.
4As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
5As no benefits are payable, the applicant is not entitled to interest.
ANALYSIS
Minor Injury Guideline (MIG)
6I find that the applicant sustained a minor injury as a result of the accident and is therefore subject to the $3,500.00 funding limit on treatment.
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 submitted an OCF-3 completed by chiropractor, Dr. Roger Singh, on August 11, 2021. The OFC-3 claimed the applicant suffered from multiple injuries due to the accident including whiplash disorder (WAD2), headache, sprain and strain of the cervical, thoracic, and lumbar spine, irritability, anger, stress, disorders initiating and maintaining sleep, anxiety disorders, dizziness, giddiness, malaise, fatigue, nervousness, lower back pain, nausea, sprain and strain of the wrist, and problems related to lifestyle, environment, and psychosocial circumstances.
10The applicant's argument to be removed from the MIG are for her consistent headaches and neck/back pain.
11The applicant relied on clinical note and records (CNRs) of her family doctor, Dr. Kiran Guru, CNRs of Brampton Civic Hospital, and CNRs of Alma Rehab Clinic. Dr. Guru CNRs from August 16, 2021, a week after the accident, stated worsening neck pain, severe fatigue, back pain, light-headedness and feeling off balance, and headaches. Dr. Guru diagnosed the applicant with tension headaches and neck and upper/lower back strain. Dr. Guru prescribed Naprosyn, Advil, and Flexeril and recommended physiotherapy. Dr. Guru's CNRs from April 6, 2022, stated the applicant still suffers from headaches, accompanied by pressure and tightness. The applicant stated to Dr. Guru the Advil/Tylenol helps with the severity of the headaches. Dr. Guru stated the applicant is suffering from tension headaches and advised to do neck stretches. The applicant submits that following the respondent's denial of the treatment plans submitted by Alma Rehab Clinic on November 25, 2021 and May 25, 2022, for chiropractic services, the applicant incurred the cost of the treatment plans in the amounts of $2,813.33 and $717.77 to help alleviate her injuries as she had made constant complaints to all health care providers about her ongoing pain and headaches.
12The respondent relied on reports from neurologist, Dr. V. John and physiatrist, Dr. R. Soric. Regarding Dr. John's report dated August 17, 2022, it was concluded the applicant's injuries are considered a minor injury and no evidence of any neurological signs or evidence of a concussion or head injury. Dr. John diagnosed the applicant with myofascial strain and sprain type injuries to her cervical spine with cervicogenic headaches. Dr. Soric's physiatry report, which is also dated on August 17, 2022, found that the applicant's injuries were minor. Dr. Soric found the applicant demonstrated a fully functional AROM of the cervical spine, a normal neurological exam, normal muscle tone, and reflexes were 2+ and symmetrical in all four limbs. Dr. Soric also found the applicant had normal muscle tone. Dr. Soric's report also found the applicant did not have any focal muscle atrophy and manual muscle testing revealed strength of 5/5 on the MRC scale in both upper and lower extremities and the applicant did not have any signs of myelopathy. Dr. Soric noted that following her treatments, the applicant reported her symptoms improved 40 to 50 percent.
13I find that the medical evidence does not support a finding that the applicant's consistent headaches and pain to her neck/pain warrant removal from the MIG. The applicant's family doctor, Dr. Guru had only two CNRs from the applicant regarding the accident. On both occasions the applicant was diagnosed with headaches and/or neck and back strains with no associated neurological symptoms. The applicant was not referred to do any medical imaging or any specialist. The applicant's prescription summary noted no prescribed medicine other then Cyclobenzaprine and Naproxen which was prescribed on her first visit to her family doctor after the accident. The applicant also reported that after her treatments, her symptoms improved 40 to 50 percent. I gave more weight to the Dr. John and Dr. Soric reports as they aligned with preponderance of medical evidence presented. Though the applicant consistently complained of headaches to the medical professionals, that alone would not remove her from the MIG. The injuries diagnosed by her family doctor are injuries that would be considered in the MIG. I was not pointed or directed to evidence of the applicant being diagnosed with any sort of concussion nor was it argued by the applicant. The only diagnosis that was made by any medical professionals were that the applicant had tension/cervicogenic headaches and neck/back strains which would fall under the definition of the MIG.
14For these reasons, the applicant has not satisfied me, on a balance of probabilities, that she suffers from injuries that would warrant removal from the MIG.
15As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
Interest
16Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are payable, the applicant is not entitled to interest.
ORDER
17The applicant sustained a minor injury as a result of the accident. She is subject to the MIG and the $3,500.00 funding limit for a minor injury.
18As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
19As no benefits are payable, the applicant is not entitled to interest.
Released: November 14, 2025
Sam Moini
Adjudicator