Licence Appeal Tribunal File Number: 24-001734/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:
Qinqiang Yang
Applicant
and
Allstate Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Moninder Khattra, Counsel
For the Respondent:
Tom Yen, Counsel
HEARD:
By Way Of Written Submissions
OVERVIEW
1Qinqiang Yang, the applicant, was involved in an automobile accident on February 10, 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, Allstate Insurance Company of Canada, 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 $3,496.96 for chiropractic services, proposed by North Toronto Rehabilitation in a treatment plan/OCF-18 (“plan”) dated March 25, 2022?
iii. Is the applicant entitled to $1,269.43 for chiropractic services, proposed by North Toronto Rehabilitation in a plan dated July 22, 2022?
iv. Is the applicant entitled to $1,997.00 for occupational therapy services, proposed by Promed Rehabilitation Clinic in a plan dated July 18, 2022?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 MIG limit.
4Since the applicant is subject to the MIG limit, it is not necessary to assess whether the proposed plans are reasonable and necessary.
5The respondent is not liable to pay an award.
6The applicant is not entitled to interest.
ANALYSIS
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 MIG limit?
7I find that the applicant’s injuries sustained in the accident are predominantly minor as defined by the Schedule.
8Section 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.”
9An 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 medical 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 is on the applicant.
10The applicant’s position is that he should be removed from the MIG because he has not reached maximal recovery, and his injuries are chronic in nature. The applicant argues that a formal diagnosis of chronic pain is not necessary to warrant removal from the MIG. Further, that the applicant’s complaints of pain have persisted for more than three to six months, sufficient to warrant removal from the MIG.
11The applicant refers me to evidence that the applicant had a laceration on the left side of his head and a CT scan was completed to rule out intracranial hemorrhage. A Neurology Consultation report by Dr. Dulara Hussain, MD, FRCPC, dated July 4, 2022, reviewing the CT scan “His head laceration was repaired in ER using staples. CT showed no acute bleed. Left scalp laceration. Today daughter denies any headache, nausea or vomiting or any focal deficits. He is back to his baseline”. I find that the applicant’s laceration is covered by the definition of a minor injury under the Schedule and that the CT scan was negative.
12Dr. Hussain also noted a syncope in 2015 in which the applicant fell backwards and hit his head but was not on any medication. Dr. Hussain notes that the applicant refused further work up including MRI of the brain and an EEG. I find that the evidence does not suggest the 2015 event is in any way related to the applicant’s MVA related injuries or a barrier to his recovery.
13The clinical notes and records (“CNRs”) of the Brimley Family Clinic show that on February 17, 2022, and March 3, 2022, the applicant complained of headaches, was diagnosed with post-traumatic headaches and was advised to follow up with his family doctor. These CNRs end on March 3, 2022, less than one-month post-accident.
14The applicant also refers me to the CNRs of North Toronto Rehabilitation and Physiotherapy to establish that he was treated for pain in his traps, neck, and back and that he had ongoing complaints of dizziness and arm, neck, and hand stiffness. These CNRs end on August 2, 2022, less than six months post-accident.
15The applicant refers me to an Occupational Therapy Attendant Care Needs Assessment Report dated July 20, 2022 by Pawan Chopra O.T. Reg. (Ont.). Pawan Chopra recommends that he receives attendant care assistance in the amount of $2,524.50 per month and a number of further physical assessments and mental and behavioural assessments are recommended. In conclusion, Pawan Chopra opines, “Without these services, client is at risk for delayed recovery, further emotional deterioration, inactivity, and the development of chronicity of the pain symptoms.” The report refers to Dr. Jiun Lai as the applicant’s new family doctor after his previous doctor retired. However, the applicant did not offer any evidence from Dr. Lai or his previous family doctor.
16I find that the applicant was not diagnosed with chronic pain. I further find that the evidence does not support that the applicant made any pain complaints after six months post-accident. For this reason, his pain complaints are best characterized as sequelae to his minor injuries because he has not established that he has chronic pain with a functional impairment warranting removal from the MIG.
17For the reasons above, on a balance of probabilities, I find that the applicant’s accident-related injuries are predominantly minor as defined in s. 3 of the Schedule and are subject to treatment within the $3,500.00 MIG limit.
Is the applicant entitled to the plans proposing chiropractic services and occupational therapy services?
18As I have found that the applicant has not met his onus to establish that his accident-related impairments are beyond the definition of a minor injury, it is unnecessary for me to consider the reasonableness and necessity of the proposed plans.
Interest
19There are no overdue benefits to which interest applies pursuant to s. 51 of the Schedule.
Award
20The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
21Since there are no unreasonably withheld or delayed payments of benefits to which the applicant is entitled, the respondent is not liable to pay an award.
ORDER
22For the reasons above, I make the following orders:
i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 MIG limit.
ii. Since the applicant is subject to the MIG limit, it is not necessary to assess whether the proposed plans are reasonable and necessary.
iii. The respondent is not liable to pay an award.
iv. The applicant is not entitled to interest.
Released: November 26, 2025
__________________________
Amar Mohammed
Adjudicator