Citation: Zhao v. Security National Insurance Company, 2025 ONLAT 24-003166/AABS

Licence Appeal Tribunal File Number: 24-003166/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:

Qing Zhao

Applicant

and

Security National Insurance Company

Respondent

DECISION

ADJUDICATOR:

Rachel Levitsky

APPEARANCES:

For the Applicant:

Sareena Samra, Counsel

For the Respondent:

Wendy Breuer, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Qing Zhao, the applicant, was involved in an automobile accident on June 12, 2019, 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, Security National 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. Is the applicant entitled to $7,370.81 for catastrophic assessments, proposed by Somatic Assessments & Treatment Clinic in a treatment plan dated July 25, 2022?

ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

RESULT

3The applicant is not entitled to the treatment plan in dispute, an award, or interest.

ANALYSIS

4To receive payment for a disputed treatment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that it is reasonable and necessary as a result of the accident.

5Section 25(5) of the Schedule states that an insurer shall not pay more than a total of $2,000.00 plus H.S.T. in respect of fees and expenses for conducting any one assessment or examination and for preparing reports in connection with it.

6The treatment plan in dispute proposed the following:

i. Physiatry Assessment (Dr. Joseph Siu-Wah Wong) - $2,000.00

ii. Occupational Therapy Assessment (Raymond Wong) - $2,000.00

iii. Psychology Assessment (Dr. Sedigheh Naisi) - $2,000.00

iv. Clinic File Review Assessment (Dr. Joseph Siu-Wah Wong) - $2,000.00

v. Overall Assessment Summary, Analysis, and Final Rating - $2,000.00

vi. Clinic File Review Assessment (Raymond Wong) - $1,000.00

vii. Clinical File Review Assessment (Dr. Sedigheh Naisi) - $1,000.00

viii. Completion of OCF-18 - $200.00

ix. Completion of OCF-19 - $200.00

x. Translation - $200.00

xi. Transportation - $200.00

xii. Travel time (Raymond Wong) - $112.81

7On August 10, 2022, the respondent approved the cost of the executive summary, psychological assessment, occupational therapy assessment, and OCF-18 and OCF-19 completion. On July 23, 2024, it approved the cost of the physiatry assessment. On February 11, 2025, it approved the translation fee. It has maintained its denial of the three clinical file reviews, transportation, and travel time.

8The applicant submits that the fees for the catastrophic assessments were reasonable and necessary and should be paid. She points to the severity of her physical and psychological symptoms and submits that heavy weight should be placed on her treating practitioners’ notes and the catastrophic assessment reports.

9The applicant relies on a number of cases which do not delve into the issue of whether file review fees, transportation costs, or travel time are payable (Monks v. ING Insurance Company of Canada, 2008 ONCA 269; Hassani v. Guarantee Company of North America, 2018 ONFSCDRS 5; Applicant v. Allstate Insurance, 2019 CanLII 101614). However, she relies on Tetruashvili v. Toronto Transit Commission, 2021 CanLII 134542, which states at paragraph 40 that a file review is a necessary part of an assessment and it is included in the $2,000.00 funding limit noted in s. 25(5) of the Schedule. The applicant in that case was accordingly not entitled to the cost of a comprehensive file review. While I am not bound by Tribunal decisions, I agree with the reasoning of the Tribunal in that case. Further, I have not been directed to case law which states otherwise.

10The applicant did not make specific submissions with respect to the denied portions of the treatment plan. She has not explained why the file reviews were necessary, or why the cost of reviewing her file would not be subsumed within the cost of the assessments that the respondent funded. Further, she has not provided any particulars or made specific submissions regarding the requested transportation costs or travel time. An applicant cannot simply submit evidence and leave it up to the Tribunal to connect the dots and make their case: Dooman v. TD Insurance, 2025 ONSC 184 at para. 50 (Div. Ct.). While I agree that it was reasonable for the applicant to have undergone catastrophic assessments generally, she has not persuaded me that the line items in dispute are reasonable and necessary.

11For those reasons, I find that the applicant has not met her burden to prove that the denied portions of the treatment plan in dispute are reasonable and necessary.

Interest

12Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, interest is not payable.

Award

13The 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. Aside from quoting s. 10, the applicant did not make any submissions regarding her entitlement to an award. In any event, as no benefits are payable, I find that the respondent is not liable to pay an award.

ORDER

14The applicant is not entitled to the treatment plan in dispute, an award, or interest.