Licence Appeal Tribunal File Number: 24-002889/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:
Anastasiia Gal
Applicant
And
TD General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Kathleen Wells
APPEARANCES:
For the Applicant:
Moninder Khattra, Counsel
For the Respondent:
Arfa Saeed, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Anastasiia Gal, the applicant, was involved in an automobile accident on February 12, 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, TD General 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:
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?
Is the applicant entitled to $3,496.96 for chiropractic, massage, and physiotherapy services, proposed by North Toronto Rehabilitation in a treatment plan/OCF-18 (“treatment plan”) dated March 29, 2022?
Is the applicant entitled to $679.67 ($1,299.43 less $619.76 approved) for chiropractic, massage, and physiotherapy services, proposed by North Toronto Rehabilitation in a treatment plan dated August 20, 2022?
Is the applicant entitled to $1,096.62 for chiropractic, massage, and physiotherapy services, proposed by North Toronto Rehabilitation in a treatment plan dated October 11, 2022?
Is the applicant entitled to $983.81 for chiropractic, massage, and physiotherapy services, proposed by North Toronto Rehabilitation in a treatment plan dated September 30, 2022?
Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
The applicant remains subject to the MIG and its $3,500.00 funding limit.
As the applicant remains within the MIG, it is not necessary for me to consider whether the treatment plans are reasonable and necessary.
As no payments are owing, no interest is due.
The applicant is not entitled to an award.
The application is dismissed.
ANALYSIS
Applicability of the MIG
4I find that the applicant’ remains subject to the MIG and its $3,500.00 spending limit.
5Section 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.”
6An 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.
7The applicant submits that she should be removed from the MIG because she is experiencing chronic pain as a result of her accident-related injuries and relies on the clinical notes and records (“CNRs”) of the Scarborough Hospital Network.
8The respondent argues that the applicant has not met her burden to prove that she has chronic pain with functional impairment as a result of her accident-related injuries, because the applicant has not submitted medical evidence to corroborate her submission that she has an ongoing impairment as a result of the accident. The respondent relies on the January 3, 2023 insurer’s examination (“IE”) report of Dr. Pravesh Jugnundan, Physician, who opined that the applicant’s soft tissue injuries fell within the MIG.
9I agree with the respondent. The only medical evidence submitted by the applicant was the CNRs of the Scarborough General Hospital, which reveal that the applicant attended the emergency room complaining of upper back pain on February 12, 2022, the day of the accident. The applicant was sent for X-ray imaging, which revealed a normal study, and was discharged with instructions to follow up with the emergency department in one week if her symptoms worsened or did not improve.
10The applicant did not provide any medical evidence that the applicant continued to suffer from pain following the accident, nor did she make any submissions or provide any evidence that she suffered functional impairment due to her accident-related injuries.
11For these reasons, I find that the applicant has not met her onus to prove on a balance of probabilities that she suffers from chronic pain with functional impairment as a result of her accident-related injuries to warrant her removal from the MIG.
12Accordingly, the applicant remains within the MIG.
13As I have found that the applicant remains within the MIG, it is not necessary for me to consider whether the treatment plans are reasonable and necessary.
Interest
14Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no payments are owing, no interest is due.
Award
15The 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.
16The applicant did not provide any submissions or evidence with respect to an award. As, a result, I find that the applicant has not met her onus to prove on a balance of probabilities that any payments were unreasonably withheld or delayed. Accordingly, the applicant is not entitled to an award.
ORDER
17I find that:
The applicant remains subject to the MIG and its $3,500.00 funding limit.
As the applicant remains within the MIG, it is not necessary for me to consider whether the treatment plans are reasonable and necessary.
As no payments are owing, no interest is due.
The applicant is not entitled to an award.
The application is dismissed.
Released: November 27, 2025
Kathleen Wells
Adjudicator