Licence Appeal Tribunal File Number: 24-002385/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:
Muzzyn Wajahat
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Alim Ramji, Counsel
For the Respondent:
Rishabh Kalani, Counsel
HEARD:
By Way Of Written Submissions
OVERVIEW
1Muzzyn Wajahat, the applicant, was involved in an automobile accident on October 31, 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, Aviva 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:
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 an income replacement benefit (“IRB”) in the amount of $400.00 per week from July 3, 2023 ongoing?
iii. Is the applicant entitled to the treatment plans/OCF-18s (“plans”) proposed by Complete Rehab Centre, as follows:
a. $230.50 for chiropractic and massage treatment, submitted March 3, 2023;
b. $3,610.50 for psychological services, submitted July 24, 2023;
c. $1,864.47 for chiropractic and massage treatment, submitted November 9, 2023;
d. $2,700.00 for an orthopaedic assessment, dated July 24, 2023; and
e. $2,530.00 for a psychological assessment, dated June 21, 2023?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant’s injuries are not predominantly minor as defined in s. 3 of the Schedule and therefore are not subject to treatment within the $3,500.00 MIG limit.
4The applicant is entitled to an IRB in the amount of $400.00 per week from July 3, 2023 to October 28, 2024, 104 weeks post-accident.
5The applicant is entitled to the plans proposed by Complete Rehab Centre, as follows:
i. $2,200.00 plus any applicable HST for an orthopaedic assessment, and
ii. $2,200.00 plus any applicable HST for a psychological assessment.
6The applicant is entitled to interest on any overdue payment of benefits.
7The applicant is not entitled to any of the other benefits sought on this application.
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?
8I find, on a balance of probabilities, that the applicant’s injuries sustained in the accident are not predominantly minor as defined by the Schedule.
9Section 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.”
10An 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.
11The applicant argues she should be removed from the MIG because she suffers from chronic pain with a functional impairment. In support of this position the applicant points me to the clinical notes and records (“CNRs”) of the applicant’s family doctor, Dr. Charanjit Kaur Thind, diagnosing accident-related chronic pain on December 5, 2022, and again on March 14, 2023. The applicant also offers a report by Dr. Manoj Bhargava resulting from an orthopaedic assessment on July 24, 2023 which provides the following accident-related diagnoses:
i. Cervical spine sprain/strain WAD I; chronic pain
ii. Lumbar spine sprain/strain; chronic pain
iii. Bilateral shoulder soft tissue injury; chronic pain
iv. Left wrist injury; rule out scaphoid fracture
12The parties refer me to the six chronic pain criteria found in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 6th Edition, 2008, (“AMA Guides”).
13The Tribunal has held that the six criteria are a helpful tool in the assessment of chronic pain. While the AMA Guides criteria for chronic pain were not incorporated into the Schedule, this Tribunal has consistently considered them a useful interpretive tool for assessing claims of chronic pain in accident benefits disputes in the absence of a diagnosis of chronic pain. I agree that they are a useful analytical tool.
14Out of the six criteria under the Guides, the applicant argues she needs to meet a minimum of three and that she specifically meets factors 4 through 6. Criterion 4 considers the applicant’s withdrawal from social milieu, including work, recreation, or other social contracts. Criterion 5 considers the applicant’s failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs. Criterion 6 considers the applicant’s development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.
15The respondent argues no weight should be given to Dr. Bhargava’s report because he does not assess on the basis of the six chronic pain criteria from the AMA Guides in his report. However, Dr. Bhargava’s evidence does not attract less weight because the AMA Guides criteria are not mentioned in it. As noted above, the criteria are not incorporated into the Schedule and are not a requirement. Also, Dr. Bhargava’s report is persuasive the reasoning is reasonable and clear that, at eight months post-accident, the applicant seems to have developed chronic pain in her neck, shoulders, and low back. Further, that she would benefit from a chronic pain assessment to assess this as there is a chance her symptoms may persist on a permanent basis.
16With respect to the fourth criterion, the applicant argues that she withdrew from work and from other pre-accident activities including playing with her brother in law’s children. With respect to the fifth criterion, Dr. Bhargava opines it is very likely that her injuries will be permanent in nature and that her injuries are considered serious as they render her partially disabled in the realms of self-care and housekeeping, and currently fully disabled in the realm of employment. I find that this is corroborated by the CNRs of Dr. Thind documenting the applicant’s inability to return to work post-accident resulting from chronic pain, anxiety and stress. Also, in relation to the sixth criterion, the psychosocial sequelae documented in Dr. Thind’s CNRs include, flashbacks, sleep disruptions, stress, and anxiety, all of which is related to the accident. I find the applicant’s evidence persuasive because it is consistent between the applicant’s family doctor and Dr. Bhargava. The family doctor’s CNRs provide a subjective and objective picture of the applicant’s situation that is contemporaneous, providing me with valuable insight.
17The respondent argues relating to criterion 4, that the applicant’s functional impairment is not severe or debilitating as discussed at paragraph 35 in Melfi v Aviva General Insurance, 2020 CanLII 87977 (ON LAT) (“Melfi”). I note that Melfi is not binding on me. In any case, paragraph 35 of Melfi does not stand for a relevant point of law because the Tribunal found that that applicant in Melfi had failed to meet their onus. Most of the Tribunal’s findings of fact in paragraph 35 of Melfi are related to that applicant’s circumstances. For example, the paragraph ends with “More importantly, the applicant told Dr. Tu that she does not feel that she needs a chronic pain assessment.” These circumstances are not substantively similar to the facts before me.
18The respondent also argues that the applicant returned to her pre-accident activity level, however I find that this cannot be reconciled with the applicant being unable to return to work since the accident for which she received IRB payments, as further explained below when assessing entitlement to IRB.
19With respect to criterion 5, the respondent argues that ongoing pain alone does not warrant removal from the MIG. However, I note that this is not the extent of the applicant’s argument as she submits that she meets three of the six criteria. The respondent also argues that a distinction between prolonged pain and chronic pain must be noted and refers me to 16-000438 v The Personal Insurance Company, 2017 CanLII 59515 (ON LAT) at paragraph 28:
“For chronic pain to be more than sequelae from the soft tissue injuries enumerated in s. 3 of the Schedule, it must be chronic pain syndrome or continuous (in that the initial minor injury never fully healed), and it must be of a severity that it causes suffering and distress accompanied by functional impairment or disability. A diagnosis of chronic pain without any discussion of the level of pain, its effect on the person's function, or whether the pain is bearable without treatment will not meet the applicant's burden to show that chronic pain is more than mere sequelae”.
20I am not bound by decisions of other adjudicators at this Tribunal; however, I agree in so far as the Tribunal requires chronic pain accompanied by a functional impairment to consider removal from the MIG. It is well established that chronic pain without evidence of a functional impairment may not warrant removal from the MIG. I also agree that evidence relating to the level of pain, its effect on the person's function, or whether the pain is bearable without treatment are some of the ways an applicant may support her position. Ultimately, this does not address the evidence of Dr. Bhargava and Dr. Thind as it relates to the fifth criterion, that the applicant has failed to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs.
21Relating to criterion 6, the respondent argues that there is no evidence the applicant’s psychosocial sequelae are related to the pain. The respondent refers me to paragraph 21.vi. of Grewal v Echelon General Insurance Company, 2023 CanLII 81826 (ON LAT) (“Grewal”) in which a single note of anxiety was insufficient to satisfy factor 6:
The applicant cites an anxiety observation and Ativan prescription provided by Dr. Nanar on March 16, 2021 as evidence of psychosocial sequelae. But this is the only note of this anxiety in the family doctor’s CNRs, and it is not connected to the accident by the physician. To me, this is not enough to demonstrate the psychosocial sequelae required to meet this criterion.
22I am not persuaded by the respondent’s argument. I find Grewal distinguishable on its facts. I note that the respondent argues I need evidence to connect the psychosocial sequelae to the applicant’s pain but the decision it relies on refers to connecting them to the accident. Dr. Thind connected the psychosocial sequelae to the accident and based their opinion on objective testing or observations as well as the applicant’s subjective reporting. Dr. Thind did so on multiple occasions. To that end, both parties refer me to Dr. Thind’s CNRs dated November 9, 2022 and December 5, 2022. Both of these entries use the standard SOAP format providing subjective and objective notes followed by the doctor’s assessment and plan, the latter of which is noted as A/P in the CNRs. For both entries the doctor’s assessment and plan relate the psychosocial sequalae back to the motor vehicle accident (“MVA”):
i. MVA anxiety/stress, chronic pain
ii. Post MVA muscle strain/stress/anxiety
23Also, in Grewal, at paragraph 24, the Tribunal notes it did not have expert reports whereas I have the benefit of Dr. Bhargava’s orthopaedic report to assist me in addition to Dr. Thind’s CNRs.
24I find that the applicant’s evidence establishes on a balance of probabilities that she has chronic pain that has continued and resulted in a functional impairment sufficient to warrant removal from the MIG.
Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from July 3, 2023 ongoing?
Pre-104 IRB
25The applicant is entitled to an income replacement benefit in the amount of $400.00 from July 3, 2023 to October 28, 2024, 104 weeks post-accident.
26To receive payment for an IRB under s. 5(1) of the Schedule, the applicant must be employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffer a substantial inability to perform the essential tasks of that employment. The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them. The applicant bears the burden of proving, on a balance of probabilities, that they meet the test.
27According to assessors the parties are relying on, the applicant was working as a general labourer at a factory, packaging items. The applicant states this job required prolonged standing, walking, lifting, bending, reaching, and carrying. I find that these are the essential tasks of the applicant’s employment.
28Turning now to the question of whether the applicant has a substantial inability to perform these essential tasks, I find that she did, on a balance of probabilities. In reaching this conclusion I note that Dr. Thind, the applicant’s family doctor, noted the applicant’s inability to go back to work post-accident. Likewise, Dr. Bhargava opined the applicant should be medically restricted from prolonged/repeated bending, lifting, twisting, or reaching, as well as repeated activities requiring use of the left hand/wrist and considered the applicant fully disabled in the realm of employment.
29The respondent states that it completed an online search of the applicant’s employer and found that the employer “provides services for packaging consumer goods such as confectionery, dry fruits, bars, cookies, candy, etc.” The respondent argues most of these products are lightweight and do not require much force. In my opinion, the respondent’s argument is speculative. Further, it does not address the applicant’s position because the applicant has not argued she cannot produce the force required to lift a lightweight item. I was not referred to evidence of the extent of the weight the applicant is able to lift but this is not the basis of the applicant’s position or evidence. Rather, Dr. Bhargava addresses prolonged and repeated lifting among other restrictions noted above. Also, the respondent argues that Dr. Bhargava’s assessment revealed no limitations. The respondent’s submissions seem to be referring me to its position on the fifth chronic pain factor wherein it refers to Dr. Bhargava’s assessment revealing normal range of motion on all plains and other negative test findings. The respondent has not persuaded me that an applicant suffering from chronic pain should be viewed as having no limitations based on results from tests completed by Dr. Bhargava, which included a range of motion test. This position also does not reconcile with Dr. Bhargava’s actual opinion on the applicant’s ability to continue working which is clearly that she cannot work and that she should be medically restricted.
30In the context of the applicant’s ability to do the essential tasks of her pre-accident employment, I give more weight to Dr. Bhargava’s expert opinion because it better accords with the CNRs of the applicant’s family doctor, Dr. Thind. In contrast, Dr. James Kenneth Stewart, M.D., prepared a s. 44 musculoskeletal assessment report dated June 23, 2023 and addendum dated January 30, 2024, which do not accord with the applicant’s family doctor’s contemporaneous notes and opinion. Dr. Stewart’s reports also do not address the basis of Dr. Bhargava’s opinion, as there is no reference to chronic pain in Dr. Stewart’s report. In Dr. Stewart’s addendum, the only time chronic pain is referenced is when Dr. Bhargava’s report is being quoted. This further weakens Dr. Stewart’s report and addendum as it is chronic pain in the neck, shoulders, and low back that the preponderance of the medical reporting indicates is predominantly causing the physical impairment, in addition to the left wrist.
31The respondent also argues that the applicant may have been eligible for pregnancy leave during the period between July 5, 2023 and January 1, 2025 “could have, and likely would have, been due to her pregnancy and applicable leaves that she could have been entitled to.” I’m not clear whether this has anything to do with the applicant’s IRB being stopped on June 23, 2023. The Schedule deals with eligibility and quantum of IRBs in different sections. As it relates to eligibility, I am not persuaded that the applicant’s pregnancy post-accident is relevant. I find that becoming pregnant after being eligible and entitled to an IRB does not mean the applicant no longer suffers a substantial inability to perform the essential tasks of her employment. To suggest that her pregnancy means that she recovered from her accident-related impairments and became able to go back to work is highly speculative. If the respondent is arguing it is relevant to eligibility, the respondent has not referred me to the Schedule to assist me on this. I am unclear as to how becoming pregnant after already having been entitled would disqualify the applicant from entitlement.
32As for quantum, the respondent already assessed the applicant at $400.00 per week. If the respondent is arguing the quantum needs to be recalculated to a lower amount because the applicant had pregnancy related benefits available to her post-accident, it has not made that clear and the argument is highly speculative. The respondent has not connected its argument to the law to assist me nor is there evidence that the applicant received pregnancy related benefits that would be relevant here.
33The applicant also relies on Dr. Brunshaw’s psychological report and the respondent relies on Dr. Schwartz’s psychological report and addendum. I find that I do not need to consider Dr. Brunshaw’s psychological report in context of this issue because the applicant has established entitled based on the evidence set out above. The respondent relies on Dr. Schwartz’s report stating the applicant does not meet the test for IRB from a psychological perspective. I accept the evidence of the applicant’s family doctor and orthopaedic assessor supporting the applicant’s position. From a physical perspective, the applicant suffered a substantial inability to perform the essential tasks of her employment, and she did not recover.
Post-104 IRB
34To receive payment for a post-104-week IRB under s. 6 of the Schedule, the applicant must demonstrate on a balance of probabilities that they suffer from a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience.
35The applicant did not make any arguments related to post-104-week IRBs or s. 6 of the Schedule. For this reason, I find that she has not met her onus to establish entitlement to a post-104-week IRB. My finding above addresses the period of the applicant’s eligibility up to 104 weeks post-accident.
36For the reasons above, I find on a balance of probabilities that the applicant is entitled to an income replacement benefit in the amount of $400.00 from July 3, 2023 to October 28, 2024, 104 weeks post-accident.
Is the applicant entitled to the treatment plans in dispute?
37To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable. I was not referred to a denial letter for any of the plans in dispute.
The plan proposing chiropractic and massage treatment
38I find that the applicant is not entitled to the disputed $230.50 on a plan proposing chiropractic and massage treatment.
39Both parties refer me to the plan proposing $230.50 of treatment as a partially approved plan. This was unclear from the wording contained in the Case Conference Report and Order (“CCRO”). The applicant did not refer me to which parts of the plan were approved and which were not. The applicant states the dispute is for $230.50 of physiotherapy services and was partially approved as follows: $1,302.51 less $1,072.01 approved. The respondent states the applicant is mistaken about the type of treatment proposed, that it is in fact a plan proposing 10 sessions of chiropractic treatment and 4 sessions of massage therapy. Both parties agree that the plan was only partially approved because the MIG limit had been reached. I note that the CCRO confirms funding under the MIG limit to cover this disputed amount was available. Funding up to the MIG limit is not based on a reasonable and necessary analysis. However, that is not the dispute before me.
40The applicant has not referred me to particulars of the partial approval and the disputed amount, the applicant also did not identify the goals of treatment, or how the goals would be met to a reasonable degree and did not address whether the overall costs of achieving them are reasonable.
41I find, on a balance of probabilities, that the applicant is not entitled to the disputed $230.50 on a plan proposing chiropractic and massage treatment.
The plan proposing psychological treatment
42The applicant is entitled to the treatment plan proposing psychological services because it is reasonable and necessary, at a maximum rate of $99.75 per hour for a psychotherapist.
43The applicant identified the goal of this plan as returning the applicant to her pre-accident activities of daily living. The applicant refers me to Dr. Brunshaw’s Psychological Assessment report dated July 18, 2023, stating the treatment would achieve its goal by helping alleviate her fear, anxiety, distressing thoughts and involve CBT and that leaving the applicant without treatment will likely impede her recovery. I have already made a finding that this is corroborated by the CNRs of Dr. Thind documenting the applicant’s inability to return to work post-accident resulting from chronic pain, anxiety and stress. The psychosocial sequelae documented in Dr. Thind’s CNRs include, flashbacks, sleep disruptions, stress, and anxiety, related to the accident. On this basis, I find that the plan proposing psychological services is necessary.
44The applicant argues that 14 sessions over 14 weeks with each session lasting 1.25 hours with Peggy-Gail DeHal-Gunraj, Registered Psychoterhapist, at the rate of $149.61 is reasonable and necessary. The argues that the rate per hour set out in part 12 of the proposed plan has not been established to be reasonable and necessary. The respondent references the Professional Services Guideline, Superintendent’s Guideline 03/14, September 2014 (“Guideline”) and submits that a psychotherapist’s hourly rate is $99.75. The Guideline states:
Services provided by health care professionals/providers, unregulated providers and other occupations not listed in the Guideline are not covered by the Guideline. The amounts payable by an insurer related to services not covered by the Guideline are to be determined by the parties involved.
45The hourly rate for psychologists and psychological associates under the Guideline is $149.61 for claimants who are not catastrophically impaired, and the Guideline is silent on the rate for psychotherapists. The Guideline states that amounts payable by an insurer related to services not covered by the Guideline are to be determined by the parties involved. As such, the Tribunal retains the authority to decide the rate of reimbursement for services not covered by the Guideline. In my view, the Guideline is assistive when deciding disputes for rates of a psychotherapist.
46The plan includes additional comments, providing reasons for the request that the hourly rate for “Counselling, mental health and addiction” by a psychotherapist should be the same as if psychologists or psychological associates were providing the same service. While the applicant refers me to a number of Tribunal files in support, I note that the decisions in those files are not binding on me.
47The reason I am not persuaded by this argument is because the Guideline does not differentiate rates based on the services provided but rather sets hourly rates based on who the health care professional or provider is. In my view, if the Guideline had intended for services that overlap between different professions or providers to be subject to the same rate it would have indicated this, or it would have sorted rates based on service provided rather than profession. Since the rates are sorted by profession in the Guideline, I am persuaded that it is the profession of the provider that predominantly determines their hourly rate.
48The applicant has not addressed arguments about the reasonableness of the hourly rate in submissions. The respondent’s submissions indicate that there is no dispute up to the rate of $99.75 per hour for the psychotherapist sessions proposed in the plan. On this basis, I find that the applicant has not persuaded me that an amount over $99.75 per hour is reasonable.
49For the reasons above, on a balance of probabilities, I find that the plan is reasonable and necessary at a maximum rate of $99.75 per hour for a psychotherapist.
The plan proposing chiropractic and massage treatment
50The applicant is not entitled to the plan proposing $1,864.47 for chiropractic and massage treatment.
51The applicant has indicated that this plan was incorrectly identified on the application as proposing physiotherapy and that it is proposing 12 sessions of chiropractic treatment and 5 sessions of massage therapy. The applicant refers me to Dr. Bhargava’s opinion that the applicant receive physiotherapy including core strengthening. The applicant argues that chiropractic treatment involves core strengthening exercises, relating it back to Dr. Bhargava’s opinion. The applicant did not make submissions on the goal of this proposed treatment or how it would be achieved, other than referring me to core strengthening exercises. I find that the medical evidence does not provide contemporaneous corroborating evidence of the need for chiropractic and massage treatment as set out in the treatment plan.
52I find on a balance of probabilities that that the applicant is not entitled to this plan.
Is the applicant entitled to the following plans for assessment
53For an applicant to prove that an assessment is reasonable and necessary, the applicant must prove that there is some objective evidence to suggest that some condition exists and warrants investigation via an assessment.
The plan proposing an orthopaedic assessment
54I find that the applicant is partially entitled to the plan proposing the orthopaedic assessment in the amount of $2,200.00 plus any applicable HST.
55The applicant seeks approval for a treatment plan in the amount of $2,700.00 for an orthopaedic assessment which proposed $2,000.00 for the assessment, $200.00 for documentation, $240.00 ($120.00 per hour) for transportation of the applicant to and from the assessment, and $260.00 for applicable tax. The applicant argues that Dr. Thind’s CNRs provide evidence of chronic pain and inability to work sufficient to warrant an investigation.
56The respondent argues the assessment is not reasonable and necessary and that Dr. Bhargava’s assessment and Dr. Stewart’s assessment showed no physical limitations. However, Dr. Bhargava’s report provided several diagnoses, functional limitations, and recommended a chronic pain assessment.
57I am persuaded by the family doctor’s CNRs pointing to chronic pain and physical complaints and note that they are within Dr. Bhargava’s scope. I find that the applicant’s family doctor’s CNRs including diagnosis of chronic pain warrant investigation. For these reasons I find the assessment proposed to be necessary.
58As for the assessment and documentation costs, s. 25(5) limits the applicant’s entitlement to $2,000.00 plus applicable HST for any one assessment, inclusive of preparing reports. In addition, the Guideline sets a maximum payable for completion of an OCF-18 at $200.00.
59The applicant did not address transportation costs in submissions, why they are reasonable and necessary and if they are in line with the Superintendent's Guideline No. 04/16: Transportation Expense Guideline (Transportation Guideline). I do not have the particulars of this proposed expense sufficient to address whether it is an authorized expense, or is reasonable and necessary, including consideration of the 50-kilometre deductible. On this basis, I find that the transportation costs are not reasonable and necessary.
60I find, on a balance of probabilities, that the applicant is partially entitled to the plan proposing the orthopaedic assessment in the amount of $2,200.00 plus any applicable HST.
The plan proposing a psychological assessment
61I find that the applicant is partially entitled to the plan proposing the psychological assessment in the amount of $2,200.00 plus any applicable HST.
62The applicant seeks $2,530.00 for a psychological assessment which proposed $2,000.00 for the assessment, $200.00 for documentation, $70.00 for pre-screening, and $260.00 for applicable tax. The applicant argues that Dr. Thind’s CNRs referring to sleep disturbance, anxiety, and stress, and the applicant’s inability to return to work were sufficient to warrant investigation. Upon my review of the parties’ reference to the December 5, 2022 CNR, I also noted the applicant cried a few times and was tearful during the visit and interview with Dr. Thind. Also, the applicant was being counseled by her family doctor for anxiety and relaxation techniques. Certainly, in my view, there was sufficient evidence to warrant an investigation.
63I again note that s. 25(5) limits the applicant’s entitlement to $2,000.00 plus applicable HST for any one assessment, inclusive of preparing reports. In addition, the Guideline sets a maximum payable for completion of an OCF-18 at $200.00.
64In so far as the pre-screening report is required in order to complete the OCF-18, the maximum of $200.00 applies and the applicant is not entitled to a further $70.00 for the pre-screening report.
65I find, on a balance of probabilities, that the applicant is partially entitled to the plan proposing the psychological assessment in the amount of $2,200.00 plus any applicable HST.
Interest
66The applicant is entitled to interest as it applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
ORDER
67For the reasons above, I make the following orders:
i. The applicant’s injuries are not predominantly minor as defined in s. 3 of the Schedule and therefore are not subject to treatment within the $3,500.00 MIG limit.
ii. The applicant is entitled to an income replacement benefit in the amount of $400.00 per week from July 3, 2023 to October 28, 2024, 104 weeks post-accident.
iii. The applicant is entitled to the plans proposed by Complete Rehab Centre, as follows:
a. $2,200.00 plus any applicable HST for an orthopaedic assessment, and
b. $2,200.00 plus any applicable HST for a psychological assessment.
iv. The applicant is entitled to interest on any overdue payment of benefits.
v. The applicant is not entitled to any of the other benefits sought on this application.
Released: November 24, 2025
__________________________
Amar Mohammed
Adjudicator