Cameron v. Aviva Insurance Company of Canada, 2025 ONLAT 23-013576/AABS
Licence Appeal Tribunal File Number: 23-013576/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:
Colin Cameron
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR: Christin Carmichael Greb
APPEARANCES:
For the Applicant: Dayana Soto Santana, Paralegal
For the Respondent: Yann Grand-Clement, Counsel
HEARD: By way of written submissions
OVERVIEW
1Colin Cameron, the applicant, was involved in an automobile accident on November 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, Aviva 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:
Is the applicant entitled to the assessments proposed by 101 Assessments in a treatment plan/OCF-18 (“plan”), as follows: i. $2,460.00 for a Chronic Pain Assessment, in a plan submitted June 9, 2023; ii. $2,158.21 for an Attendant Care Assessment, in a plan submitted July 11, 2022; and iii. $2,460.00 for a Neuropsychological Assessment, in a plan submitted July 11, 2022?
Is the applicant entitled to the services proposed by 101 Physiotherapy, as follows: i. $564.00 ($2,764.00 less $2,200.00 approved) in a plan submitted November 15, 2021; and ii. $1,298.79 for chiropractic and massage therapy services, in a plan submitted November 9, 2023?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The application is dismissed. The applicant is not entitled to the denied amounts on the treatment plans in question, and no interest is payable.
ANALYSIS
4To 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 the treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
The applicant is not entitled to the OCF-18 in the amount of $2,460.00 for a Chronic Pain Assessment
5I find the applicant has not established entitlement to the treatment plan for a chronic pain assessment on a balance of probabilities.
6The applicant submits that the chronic pain assessment is reasonable and necessary based on the medical evidence that has been in included in the records of Dr. Singh, Family Doctor, and Dr. Sohanpal, Anesthesiologist and Pain Specialist. The records include information on the applicant’s chronic back pain, chronic neck pain, and chronic shoulder pain. The applicant goes on to submit that the purpose of the chronic pain assessment is essential in developing a comprehensive, personalized treatment and management plan that improves the patient’s quality of life. However, the referral by Dr. Singh to Dr. Sohanpal states that the purpose of the referral is for an assessment of chronic pain and what his other options may be in terms of treatment, which is also the goal of the disputed chronic pain assessment.
7The respondent submits that a chronic pain assessment is duplicative and redundant as the applicant already has a management plan for his pain as he was referred to, and attended, Dr. Sohanpal. As well, the respondent submits that the applicant has undergone an MRI and treatment for degenerative disc disease as part of that plan. The respondent goes on to submit that as this treatment plan was submitted nearly two years after the date of loss, there is no explanation why another assessment is necessary when the applicant’s physical state has been repeatedly assessed.
8While the applicant does seemingly suffer from chronic pain stemming from the accident, the evidence put forward by the applicant does not support that a further chronic pain assessment is reasonable and necessary. The goals the applicant states of the assessment are valid, however, these goals have already been obtained via the referral to and treatment by Dr. Sohanpal. The applicant does not make any submissions as to why the treatment plan for this chronic pain assessment is reasonable and necessary, if he is already being treated by Dr. Sohanpal. I agree with the respondent that this assessment is duplicative and redundant.
9Accordingly, I find that the applicant has not proven on a balance of probabilities that a chronic pain assessment is reasonable and necessary.
The applicant is not entitled to the OCF-18 in the amount of $2,158.21 for an Attendant Care Assessment
10I find that the applicant has not established, on a balance of probabilities, that an attendant care assessment is reasonable and necessary.
11The applicant submits he is entitled to an attendant care assessment. The applicant further submits that as previously demonstrated by medical evidence he is precluded from engaging in various daily activities, mild to moderate memory and concentration levels, and social isolation.
12The respondent argues that the applicant has not met his burden to establish that an attendant care assessment is reasonable and necessary. The respondent argues that the applicant has not brought forward any evidence of difficulties with his daily activities and that there are no records of the same contained in the family doctor’s records. The respondent also points to comments about daily activities in the applicant’s 2022 psychological assessment report by Dr. Papazoglou, Psychologist, that are not reflected in any other medical evidence.
13I agree with the respondent. The applicant has not pointed or directed me to any clinical notes or medical records to substantiate that the applicant is unable to engage in various daily activities that would warrant an assessment. The applicant only submits that previously demonstrated medical evidence exists but does not point to the medical evidence he is relying upon. Dr. Papazoglou’s report does state that the applicant sometimes takes longer to do certain activities but does not state that the applicant requires assistance or that he is unable to complete these activities. I was unable to find any further comments in the clinical notes and records of the applicant stating that he had reported restrictions of limitations in his daily activities.
14For these reasons, I find that the applicant has not met his onus to establish on a balance of probabilities that an attendant care assessment is reasonable and necessary.
The applicant is not entitled to the OCF-18 in the amount of $2,460.00 for a Neuropsychological Assessment
15I find that the applicant has not established, on a balance of probabilities, that a neuropsychological assessment is reasonable and necessary.
16The applicant relies upon a single Tribunal decision, Buckley v. Certas Direct Insurance Company, 2023 CanLII 26953 (ON LAT), to support an assessment but makes no comments on how it is related to this assessment. No medical evidence or other arguments are made in support of such an assessment.
17The respondent submits that the applicant has already undergone two psychological assessments and has not brought forward any evidence showing that he requires another similar assessment or that he has suffered any sort of neurological impairment.
18The applicant has not brought forward any medical evidence to support a neuropsychological assessment, other than citing a previous Tribunal decision. I was not pointed or directed to any medical notes or records in support of a neuropsychological assessment.
19Accordingly, I find that the applicant has not met his onus to establish, on a balance of probabilities, that a neuropsychological assessment is reasonable and necessary.
The applicant is not entitled to an OCF-18 in the amount of $564.00 ($2,764.00 less $2,200.00 approved) for physiotherapy services
The applicant is not entitled to an OCF-18 in the amount of $1,298.79 for chiropractic and massage therapy services
20I find that the applicant has not met the onus to prove that the treatment plans for physiotherapy, chiropractic, and massage therapy services are reasonable and necessary. The parties made their submissions respecting both plans together, so I have addressed the two plans together.
21The applicant states that these plans are reasonable and necessary for the treatment of chronic back pain, chronic shoulder pain, and chronic neck pain. To support this claim, the applicant argues that Dr. Singh has made multiple referrals to physiotherapy and chiropractic services. The applicant also cites past Tribunal decisions to support the need for these treatment plans, including S.M. vs. Aviva General Insurance Company-008818/AABS, 2020 CanLII 27439 (ON LAT) and Wright v the Personal, 2021 CanLII 134536 (ON LAT). The applicant made no submissions on the outstanding amount of $564.00 and why the amount was reasonable and necessary.
22The respondent argues that the applicant has not shown any evidence in his submissions as to why these specific treatment plans are reasonable and necessary. The respondent points to the s. 44 Physician Assessment by Dr. Gelman, Medical Doctor, which reports no significant objective signs of ongoing musculoskeletal accident-related impairment.
23Despite having the onus, I was not led to medical evidence from the applicant that establishes the goals of the treatment plans are being met. The clinical notes and records of Dr. Singh indicate that the applicant has been receiving various physiotherapy treatments, and outlined the injuries sustained, but I was not led to evidence stating that progress has been made. The last notes from Dr. Singh were January 3, 2022, which mentioned continuing with physiotherapy. There is no mention in Dr. Singh’s notes of chiropractic or massage therapy. This lends support to the respondent’s claim that there are no longer any objective signs of ongoing musculoskeletal accident-related impairments.
24While there is no doubt that the applicant has sustained injuries, I have not been led to supporting medical evidence to indicate that prior treatment plans have been successful in reducing pain or improving range of movement, nor any other goals. I was not led to a progress report or other indication of successful healing.
25Accordingly, I find that the applicant has not met his onus to establish, on a balance of probabilities, that an OCF-18 for physiotherapy services and an OCF-18 for chiropractic and massage therapy services are reasonable and necessary.
Interest
Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefit payments, no interest is owing.
ORDER
26I find that:
i. The applicant is not entitled to $2,460.00 for a chronic pain assessment.
ii. The applicant is not entitled to $2,158.21 for an attendant care assessment.
iii. The applicant is not entitled to $2,460.00 for a neuropsychological assessment.
iv. The applicant is not entitled to $564.00 ($2,764.00 less $2,200.00 approved) for physiotherapy services.
v. The applicant is not entitled to $1,298.79 for chiropractic and massage therapy services.
vi. No interest is owing.
vii. The application is dismissed.
Released: December 3, 2025
Christin Carmichael Greb Adjudicator