Licence Appeal Tribunal File Number: 24-002828/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:
Ampomah Adutwum
Applicant
and
TD Insurance
Respondent
DECISION
ADJUDICATOR:
Roderick Walker
APPEARANCES:
For the Applicant:
John K Russell, Counsel
For the Respondent:
Nicole De Bartolo, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Ampomah Adutwum, the applicant, was involved in an automobile accident on February 6, 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 Insurance and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
PRELIMINARY ISSUE
2Pursuant to paragraph 5 of the Case Conference Order and Report, (CCOR) dated, August 9, 2024, the applicant withdrew the MIG issue from the matters in dispute. Therefore, the MIG will not be considered in this hearing.
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $2,235.37 for a case management assessment, proposed by Red Door MediCare Inc., in a treatment plan/OCF-18 (“plan”) dated January 30, 2024?
i. Is the applicant entitled to $115.95 for chiropractic services, in a plan dated January 24, 2024?
ii. Is the applicant entitled to $1,574.48 for chiropractic services, proposed by InMotion Rehab, in a plan dated September 15, 2023?
iii. Is the applicant entitled to $3,041.02 for chiropractic services, proposed by InMotion Rehab, in a plan dated July 20, 2023?
iv. Is the applicant entitled to $3,041.02 for chiropractic services, proposed by InMotion Rehab, in a plan dated April 3, 2023?
v. Is the applicant entitled to $1,574.48 for chiropractic services, proposed by InMotion Rehab, in a plan dated August 14, 2023?
RESULT
4The application is dismissed. The applicant is not entitled to any of the disputed benefits.
5To 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.
The applicant is not entitled to any of the disputed treatment plans
ANALYSIS AND CONCLUSION
6I find that the applicant is not entitled to any of the disputed treatment plans. The applicant relies on the Clinical Notes and Records (CNRs) of Dr. S. Mok, family physician, and Dr. H. Li, orthopedic surgeon. In paragraph 2 of the applicant’s submissions, he attributes a partial shoulder tear and generalized ligament strain throughout his body to the accident.
7Post-accident imaging of the left hip revealed normal findings. On the same day, an ultrasound of the shoulders showed degenerative changes and a partial thickness tear due to calcific tendinitis, which occurs when calcium deposits accumulate in the shoulder tendons.
8On May 10, 2022, x-rays and ultrasounds of the pelvis and hips showed degenerative changes compared to March 21, 2022, indicating that any worsening was due to degeneration rather than the accident.
9An MRI of the cervical spine on September 1, 2022, revealed advanced disc disease and mild narrowing. A report dated November 8, 2022, by Dr. Hui Li, neurosurgeon, noted L4-5-disc herniation and lumbar stenosis, recommending lumbar laminectomy and fusion. The applicant declined surgery.
10A subsequent MRI on November 6, 2023, showed uncovertebral arthrosis and a small central disc protrusion in the cervical spine, which can cause headaches, numbness, and tingling in the arms and hands.
11The respondent argues these findings reflect a long-standing degenerative condition known since 2018, which the applicant failed to address. I agree. The applicant has not provided compelling evidence that the disputed treatment plans are reasonable or necessary. No OCF-18s were filed with the Tribunal, and the applicant did not outline treatment methods, goals, or timelines.
12The applicant bears the onus of proving entitlement to the disputed benefits. By failing to submit the required documentation and supporting evidence, the applicant has not met this burden.
ORDER
13The applicant did not provide any of the disputed OCF-18 ‘s and tendered limited evidence to the Tribunal in support of their claim. As a result, I find that the applicant has not satisfied his burden to demonstrate entitlement to the disputed plans.
14The application is dismissed.
Released: December 3, 2025
Roderick Walker
Adjudicator