Licence Appeal Tribunal File Number: 24-002369/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:
Jumeila Williamson
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR: John Mazzilli
APPEARANCES:
For the Applicant: Jasmine Patel, Counsel
For the Respondent: Tefiney E Scarlett, Paralegal
HEARD: By way of written submissions
OVERVIEW
1Jumeila Williamson, (the “applicant”), was involved in an automobile accident on February 3, 2023, 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 Aviva General Insurance Company (the “respondent”) 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 limit? Note: The parties agree the MIG limits have been exhausted.
ii. Is the applicant entitled to $171.01 ($1,293.11 less $1,122.10) for chiropractic services, proposed by Inline Rehabilitation Centre in a treatment plan/OCF-18 (“plan”) submitted April 26, 2023, and partially denied April 27, 2023?
iii. Is the applicant entitled to $3,978.01 for chiropractic services, proposed by Inline Rehabilitation Centre in a plan submitted June 15, 2023, and denied June 28, 2023?
iv. Is the applicant entitled to $1,920.52 for psychological services, proposed by Inline Rehabilitation Centre in a plan submitted May 17, 2023, and denied May 30, 2023?
v. Is the applicant entitled to $2,519.00 for psychological services, proposed by Inline Rehabilitation Centre in a plan submitted July 11, 2023, and denied July 21, 2023?
vi. Is the applicant entitled to $2,993.11 for physiotherapy services, proposed by Inline Rehabilitation Centre in a plan submitted December 5, 2023, and denied December 6, 2023?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant remains in the MIG, therefore an analysis of the reasonableness or necessity of the disputed treatment or assessment plans is not necessary.
4Since no benefits are owing interest is not owing.
5The application is dismissed.
ANALYSIS
Minor Injury Guideline
6Section 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.”
7An 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 a functional impairment or a psychological condition may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
8The respondent characterized the applicant’s accident-related injuries as falling within the minor injury guideline (“MIG”) definition as outlined in section 3(1) of the Schedule and denied funding for the treatment and assessment plans in dispute. The applicant disagrees and submits that she ought to be removed from the MIG due to her physical and psychological injuries sustained in the accident.
Minor Injury Guideline – Physical injuries
9I find that the applicant has not established that she should be removed from the MIG due to her physical injuries.
10The applicant submits that as a result of the accident she suffers from pain in her neck, shoulders and has ongoing back pain that require ongoing physiotherapy and chiropractic treatment to temporarily alleviate her pain symptoms. She further submits that additional treatment is required to mitigate her injuries to return to her pre-accident state. The applicant relies on the Clinical Notes and Records (“CNRs”) of her family physician Dr. Orebiyi, an OCF-3 dated February 9th, 2023, completed by Kevin Bar, chiropractor and the CNRs of Inline Rehab.
11The respondent argues that the applicant sustained uncomplicated soft tissue injuries as a result of the accident. It argues that the applicant has not provided compelling evidence that link her present physical complaints with the subject accident and therefore the applicant’s injuries can be addressed within the confines of the MIG. The respondent relies of the report of Dr. Ming-Wai Tu, physician dated July 11, 2023.
12The applicant has failed in her onus to prove she should be removed from the MIG because of her accident-related physical injuries, namely because the sprain/strain to her lower back are injuries that fall within the confines of the MIG. Therefore, the applicant remains in the MIG.
13Following the accident the applicant began mitigating her injuries at Inline Rehab. The OCF-3 completed by Kevin Bar diagnosed the applicant to have suffered mild cognitive disorder, nervousness and sprain and strain of the lumbar spine and the anticipated duration of the applicant’s injuries are nine to twelve weeks. The applicant began treatments that included physiotherapy, TENS/IFC treatment, heat therapy, massage, and chiropractic treatment.
14Kevin Bar’s diagnosis of the applicant’s sprain and strain of her lumbar spine is corroborated by the applicant’s family physician’s CNRs of July 18, 2023, and July 31, 2023, which reveals mild tenderness in the applicant’s lower back and the applicant advised her family doctor that she was doing better and that her pain improved but still gets the “occasional niggles”. Dr. Orebiyi did not note any other psychical impairments, other than the sprains and strains, however Dr. Orebiyi recommends the applicant undergo imagining by way of an X-ray. On July 25, 2023, the applicant underwent an X-ray at Ontario Diagnostic Centre and the impression from this X-ray reveals no significant pathology.
15In addition, the applicant was examined by Dr. Ming-Wai Tu by way of an insurer’s examination. The examination revealed that there is no swelling, erythema, or deformities in the applicant’s lower back, however there was focal tenderness in bilateral paraspinals of the lower back and that the applicant has full active range of motion of her back in all directions with no concerns.
16Dr. Ming-Wai Tu opines that from a musculoskeletal perspective, the applicant has likely suffered from a lumbar strain as direct result of the accident and that as her injury is uncomplicated soft tissue injury she opines that further facility-based treatment is not required as there is no evidence that ongoing facility based therapy has superior outcomes compared to the self-directed home based exercise program the applicant has already began to undertake.
17Dr. Ming-Wai Tu’s opinion and the contemporaneous medical evidence indicates that the applicant has sustained an uncomplicated soft tissue injury in her lower back that has not resulted in a functional impairment. Therefore, the applicant has not met her onus to prove that her impairments cannot be addressed within the confines of the MIG.
18The applicant is independent in her daily activities, continues to drive, work at her pre-accident employment, attend university classes, plays volleyball and basketball, which is further indicative that the applicant’s physical injuries have been addressed within the confines of the MIG and do not warrant ongoing facility-based treatment.
19I find on a balance of probabilities that the applicant has not established that she should be removed from the MIG because her accident-related sprain/strain to her lower back are minor injuries
The applicant has not demonstrated that she should be removed from the Minor injury guideline due to a psychological impairment
20I find that the applicant does not suffer from a psychological impairment as a result of the accident that warrants removal from the MIG.
21The applicant submits that she suffers from significant accident-related psychological impairments. The applicant submits that she should be removed from the MIG because she was diagnosed with specific phobia that is driving/passenger related. The applicant relies on the report of Dr. Kleiman, psychologist dated May 24, 2023.
22The respondent argues that the applicant suffered from a normal reaction of increased anxiety immediately after the accident, which it argues has dissipated over time because the applicant is driving frequently. The respondent argues that the applicant did not sustain a psychological impairment as a direct result of the accident. The respondent relies on the report of Dr. Bacchiochi dated July 25, 2023, and his paper review report dated August 14, 2023.
23In find that the contemporaneous evidence does not support a finding that the applicant has sustained a psychological impairment as a result of the accident that warrants removal from the MIG.
24In her report Dr. Kleiman opined that the applicant is experiencing driving anxiety since the accident, especially when she is stopping or sees another vehicle stopping behind her and because she has also reported experiencing passenger anxiety because the applicant particularly dislikes the lack of control as a passenger.
25While the applicant did experience driving and passenger anxiety following the accident, the evidence shows that the applicant continued to drive following the accident. This is corroborated by the applicant’s self report to Dr. Ming-Wai Tu that she has a bit more driving anxiety since the accident however this has improved a lot over the past five months. The applicant’s self report to Dr. Ming-Wai Tu aligns with the report and opinion of Dr. Bacchiochi, namely that the applicant did report some increased anxiety related to driving immediately after the accident, but she continues to drive on a regular basis and this anxiety has dissipated over time and because the applicant was not describing any profound anxiety, cautiousness, or avoidance related to driving at this time of his assessment.
26While I accept that the applicant has experienced some driving/passenger anxiety as a result of her first accident, her only accident-related complaints to her family physician were in relation to pain in her lower back and not psychological in nature. The contemporaneous evidence supports a finding that the applicant’s driving/passenger anxiety has dissipated over time because the applicant has continued to drive following the accident. Therefore, I accept Dr. Bacchiochi’s opinion that the applicant is not presenting with any psychological symptoms that would fall outside of the definition of a minor injury.
27I find on a balance of probabilities that the applicant does not suffer from a psychological impairment as a result of the accident that warrants removal from the MIG.
The OCF-18s in dispute
28The applicant remains in the MIG, so an analysis of the reasonableness and necessity of the disputed treatment and assessment plans is not required.
Interest
29Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, interest is not owing.
ORDER
30It is ordered that:
i. The applicant remains in the MIG.
ii. As the applicant is in the MIG, it is not necessary to consider whether the treatment and assessment plans in dispute are reasonable and necessary.
iii. Since no benefits are owing, interest is not payable.
iv. The application is dismissed.
Released: December 5, 2025
John Mazzilli
Adjudicator