Licence Appeal Tribunal File Number: 24-002408/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:
Vagif Huseynov
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR: Lisa Holland
APPEARANCES:
For the Applicant: Kateryna Vlada, Paralegal
For the Respondent: Peter Durant, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Vagif Huseynov, the applicant, was involved in an automobile accident on December 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, Co-operators 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 $4,328.58 for physiotherapy services, proposed by HM Medical Network Ltd., in a treatment plan/OCF-18 (“plan”) dated February 3, 2022?
iii. Is the applicant entitled to $2,486.00 for a psychological assessment, proposed by AGV Health in a plan dated October 17, 2022?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not demonstrated on a balance of probabilities that he sustained injuries as a result of the accident that warrant removal from the MIG.
4The applicant is entitled to treatment up to the MIG limits and it is not necessary to consider whether the disputed plans are reasonable and necessary.
5No interest is payable.
ANALYSIS
The applicant has not sustained accident-related injuries that warrant removal from the MIG
6I find that the applicant has not proven on a balance of probabilities that he sustained a psychological condition as a result of the accident such that he should be removed from the MIG on this basis.
7Section 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 in accordance with the MIG. 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.”
8An 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 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.
9The applicant submits that he should be removed from the MIG on account of his multiple psychological impairments, which include symptoms of post-traumatic stress disorder, anxiety, depressed mood, emotional distress, nightmares, fatigue and low energy. The applicant submits that during the assessment on February 21, 2023 with Vera Iskhakova (under the supervision of Dr. Keeling), he reported memory and concentration impairment, low energy, social isolation and driving avoidance. The applicant relies on a psychological report dated March 9, 2023, by Dr. Kenneth Keeling, psychologist, of AGV Heath in support of his position. In his report, Dr. Keeling diagnoses the applicant with an adjustment-like disorder, and chronic pain with somatic and psychological factors.
10The respondent relies on Insurer Examination (“IE”) report dated January 19, 2023 by Dr. Shulamit Mor, psychologist. The respondent submits that Dr. Mor opined that the applicant does not suffer from a psychological condition, and he has at most, adjustment difficulties related to his pain. The respondent submits that the applicant did not report any psychological symptoms to his doctor after the accident.
11I do not find the applicant’s evidence persuasive because although there are psychological symptoms of low energy, decreased memory and concentration, social isolation and driving avoidance, there is no actual psychological condition to warrant removal from the MIG. Further, I find that the evidence does not support that the applicant has a psychological impairment.
12I find that although the applicant reported to Vera Iskhakova that he avoids driving and he is socially isolated, Dr. Keeling’s report indicates that he returned to work two to three weeks after the accident. He reported that he works on a daily basis as a driver for Uber Eats and Door Dash. In addition, the clinical notes and records of Dr. Asim Hoca, family physician do not mention any psychological complaints.
13I find that the applicant has not met his onus of establishing entitlement to treatment beyond the MIG on the basis of a psychological impairment. The applicant reported to Vera Iskhakova that he returned to his pre-accident vocational activities. Although the applicant may have some psychological symptoms associated with his minor injuries, there is no psychological impairment as a result of the accident.
14Since the applicant has not demonstrated that his accident-related injuries warrant removal from the MIG, it is not necessary to consider whether the plans are reasonable and necessary. The applicant is entitled to treatment up to the MIG limits.
Interest
15Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since the applicant was not successful in demonstrating his entitlement to the disputed physiotherapy services and psychological assessment, no benefits are owing and interest does not apply.
ORDER
16For the reasons set out above, I find that:
i. The applicant’s injuries are predominantly minor and therefore are subject to treatment within the MIG treatment limit. The applicant is entitled to treatment up to the MIG limits and it is not necessary to consider whether the disputed plans for physiotherapy services and a psychological assessment are reasonable and necessary.
ii. Interest is not payable.
iii. The application is dismissed.
Released: December 9, 2025
Lisa Holland
Adjudicator```