Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 24-002470/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:
Curt Forde
Applicant
and
Belair Direct Insurance
Respondent
DECISION
ADJUDICATOR:
John Mazzilli
APPEARANCES:
For the Applicant:
John K Russell, Counsel
For the Respondent:
Raman Pandher, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Curt Michael Forde, (the “applicant”), was involved in an automobile accident on October 12, 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 Belair Direct Insurance (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 (“MIG”) limit? Note: The parties agree the MIG limits have not been exhausted and their submission shall identify the amounts remaining.
ii. Is the applicant entitled to $5,812.75 for chiropractic and physiotherapy services proposed by The Centre for Physical Health in a treatment plan/OCF-18 (“plan”) dated June 29, 2023?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
3Although the parties were to provide submissions identifying the amounts remaining in the MIG, the parties were silent on the amount remaining in the MIG.
RESULT
4The applicant remains in the MIG, therefore an analysis of the reasonableness and necessity of the treatment plan in dispute is not necessary.
5The application is dismissed.
PROCEDURAL ISSUES
Respondent’s request for a sur-reply
6The respondent sought a leave to file a sur-reply because it submits that the applicant tendered new medical evidence in his reply to submissions, namely a letter dated March 17, 2025, from Jackson Gadjovich, physiotherapist, that ought to have been provided by the applicant in his initial submissions.
7The applicant argues that it tendered the letter from Jackson Gadjovich in his reply to submissions due to a clerical error. The applicant argues that the exclusion of the letter would result in an incomplete review of the dispute.
8For the reasons below I find that the applicant cannot rely on the letter of Jackson Gadjovich at the hearing. I further find that the respondent’s request for a sur-reply is denied.
9I did not allow the letter of Jackson Gadjovich to be admitted into evidence at the hearing because in my view it is not appropriate for the applicant in his reply to submissions to tender evidence that he failed or chose not to submit at first instance, therefore I find that the letter of Jackson Gadjovich is not properly before me. However, I note that even if I consider Jackson Gadjovich’s letter as evidence in keeping with the consumer protection intent of the Schedule, the letter will not have a material effect on the outcome of my findings on its merits.
10The respondent’s request to file a sur-reply is denied. The applicant’s request to rely on the letter of Jackson Gadjovich as evidence at the hearing is also denied.
ANALYSIS
Minor Injury Guideline-Pre-existing condition
11I find that the applicant has not established that he should be removed from the MIG.
12Section 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.”
13An 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.
14The applicant submits that he was previously involved in an automobile accident as a pedestrian and as a result of this accident he sustained a traumatic brain injury, fractured legs, and vision lost. He submits that as a result of the subject accident his previous injuries have been exacerbated and therefore, he should be removed from the MIG. The applicant submits that he continues with physiotherapy treatment for his ongoing hip, back and leg pain. The applicant relies on a letter from Jackson Gadjovich, physiotherapist dated March 17, 2025.
15The respondent argues that the applicant has not tendered medical evidence that supports the exacerbation of his pre-existing medical injuries or how these injuries would preclude maximum recovery within the MIG and therefore he should remain within the confines of the MIG. The respondent relies on the report of Dr. Qadeer, physician dated September 28, 2023.
16It is well established that the onus is on the applicant to prove that he has 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. In this case the applicant has failed in his onus to provide the Tribunal with evidence that his documented pre-existing injury or condition combined with compelling medical evidence that states that his condition precludes recovery within the confines of the MIG, because the applicant did not tender any medical evidence to support his claim to be removed from the MIG.
17The applicant only provided submissions that he deals with chronic neck, back and shoulder issues with no medical evidence to support his claim. For this reason, I was persuaded by and placed full weight to the report of Dr. Qadeer.
18Dr. Qadeer’s assessment of the applicant included a file review of the applicant’s family physician’s CNRs in addition to her examination. Dr. Qadeer is alive to the applicant’s injuries from his previous accident approximately 10 years prior to the subject accident and his history of stroke.
19In her report, Dr. Qadeer opines that there is no compelling evidence by the applicant’s physician or from her examination that his accident-related sprains will exacerbate his pre-existing conditions, and that his pre-existing conditions will not prevent the applicant from achieving maximal medical recovery within the confines of the MIG. I accept Dr. Qadeer’s opinion based on her assessment and her document review of the applicant’s medical files, accordingly the applicant remains in the MIG.
20I find on a balance of probabilities that the applicant has failed to demonstrate that his documented pre-existing injury or condition combined with compelling medical evidence that shows his condition precludes recovery within the confines of the MIG. Accordingly, the applicant remains in the MIG.
The OCF-18 in dispute
21The applicant remains in the MIG, so an analysis of the reasonableness and necessity of the disputed treatment and assessment plans is not required.
Interest
22Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As not benefits are owing, interest is not owing.
ORDER
23It 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 plan in dispute is reasonable and necessary.
iii. Since no benefits are owing, interest is not payable.
iv. The application is dismissed.
Released: December 11, 2025
John Mazzilli
Adjudicator