Licence Appeal Tribunal File Number: 24-001019/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:
Jin Chun Liu
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
Steve Clarke
APPEARANCES:
For the Applicant:
Sareena Samra, Counsel
For the Respondent:
Morgan A. MacDonald, Counsel
HEARD:
In Writing
OVERVIEW
1Jin Chun Liu, the applicant, was involved in an automobile accident on July 1, 2019, 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 Wawanesa Mutual Insurance Company and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2A case conference was held on July 5, 2024 and the matter was set down for a written hearing.
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $4,383.90 for chiropractic services, proposed by Total Recovery Rehab Centre in a treatment plan/OCF-18 (“plan”) dated January 8, 2024?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant is not entitled to the treatment plan in dispute.
5The applicant is not entitled to interest.
6The respondent is not liable to pay a section 10 award.
ANALYSIS
Is the applicant entitled to $4,383.90 for chiropractic services submitted January 8, 2024?
7I find, on a balance of probabilities, that the applicant is not entitled to the treatment plan for chiropractic services, dated January 8, 2024.
8To 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.
9The treatment plan dated January 6, 2024, proposes 8 weeks of chiropractic services that include the following goals: pain reduction, increase in strength, increase in range of motion and a return to activities of normal living and pre-accident work activities. The plan was recommended by Dr. Georgia Palantzas, Chiropractor.
10The applicant submits that, as a result of the accident, he sustained serious physical injuries that included: injury of muscle and tendon at the neck, thorax, shoulder, upper arm, abdomen, lower back and pelvis; dislocation sprain and strain of joints and ligaments at neck, thorax, lumbar spine, pelvis and shoulders, and sprain and strain of sacroiliac joint. The applicant further submitted that he was experiencing ongoing neck and back pain. He relies on the clinical notes and records (CNRs) of family doctor, Dr. Kenneth Liu, and Dr. Bill Lim, General Practitioner. The applicant also relies on two psychological reports from Somatic Assessments.
11The respondent submitted that the applicant has provided insufficient evidence that the treatment plan is reasonable and necessary and, further, that the documents provided by the applicant are subjective with self-reported symptoms rather than providing medically sound evidence that the proposed treatment plan will resolve reported pain and mobility issues.
12Based on the submissions and evidence provided by both parties, it appears the applicant did sustain injuries, as a result of the subject accident.
13However, I am not pointed to medical evidence that illustrates previous chiropractic treatment has provided any level of success in alleviating the applicant’s symptoms.
14Further, I am not shown that any future/similar treatment plan would have a significant probability of success.
15Additionally, although Dr. Palantzas does recommend chiropractic services, I am not directed to any corroborating contemporaneous medical opinion that supports this recommendation.
16It is well established that a treatment plan on its own is not sufficient to establish that it is reasonable and necessary. There must be corroborating, contemporaneous medical evidence.
17I have reviewed the CNRs of Dr. Liu. I was not pointed to any recommendation for treatment after December 2019, and that recommendation was for physiotherapy.
18I also reviewed the CNRs of Dr. Lim. The only references to accident-related issues were concerns expressed by the applicant. I was not directed to any objective medical evidence that the applicant was experiencing any physical accident-related issues. Further, there was no recommendation for a treatment plan. The only referral referenced was to a specialist for an unrelated issue, and that was in 2021.
19Additionally, I was pointed to two psychological reports from Somatic Assessments. In each case, the reports note subjective references to pain by the applicant and recommend further psychological support. There was no recommendation for chiropractic services.
20I find, on a balance of probabilities, that the applicant is not entitled to the treatment plan for chiropractic services, dated January 8, 2024.
Interest
21As there are no overdue payments, the applicant is not entitled to interest, pursuant to section 51, of the Schedule.
Award
22As there are no benefits withheld or delayed, the applicant is not entitled to a section 10 award.
ORDER
23I find that:
i. On a balance of probabilities, the applicant is not entitled to the treatment plan for chiropractic services, dated January 8, 2024.
ii. The applicant is not entitled to interest.
iii. The applicant is not entitled to an award, under section 10.
iv. This application is dismissed.
Released: December 16, 2025
__________________________
Steve Clarke
Adjudicator