Kryvokulskyi v. Allstate Insurance, 2025 CanLII 13546

Citation: Kryvokulskyi v. Allstate Insurance, 2025 ONLAT 22-014138/AABS

Licence Appeal Tribunal File Number: 22-014138/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:

Oleksandr Kryvokulskyi

Applicant

and

Allstate Insurance

Respondent

DECISION

ADJUDICATOR: Robert Rock

APPEARANCES:

For the Applicant: Denis Chubar, Paralegal

For the Respondent: Andrew Rodrigues, Counsel

HEARD: By way of written hearing

OVERVIEW

1Oleksandr Kryvokulskyi, the applicant, was involved in an automobile accident on May 15, 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, Allstate Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issues to be decided in the hearing 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 $4,314.20 for psychological services, proposed by Mediwise Healthcare Clinic in a treatment plan/OCF-18 (“plan”) dated March 15, 2022?

iii. Is the applicant entitled to $3,195.84 for a chiropractic services, proposed by Mediwise Healthcare Clinic in a treatment plan dated December 7, 2021?

iv. Is the applicant entitled to $1,920.53 for psychological services, proposed by Mediwise Healthcare Clinic in a treatment plan dated December 13, 2021?

v. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant has not proven on a balance of probabilities that the injuries he suffered as a result of the accident are non-minor as defined in the Schedule.

4As the applicant has been found to remain in the MIG, there is no need to conduct the reasonable and necessary analysis of the disputed treatment plans. The plans are not payable.

5As there are no overdue payments of benefits, no interest is due.

ANALYSIS

The Minor Injury Guideline (“MIG”)

6Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured person sustains impairments that are predominantly minor injuries. 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 person may be removed from the MIG if it can be established that accident-related injuries fall outside of the MIG, or if there is documentation of a pre-existing condition combined with compelling medical evidence stating that the condition precludes recovery from any accident-related minor injury if they are kept within the MIG, pursuant to s. 18(2) of the Schedule. The Tribunal has determined that chronic pain with a functional impairment or a psychological condition may warrant MIG removal.

8The burden is on the applicant to demonstrate, on a balance of probabilities, that his injuries fall outside of the MIG. In this instance, the applicant submits that he should be removed from MIG due to a psychological condition.

9The respondent argues that the applicant has not met the burden of proof that he suffers from a psychological condition that warrants removal from MIG.

The applicant does not suffer from a psychological condition

10I find that the applicant has not proven on a balance of probabilities that he suffers from an accident-related psychological condition to warrant removal from MIG.

11The applicant submits that the psychological injuries suffered in the subject accident fall outside the MIG. The applicant relies on a psychological assessment report from Dr. Mrahar, psychologist, completed on February 25, 2022.

12I find that the psychological assessment report by Dr. Mrahar diagnoses the applicant with adjustment disorder (with mixed anxiety and depressed mood). In the testing, the applicant ranked as average for depression, anxiety, and somatic problems with the Patient Pain Profile test. He was a mild clinical risk for depressed mood and anxiety/worry in the clinical assessment of depression test, and in the moderate range for anxiety for the beck anxiety index test. Only in the beck depression inventory test did the applicant score severe.

13The respondent submits that the applicant has not provided sufficient medical evidence to establish that he suffers from a psychological condition that warrants removal from MIG. The respondent relies on a psychologist’s report by Dr. Dumitrascu, psychologist, on May 2, 2022. Additionally, the respondent relies on a physiatry report, completed by Dr. Soric, physiatrist, on May 16, 2022.

14I find that the psychologist’s report completed by Dr. Dumitrascu does not support the applicant’s claim of a psychological condition. Dr. Dumitrascu’s clinical opinion was that the applicant’s testing results were not suggestive of any symptomology. The doctor administered psychometric testing, and the applicant scored in the mild range for the beck anxiety inventory, within normal limits of the trauma symptom inventory 2-A test, and in the normal range in the clinical assessment of depression test. Dr. Dumitrascu noted that the applicant’s results on the structured inventory of malingered symptomatology test were above the cut-off score for the identification of suspected malingering and/or symptom magnification. This would mean, according to this test, that the applicant likely affected his responses on all administered psychometric measures. Beyond the testing, the applicant did not report having any significant emotional problems as they pertain to the subject accident.

15I find that the physiatry report by Dr. Soric does not support the applicant’s claim of a psychological condition. During the physiatry report, the applicant denied experiencing any emotional difficulties.

16In review of the evidence, I note that similar tests were undertaken by both Dr. Mrahar and Dr. Dumitrascu, with similar results being mostly average, mild or in normal range in comparing the results. The largest difference was Dr. Mrahar administered the Miller Forensic Assessment of Symptoms Test that showed that applicant as not malingering or feigning symptoms. Dr. Dumitrascu administered the structured inventory of malingered symptomatology test, which showed the applicant as suspected of malingering and symptom magnification. I place more weight on Dr. Dumitrascu’s report, as it matched other reporting from the applicant that he was not experiencing emotional difficulties, which he reported to both Dr. Dumitrascu and Dr. Soric.

17The applicant has not proven on a balance of probabilities that he suffers from an accident-related psychological condition to warrant removal from MIG.

18As the applicant has been found to remain in the MIG, there is no need to conduct the reasonable and necessary analysis of the disputed treatment plans. The plans are not payable.

Interest

19Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefit payments, no interest is owing.

ORDER

20I find that:

i. The applicant remains in the MIG.

ii. As the applicant has been found to remain in the MIG, there is no need to conduct the reasonable and necessary analysis of the disputed treatment plans. Currently, the MIG limit has $943.45 available. The applicant is entitled to this amount.

iii. As there are no overdue benefit payments, no interest is owing.

iv. The application is dismissed.