Licence Appeal Tribunal File Number: 24-005246/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:
Bibi Yonas
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR: Laura Goulet
APPEARANCES:
For the Applicant: Jasmine Patel, Counsel
For the Respondent: Michael Rattray, Counsel
HEARD: By way of written submissions
OVERVIEW
1Bibi Yonas, the applicant, was involved in an automobile accident on September 1, 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, Wawanesa Mutual 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 Minor Injury Guideline (“MIG”) limit?
ii. Is the applicant entitled to $2,967.84 for psychological services proposed by Inline Rehabilitation Centre Inc. in a treatment plan/OCF-18 dated August 10, 2022?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
3In her submissions, the applicant withdrew her claim for a non-earner benefit, listed as issue #2 in the Case Conference Report and Order dated October 8, 2024.
RESULT
4The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the MIG.
5Since the applicant has not demonstrated that her accident-related impairments warrant removal from the MIG, it is not necessary to determine the reasonableness and necessity of the disputed treatment plan.
6The applicant is not entitled to interest.
7The application is dismissed.
ANALYSIS
Applicability of the MIG
8Section 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.”
9An 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.
10The applicant submits that she should be removed from the MIG because she suffers from a psychological impairment due to the accident.
11The parties agree that the MIG limit has been exhausted.
The applicant does not suffer from a psychological condition because of the accident
12The applicant has not met her onus of proving on a balance of probabilities that she suffers from a psychological condition from the accident that would remove her from the MIG.
13In support of her position, the applicant relies on the s. 25 Psychological Assessment Report dated April 22, 2022 that was prepared by Sabrina Simmons, MA, and Valery Kleiman, Dipl. Psych., C. Psych. During the assessment, the applicant reported sleep difficulties, feeling down, upset and annoyed, reduced socialization, memory and concentration difficulties, a decrease in appetite, and driver and passenger anxiety. Based on the assessment, the applicant was diagnosed with Adjustment Disorder with Mixed Anxiety and Depressed Mood, and Specific Phobia (passenger related).
14The applicant also refers to the OCF-3 dated September 22, 2021 prepared by Dr. Kevin Bar, chiropractor, where the applicant was diagnosed with physical injuries, as well as organic catatonic disorder, and disorders of initiating and maintaining sleep (insomnias).
15The respondent submits that the applicant’s reporting during her psychological assessment greatly differs from her reporting to her treating physicians and treatment providers. Specifically, the respondent refers to clinical notes and records (“CNRs”) from the following treatment providers, submitting that the applicant did not report any psychological symptoms from the accident:
i. Brandongate Medical clinic from September 2, 2021 to August 12, 2023, which includes the CNRs from the applicant’s primary care physician, Dr. Bahauddin Danial.
ii. Inline Rehabilitation Centre from September 20, 2021 to October 26, 2022.
iii. Brampton Civic Hospital.
iv. Etobicoke General Hospital.
16I place no weight on the psychological diagnoses that were made by Dr. Bar because I find that under ss. 3 and 4 of the Chiropractic Act, 1991, SO 1991, c. 21, it is not within a chiropractor’s scope of practice to diagnose psychological impairments.
17I place little weight on the applicant’s s. 25 psychological report for the following reasons:
i. The assessor(s) did not review any of the applicant’s medical records as part of the assessment.
ii. The report indicates that the assessment on February 24, 2022 was based on a video interview by Sabrina Simmons, MA, under the supervision of Valery Kleiman, Dipl. Psych., C. Psych., as well as six psychological self-report questionnaires. The report does not indicate Sabrina Simmons’ occupation.
iii. It is not clear who prepared the report and diagnosed the applicant. The report is signed by Sabrina Simmons. Next to this, Valery Kleiman’s name is typed, with “Supervisor” typed underneath, however, where the signature should be, the applicant’s name is typed. In other words, there is no signature on the report other than that of Sabrina Simmons, whose occupation is unknown.
iv. There is no indication in the report that any of the psychological self-report questionnaires contain validity testing.
18Further, in addition to putting little weight on the s. 25 report, I am not satisfied, based on the applicant’s self reporting to assessors on one occasion, i.e. February 24, 2022, well over five months after the accident, that she has a psychological condition that would remove her from the MIG. The applicant does not direct me to evidence that she reported any psychological symptoms to any of her treatment providers after the accident.
19For these reasons, I find that the applicant has not met her onus of proving on a balance of probabilities that she suffers from a psychological condition that would remove her from the MIG.
20Accordingly, I find that the applicant’s injuries are predominantly minor as defined in s.3 of the Schedule and therefore subject to treatment within the MIG funding limit.
21As the applicant is in the MIG, it is unnecessary to consider the reasonableness and necessity of the treatment plan in dispute.
Interest
22Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since there are no overdue payments, no interest is ordered.
ORDER
23For the above reasons, I find:
i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the MIG.
ii. Since the applicant has not demonstrated that her accident-related impairments warrant removal from the MIG, it is not necessary to determine the reasonableness and necessity of the disputed treatment plan.
iii. The applicant is not entitled to interest pursuant to s. 51 of the Schedule.
iv. The application is dismissed.
Released: December 23, 2025
Laura Goulet
Adjudicator