Yin v. Co-operators General Insurance Company, 2025 CanLII 135587
Licence Appeal Tribunal File Number: 24-002219/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:
Jia Ning Yin
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR: Gurleen Thethi
APPEARANCES:
For the Applicant: Aylina Dhanji, Counsel
For the Respondent: Emily Schatzker, Counsel
HEARD: By way of written submissions
OVERVIEW
1Jia Ning, the applicant, was involved in an automobile accident on November 23, 2022, 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? Note: The parties agree the MIG limits have been exhausted.
ii. Is the applicant entitled to $2,144.93 for a psychological assessment, proposed by Somatic Assessment and Treatment Clinic in a treatment plan/OCF-18 submitted on January 17, 2024?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
iv. Is the respondent liable to pay an award under s. 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?
RESULT
3The applicant sustained minor injuries in the accident as defined under the Schedule. She remains within the MIG and is subject to the treatment limits of the MIG.
4As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
5Given there are no benefits owed or payments outstanding, the applicant is not entitled to interest pursuant to section 51 of the Schedule.
6The respondent is not liable to pay an award under s. 10 of Regulation 664.
ANALYSIS
The applicant is within the MIG
7I find that the applicant has not demonstrated that she should be removed from 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 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 functional impairment or a psychological condition may warrant removal from the MIG.
10The burden is on the applicant to demonstrate, on a balance of probabilities, that her injuries fall outside of the MIG.
11The applicant is seeking removal from the MIG on the basis that she suffers from chronic pain and psychological impairments as a result of the subject accident.
The applicant does not suffer from a psychological impairment
12The applicant has not proven on a balance of probabilities that she suffers from a psychological impairment that would warrant removal from the MIG as a result of the subject accident.
13The applicant submits that she suffers from psychological injuries as a result of the subject accident. The applicant relies on the clinical notes and records (“CNRs”) from her family physician, Dr. Hong Ge, and a psychological pre-screen report completed on January 3, 2024, under the direct supervision of Dr. Svetlana Gabidulina, a psychologist.
14The respondent did not provide any competing medical evidence. To support its position, the respondent relies on Riad v. Economical and P.S. v. Wawanesa Mutual insurance Company and submits that little weight should be given to the psychological pre-screen interview report as it does not contain any objective testing results and was not supported by any of the applicant’s other contemporaneous medical records.
15I agree with the respondent. The report appears to rely entirely on the applicant’s subjective self-reporting and does not include a review of any medical documentation to corroborate. The assessment was also provisional, conducted by an interviewer rather than through a full psychological evaluation, and was completed without any validity testing.
16Notably, the report itself recommends a comprehensive psychological assessment, including psychometric testing and an in-depth clinical interview, to establish an accurate diagnosis and treatment plan. These limitations significantly diminish the reliability and evidentiary value of the report.
17I have reviewed the CNRs of the family physician and find that they do not speak to any psychological impairments that would warrant the applicant’s removal from the MIG. The CNRs from Dr. Ge do not show any ongoing accident-related complaints. The only mention of the accident in the CNRs are the few instances noted in the applicant’s submissions:
i. On November 23, 2022, the applicant informed her doctor of the motor vehicle accident.
ii. On November 28, 2022, Dr. Ge diagnosed the applicant with a concussion and recommended one week off school.
iii. On May 8, 2023, records note depression, and a doctor’s note advised four days off school.
iv. On November 30, 2023, Dr. Ge documented depression and insomnia.
v. On December 4, 2023, Dr. Ge again diagnosed depression and insomnia.
18I find that these CNRs do not support a finding that the applicant suffers from a psychological impairment. The clinical notes are limited, and the applicant did not provide detailed symptom reports. The applicant was not prescribed any medication, and the family physician did not make any referrals.
19Further, a family physician’s observations alone are insufficient to confirm diagnoses such as depression, insomnia, or concussion without corroborating medical evidence. There is also no clear link between the depression and insomnia noted and the accident.
20The applicant has not supplied any additional evidence that would support that she suffers from a psychological condition because of the subject accident.
21I find that the applicant has not proven on a balance of probabilities that she suffers from a psychological impairment as a result of the subject accident.
22As such, the applicant has not established that her accident-related impairments warrant removal from the MIG.
The applicant does not suffer from chronic pain
23The applicant has not proven on a balance of probabilities that she suffers from chronic pain that would warrant removal from the MIG as a result of the subject accident.
24The applicant relies on the CNRs from her family physician and the pre-screening report completed by Dr. Gabidulina. The applicant submits that she has reported ongoing pain for over two years after the accident. However, I am unable to pinpoint complaints relating to pain in the CNRs.
25I find that the pre-screen report prepared by the psychologist is not sufficient to establish or comment on the applicant’s chronic pain condition. Psychologists are trained to assess psychological functioning, mental health, and cognitive issues; they are not qualified to diagnose or evaluate physical conditions such as chronic pain, which require medical expertise in areas like pain management, orthopedics, or neurology. The report in question does not include objective clinical findings or diagnostic testing relevant to chronic pain. Its scope is limited to psychological screening and does not meet the evidentiary standard for determining the existence or severity of a pain disorder. Accordingly, I give little weight to this report on the issue of chronic pain.
26I find that the CNRs do not support a finding that the applicant suffers from chronic pain. The CNRs do not show any ongoing accident-related complaints, and nor has the applicant directed me to any evidence to establish the same.
27In the present case, I am not presented with any evidence from a medical practitioner that the applicant has chronic pain syndrome or even chronic pain.
28As I have found that the applicant remains within the MIG, it is not necessary for me to consider the reasonableness and necessity of the disputed treatment plans.
Interest
29Interest 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.
Award
30The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. The applicant sought an award under s. 10 of Reg. 664. The applicant is not entitled to an award under s. 10, because the applicant is not entitled to the benefits or interest claimed.
ORDER
31The applicant sustained minor injuries in the accident as defined under the Schedule. She is subject to the treatment limits of the MIG.
32As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
33Given there are no benefits owed or payments outstanding, the applicant is not entitled to interest pursuant to section 51 of the Schedule.
34The respondent is not liable to pay an award under s. 10 of Regulation 664.
Released: December 31, 2025
Gurleen Thethi
Adjudicator