Fiaz A Sajid v. Intact Insurance Company, 2025 CanLII 15963

Citation: Sajid v. Intact Insurance Company, 2025 ONLAT 22-013264/AABS

Licence Appeal Tribunal File Number: 22-013264/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.

Parties

Between:

Fiaz A Sajid

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR: Robert Rock

APPEARANCES:

For the Applicant: Linda M Spurrell, Paralegal

For the Respondent: Olivia Hajdas, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Fiaz A Sajid, the applicant, was involved in an automobile accident on June 12, 2020, 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, Intact 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 $2,486.00 for psychological services, proposed by Medex Assessments in a treatment plan/OCF-18 dated September 3, 2020?

iii. Is the applicant entitled to $315.38 for physiotherapy services, proposed by Airport Rehabilitation Centre in a treatment plan dated September 3, 2020?

iv. Is the applicant entitled to $3,342.40 for physiotherapy services, proposed by Airport Rehabilitation Centre in a treatment plan dated November 21, 2020?

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 his injuries suffered from the subject vehicle accident are beyond those as outlined by the MIG.

4As the applicant remains in MIG, he is only eligible for funding to the MIG limit, and he is not entitled to the treatment plans in dispute.

5As no benefits are owing, 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 due to a chronic pain.

9The respondent argues that the applicant has not met the burden of proof that he suffers from chronic pain with a functional impairment.

The applicant does not suffer from chronic pain with a functional impairment.

10I find that the applicant has proven on a balance of probabilities that he suffers from chronic pain with a functional impairment.

11The applicant submits that he has developed chronic pain with a functional impairment because of the accident, and he relies on the clinical notes and records (“CNRs”) of his family doctor, Dr. Sandhu.

12I find that the CNRs of Dr. Sandhu do not support that the applicant is suffering from chronic pain with a functional impairment. In the CNRs, Dr. Sandhu does use the term chronic pain regarding the applicant’s lower back pain. I placed reduced weight on the doctor using this term, as the doctor does not refer the applicant to any specialist, nor does the doctor describe in his CNRs how he determined or established chronic pain. Additionally, all medical imaging produced relatively unremarkable results.

13The respondent submits that the applicant has not provided evidence that he has developed chronic pain with a functional impairment, and it relies on a musculoskeletal examination completed by Dr. Belfon, GP and member of the Canadian Society of Medical Evaluators, on November 14, 2020. Additionally, the respondent relies on a GP MIG assessment completed by Dr. Ming-Wai Tu, GP, family medicine, on December 3, 2022.

14I find that the musculoskeletal examination from Dr. Belfon does not support the claim that the applicant suffers from chronic pain with a functional impairment. The doctor’s findings were that the applicant sustained sprain/strain injuries from the subject accident. Additionally, during the examination, the applicant described he is still working two jobs, and that he was independent in his activities of daily life. No functional impairment was identified during the examination.

15I also find that the MIG assessment by Dr. Ming-Wai Tu does not support the applicant’s claim of chronic pain. During the assessment, the doctor diagnosed the applicant with minor injuries as defined by the MIG. Additionally, the applicant reported being independent with his activities of daily living, and that he is working two jobs. Dr. Ming-Wai Tu noted inconsistencies during her assessment between observation and formal testing. These inconsistencies were noted with range of motion testing on examination, versus the active movement of the applicant during the assessment. The doctor suggests that the applicant is over reporting symptoms of pain.

16I find that the applicant has not proven on a balance of probabilities that he suffers from chronic pain with a functional impairment. Neither insurer’s examination report supported that the applicant suffered non-minor injuries as a result of the accident. In addition, they did not identify a functional impairment as in both reports, that applicant shares that he is working two jobs, is independent with his activities of daily living, and no functional impairments were identified. I did not find any evidence in the CNRs to show Dr. Sandhu referred the applicant to specialists for additional testing. I was not directed to any evidence that would support that the applicant suffers from any functional impairment, which is required for removal from this MIG on this ground.

17The applicant has not proven on a balance of probabilities that he suffers from chronic pain with a functional impairment to warrant removal from MIG.

18The treatment plan for psychological services, proposed by Medex and submitted on September 3, 2020, was withdrawn by the applicant in his written submissions. Additionally, the Case Conference Report and Order listed $315.38 as the amount for physiotherapy services, proposed by Airport Rehabilitation Centre in submitted on September 3, 2020. This amount represents a partial approval. The original treatment plan was $1,300.00 and was partially approved for $984.62.

19As the applicant remains within the MIG limit, I find I do not have to conduct the reasonable and necessary analysis for the disputed treatment plans. The applicant is entitled to any remaining amount left under the MIG limit.

Interest

20Interest 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 due.

ORDER

21I find that:

i. The applicant remains in the MIG.

ii. The applicant is not entitled to the treatment plans in dispute.

iii. The applicant is not entitled to any interest.

iv. The application is dismissed.