Licence Appeal Tribunal File Number: 23-003863/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:
Olivia Milton
(A minor by their litigation guardian, Danuta Milton)
Applicant
and
Economical Insurance Company
Respondent
AMENDED DECISION
ADJUDICATOR:
Anita Sol-Edeigba
APPEARANCES:
For the Applicant:
Denis Chubar, Counsel Paralegal
For the Respondent:
Sunjary Mistry, Counsel, Paralegal
HEARD:
By way of written submissions
OVERVIEW
1Olivia Milton, the applicant, is a minor involved in an automobile accident on September 5, 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, Economical 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? The insurer states that the applicant has exhausted the medical rehabilitation limit of $3,500.
ii. Is the applicant entitled to chiropractic services, proposed by Clinic United Healing in a treatment plan/OCF 18 (“plan”) submitted April 13, 2021, and denied April 13, 2020?
iii. Is the applicant entitled to interest on any overdue payments of benefits?
RESULT
3I find that the applicant’s injuries are predominantly minor as defined by the Schedule, and therefore the applicant is not removed from the MIG. It is therefore unnecessary to consider the necessity and reasonableness of the treatment plans or the issue of interest.
4The application is dismissed.
ANALYSIS
The Minor Injury Guideline
5The applicant has not established on a balance of probabilities that her injuries are outside the MIG.
6Section 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.”
7An 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. In all cases, the burden of proof lies with the applicant.
8The applicant’s arguments with respect to the MIG are not clear. The applicant has not identified that she suffers from any pre-existing medical condition that would meet the requirements for removal from the MIG under s. 18(2). Although she references psychological symptoms and treatment, she has not pointed me to evidence of a psychological impairment or chronic pain that warrants removal from the MIG.
9With respect to her physical injuries, the applicant was diagnosed with lumber sprain and strain and thoracic sprain and strain injuries by the Chiropractic Assessment of Mediwise Health Centre. These are injuries that fall within the definition of minor injuries.
10The clinical notes and records (“CNRs’’) from St Joseph Health Centre, dated September 5, 2020, indicate that although the complaint was initially categorized as Multisystem Trauma, the reported symptoms of nosebleed and headache had resolved, and no immediate physical injuries were detected.
11I also find the CNRs indicate that the applicant visited her family physician, Dr Saad Hussain, on March 20, 2021, regarding complaints of fatigue. I find that these notes indicate that the applicant has minor injuries because the CNRs of Dr Hussain state that the applicant has no low moods, no sleep problem, no post exertional malaise, no joint pain, no headache. These notes suggest that these notes suggest that the applicant has minor injuries.
12I find on a balance of probabilities that the applicant has not established grounds for removal from the MIG.
13As I have found the applicant is subject to the MIG, it is not necessary for me to consider whether the treatment plan is reasonable and necessary.
Interest
14As there are no overdue benefits interest is not payable pursuant to s. 51 of the Schedule.
ORDER
15I find that:
i. The applicant has not demonstrated that her accident-related impairments warrant removal from the MIG.
ii. As the applicant is subject to the MIG, it is not necessary for me to consider whether the treatment plans are reasonable and necessary.
iii. The applicant is not entitled to interest.
iv. The application is dismissed.
Released: May 29, 2025
__________________________
Anita Sol-Edeigba
Adjudicator