Citation: Ahmed v. Economical Mutual Insurance Company, 2025 ONLAT 22-005807/AABS - A

Licence Appeal Tribunal File Number: 22-005807/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:

Tooba Ahmed

Applicant

and

Economical Mutual Insurance Company

Respondent

AMENDED DECISION

ADJUDICATOR:

Kieffer Norton

APPEARANCES:

For the Applicant:

Arvin Gupta, Counsel

For the Respondent:

Lori Marzinotto Danielle Gauvreau, Counsel

Written Hearing:

Heard by way of written submissions

OVERVIEW

1Tooba Ahmed, the applicant, was involved in an automobile accident on December 6, 2019, 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, Insurer, 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 Minor Injury Guideline limit?

ii. Is the applicant entitled to $1302.19 for chiropractic treatment, proposed by Reddy’s Physio and Rehab in an OCF-18/treatment plan (“plan”) dated September 10, 2021?

iii. Is the applicant entitled to interest on any overdue payments?

RESULT

3I find that:

i. The applicant’s injuries are predominantly minor and are therefore subject to treatment within the $3,500 limit of the MIG.

ii. I have found that the applicant is subject to the MIG and the MIG limit has been exhausted, there is no need to consider whether the remaining balance of $2.19 is payable.

iii. As there are no overdue payments, the applicant is not entitled to interest.

ANALYSIS

The Minor Injury Guideline

4An 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.

5The applicant submits that they have produced compelling evidence that their injuries are not minor in nature and that they have produced compelling evidence to warrant removal. They rely on an X-ray dated June 15, 2021 which showed a calcific density seen superior to the AC Joint and an ultrasound dated August 25, 2021.

6The applicant relies on an x-ray dated, June 15, 2021 and ultrasound dated, August 25, 2021 of the right shoulder which indicate a tear that is noted as being possibly related to trauma. The applicant appears to be saying that these injuries are a result of the accident that occurred on December 6, 2019.

7The respondent argues that the applicant has not met their onus to prove their injuries were a result of the accident and that the injuries themselves do not warrant removal from the MIG. They argue that the applicant has failed to provide sufficient evidence that his injuries are not predominantly minor, and the treatment plans in dispute are not reasonable or necessary.

8The applicant attended Reddy’s Physiotherapy from December 24, 2019 to March 12,2020. The diagnosis provided by the clinic were whiplash associated disorder II, Sprains/ Strains and subluxation affecting Neck and Back. These injuries are defined as being within the MIG.

9The clinical notes and records from the applicant Physician, Dr. Gad, do not contain any reference to the motor vehicle accident and do not make any diagnosis of injury in relation to the motor vehicle accident.

10The section 44 reports of Dr. Lee diagnose that the applicant suffered cervical myofascial sprain/strain, right shoulder sprain/strain and lumbar myofascial sprain/strain. There was no evidence of any musculoskeletal injury or impairment. The injuries are defined as being within the MIG.

11The applicant submits that the conclusions of Dr. Lee are not reliable because an x-ray and ultrasound indicated a tear in the applicant’s right shoulder. However, I place little weight on the x-ray and ultrasound results as I find that these tests were done nearly 16 months post accident and do not reference or make any conclusions that these injuries were caused by the motor vehicle accident.

12The applicant has provided some medical evidence in their submissions however I do not find it persuasive for the following reasons. There is no evidence before me that the Applicant’s shoulder injury was caused by the MVA, and there is no evidence before me in the applicant’s submissions that they are suffering from any level of chronic pain. There is no diagnosis of injury that would remove the applicant for the Minor injury guideline nor any diagnosis of chronic pain.

13After considering the submissions and evidence of the parties, I find that the applicant has not met their evidentiary burden of providing compelling evidence in support of their claim that they should be removed from the MIG.

14The Applicant remains in the MIG.

15The applicant submitted to the respondent a treatment plan dated August 26, 2021 completed by Frederick Levenston, chiropractor, of Reddy’s Physio Inc. The plan is for Physical therapy services for a total of $1302.19.

16The applicant is not entitled to the remaining balance because it is outside of the MIG limit.

Interest

17Given that no benefits are overdue, the applicant is not entitled to interest.

ORDER

18I find that:

i. The applicant’s injuries are predominately minor and therefore subject to the treatment within the $3,500.00 limit of the MIG.

ii. As there are no overdue payments, the applicant is not entitled to interest.