Mangal v. The Personal Insurance Co., 2025 CanLII 3756

Citation: Mangal v. The Personal Insurance Co., 2025 ONLAT 22-013737/AABS

Licence Appeal Tribunal File Number: 22-013737/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:

Ramnarain Mangal

Applicant

and

The Personal Insurance Co.

Respondent

DECISION

ADJUDICATOR: Sarah Sheaves

APPEARANCES:

For the Applicant: Andrej Rondas, Counsel

For the Respondent: Vicky Chan, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Ramnarain Mangal, the applicant, was involved in an automobile accident on July 31, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”).

2The applicant was rear-ended while travelling westbound on Highway 401.

3The applicant was denied benefits by the respondent, The Personal Insurance Co., and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

4The issues in dispute listed in the Case Conference Report and Order dated August 3, 2023, are:

i. Is the applicant entitled to $2,028.10 for chiropractic services proposed by Islington Village Clinic, in a treatment plan (“plan”) dated October 27, 2022?

ii. Is the applicant entitled to $2,195.00 for a chronic pain assessment, proposed by Assurance Medical Services Inc., in a plan dated October 1, 2022?

iii. Is the applicant entitled to $1,452.48 for chiropractic assessment and treatment, proposed by Village Chiropractic and Physio, in a plan dated December 13, 2022?

iv. Is the applicant entitled to interest on any overdue payment of benefits?

5While the applicant made submissions about an award pursuant to s. 10 of Reg. 664, this is not listed as an issue in dispute, and therefore I will not address it.

6The applicant also made submissions related to the Minor Injury Guideline (“MIG”) that suggest his injuries don’t fall within the MIG.

7In its submissions, the respondent submits that the applicant sustained minor injuries and is therefore subject to the MIG limit on treatment.

8While the MIG wasn’t listed in the Case Conference Report and Order as an issue to be decided by me, both parties have made submissions about whether the MIG applies.

9In addition, an analysis of whether the MIG applies is a key factor for consideration required for me to make a finding about the issues in dispute. As a result, I find I must decide whether the applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and are therefore subject to treatment within the $3,500.00 MIG limit.

RESULT

10The applicant has not proven that he has chronic pain that results in a functional impairment or disability. The applicant remains within the MIG.

11The applicant is not entitled to the medical and rehabilitation benefits in dispute.

12As there are no overdue benefits, there is no interest payable.

ANALYSIS

13Section 3(1) of the Schedule 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”.

14The applicant has the burden of proving that the MIG does not apply to his accident-related impairments and, if successful, also has the burden of demonstrating entitlement to the benefits he has claimed on a balance of probabilities.

The applicant is subject to treatment within the MIG limit

15I find that the applicant has not demonstrated on a balance of probabilities that he suffered injuries that fall outside of the definition of “minor injury”.

16The applicant submits that he should be removed from the MIG based on a diagnosis that he has chronic pain, made by Dr. Joshi in a multidisciplinary pain report dated April 15, 2017.

17The applicant did not make any specific submission about the contents of the report; he simply relies on the existence of a diagnosis that mentions chronic pain.

18The report makes a diagnosis of chronic myofascial pain in the neck and upper back. It notes the current treatment of medication and use of a TENS machine is effective and provides relief. Medication, physiotherapy as needed, and psychotherapy were recommended. Lifestyle changes such as diet and exercise were also suggested. It notes the applicant feels limited at home, and socially due to pain, with no details about those limitations. It indicates pain and stiffness following prolonged activities. While the report recommends “medication” there is no recommendation for any specific medication or dosage. Injections for pain were not required.

19The respondent relied upon Y.X.Y. and The Personal Insurance Company, 2017 CanLII 59515 (ONLAT) and submitted that pain and discomfort alone are not enough to remove an applicant from the MIG. This case provides a compelling outline of factors to consider when deciding whether chronic pain will remove an applicant from the MIG. I agree with the reasoning from the decision and note that it has been widely referenced in decisions of the Tribunal.

20In this decision, the Adjudicator confirmed that for chronic pain to warrant removal from the MIG, it must cause suffering and distress, accompanied by functional impairment and disability and states “a diagnosis of chronic pain without any discussion of the level of pain, it’s effect on the person’s function, or whether the pain is bearable without treatment will not meet the applicant’s burden to show that chronic pain is more than mere sequelae.”

21The Adjudicator in that case confirmed an applicant was required to provide evidence to address all the listed elements outlined above to be removed from the MIG.

22Dr. Joshi’s report suggests that the applicant’s pain was bearable with his current treatment regime. This does not meet the threshold for chronic pain that would warrant removal from the MIG. The report did not discuss the level of pain the applicant was experiencing. It did not mention any level of suffering or distress.

23I considered the other medical evidence available to determine if there was additional evidence from the same period to corroborate Dr. Joshi’s diagnosis or to prove the required elements for removal from the MIG.

24There was no further evidence to show functional impairment, disability, or level of pain, suffering or distress in the records of Dr. Louli, the family physician.

25Dr. Louli’s records confirmed that the applicant as working full-time hours and duties at his pre-accident job as an electrical technician since April 2016. There is no mention in the records of functional limitations in completing his work tasks or activities of daily living.

26There was one visit to Dr. Louli between the return to full-time work in April 2016 and the request for a chronic pain referral in March 2017, and it was for an unrelated ankle fracture.

27There were no further visits to Dr. Louli mentioning upper back or neck pain specifically until March 2023, six years after Dr. Joshi’s report. There is no evidence the applicant followed any of the recommendations for treatment in Dr. Joshi’s report.

28The OHIP records submitted by the applicant confirm there were no medical visits for over one year following the multi-disciplinary pain assessment with Dr. Joshi.

29Based on the medical evidence available, the applicant hasn’t demonstrated chronic pain that results in functional limitation or disability, or that the pain is not bearable without treatment. There is no medical evidence of suffering or distress because of accident-related injuries.

30There is no evidence about the level of pain the applicant was experiencing and how it impacted his ability to function. However, the lack of medical visits for over one year following Dr. Joshi’s diagnosis does provide some anecdotal insight on the level of pain, and disability that the applicant was likely experiencing.

31As a result, I do not find that the applicant has met the burden of demonstrating, on a balance of probabilities, that his injuries fall outside of the MIG, or that he has chronic pain that results in functional impairment or disability.

32The applicant is not entitled to any of medical and rehabilitation benefits claimed in this appeal because he is in the MIG.

Interest

33Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. I find there are no overdue benefits to which interest applies.

ORDER

34For the reasons provided, I order as follows:

i. The applicant is in the MIG and is subject to a $3,500.00 limit on treatment.

ii. The applicant is not entitled to $2,028.10 for chiropractic services.

iii. The applicant is not entitled to $2,195.00 for a chronic pain assessment.

iv. The applicant is not entitled to $1,452.48 for chiropractic assessment and treatment.

v. The applicant is not entitled to interest.