Chang v. Certas Direct, 2025 CanLII 39287

Licence Appeal Tribunal

Citation: Chang v. Certas Direct, 2025 ONLAT 23-009180/AABS

Licence Appeal Tribunal File Number: 23-009180/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:

Ikjoon Chang

Applicant

and

Certas Direct

Respondent

DECISION

ADJUDICATOR:

Lisa Holland

APPEARANCES:

For the Applicant:

Ahmadreza Bazyar, Paralegal

For the Respondent:

Tresa S Zacharia, Counsel

HEARD:

By Way of Written Submissions

OVERVIEW

1Ikjoon Chang, the applicant, was involved in an automobile accident on July 27, 2018, 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, Certas Direct, 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. Is the applicant entitled to the catastrophic assessments and reports proposed by Verity Medical Assessments Inc. in a treatment plan/OCF-18 (“plan”) submitted May 2, 2023, as follows:

(a) $4,000.00 for a psychological assessment;

(b) $2,000.00 for the preparation of the psychological assessment;

(c) $2,000.00 for a neurological assessment;

(d) $2,000.00 for the preparation of the neurological assessment;

(e) $2,000.00 for an orthopaedic assessment;

(f) $2,000.00 for the preparation of the orthopaedic assessment;

(g) $2,000.00 for a comprehensive physician assessment;

(h) $2,000.00 for the preparation of the comprehensive physician assessment;

(i) $2,000.00 for an in-home assessment and report preparation;

(j) $2,000.00 for an executive report preparation; and

(k) $200.00 for the completion of the OCF-18?

RESULT

3I find that the applicant is not entitled to the disputed assessments and reports in a plan dated May 2, 2023 from Verity Medical Assessments Inc.

PROCEDURAL ISSUE

4The respondent submits that the applicant’s submissions and evidence are not formatted to include page numbers, paragraph numbers or tabbed pages. However, since the respondent does not raise any concerns of prejudice as a result of the applicant’s submissions. I have considered the applicant’s submissions and evidence.

ANALYSIS

5To receive payment for a treatment plan under sections 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. The applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving same are reasonable.

The applicant is not entitled to the May 2, 2023 plan from Verity Medical Assessments Inc.

6I find that the applicant has not established on a balance of probabilities that he is entitled to the May 2, 2023 plan for catastrophic assessments and reports.

7The applicant submits that his medical evidence supports the criteria for a catastrophic impairment designation under the Schedule. The applicant relies on various consultation reports of Dr. Hossein Amani, physiatrist, Dr. Mehdi Sadoughi, neurosurgeon, Dr. Michael Olsen, orthopaedic surgeon, and Dr. Hae Kim, psychiatrist.

8The applicant does not address the question of whether the disputed assessments and reports, or fees charged are reasonable and necessary regarding his accident-related injuries. Further, the applicant has not provided a copy of the proposed plan for catastrophic assessments. Therefore, it is not possible to determine the goals of the assessments and reports.

9The respondent submits that the applicant has not met his onus of establishing entitlement to each of the assessments and the fees charged in the disputed plan for catastrophic assessments.

10The onus is on the applicant to prove on a balance of probabilities that each of the examinations and reports within the treatment plan are reasonable and necessary and if so, whether the fees are reasonable.

11I find that the evidence before me does not corroborate the need for the plan dated May 2, 2023 of Verity Medical Assessments for catastrophic assessments, totaling $22,200.00.

12As the applicant did not make submissions with respect to this treatment plan, or submit it into evidence, I find on a balance of probabilities that the applicant has not established entitlement to the catastrophic assessments since he has not addressed whether the plan is reasonable and necessary.

ORDER

13For the reasons set out above, I find that:

i. The applicant is not entitled to the disputed plan.

ii. The application is dismissed.