Wang v. Allstate Insurance, 2025 CanLII 47360

Citation: Wang v. Allstate Insurance, 2025 ONLAT 23-009016/AABS

Licence Appeal Tribunal File Number: 23-009016/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:

Ning Wang

Applicant

and

Allstate Insurance

Respondent

DECISION

ADJUDICATOR: Estella Muyinda

APPEARANCES:

For the Applicant: Aylina Dhanji, Counsel

For the Respondent: Rajesan Rajendran, Counsel

HEARD: By way of written submissions

OVERVIEW

1Ning Wang, the applicant, was involved in an automobile accident on October 31, 2022, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”).

2The applicant was denied benefits by the respondent, Allstate Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

3The issues in dispute are:

i. Is the applicant entitled to $1,620.53 for chiropractic services, proposed by Easy Health Centre in a treatment plan/OCF-18 (“plan”) submitted April 26, 2023?

ii. Is the applicant entitled to $2,094.04 for chiropractic services, proposed by Easy Health Centre in a plan submitted June 21, 2023?

iii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

4The parties agreed in their submissions that MIG was no longer in dispute. The applicant also indicated in her submissions that issue 4 as listed in the CCRO was approved and therefore is no longer in dispute. The list of issues has been updated accordingly.

RESULT

5The applicant is not entitled to $1,620.53 for the chiropractic treatment.

6The applicant is not entitled to $2,094.04 for the chiropractic treatment.

7The applicant is not entitled to an award.

8The applicant is not entitled to interest.

9The application is dismissed.

ANALYSIS

10I find that the applicant has not satisfied her onus to prove that she is entitled to the treatment plans in dispute.

Chiropractic Treatment Plans

11To receive payment for a treatment and assessment plan under s. 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.

12To do so, 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 them are reasonable.

13The applicant bears the onus of establishing entitlement to a proposed treatment plan.

14I find that the applicant is not entitled to the chiropractic services because the treatment plans are not reasonable or necessary. As a result, I find that the applicant is not entitled to the treatment plans in dispute dated April 26, 2023, and June 21, 2023.

Chiropractic Treatment plan dated April 26, 2023

15The respondent asserts that the treatment plan was denied because the applicant failed to provide any objective evidence to substantiate the claim that the physical therapy was beneficial, reasonable, or necessary.

16To support the claim for the treatment plans, the applicant relies on the reports from Dr. Naisi Sedigheh, (psychologist) Dr. Kim Hyo, (chiropractor) and Jaynath Sreejith, (physiotherapist) on the kind of physical injuries she suffered because of the accident.

17I find that in his report, Dr. Sedigheh states that the applicant experiences pain in the neck, back, hip, leg, and shoulder, as well as stiffness and reduced range of motion. Similarly, Sreejith (PT) states that the applicant suffered from whiplash, sprain/strain of the lumbar spine, sprain/strain of the hip, sprain/strain of the shoulder joint, tension-type headache, generalized anxiety disorder, sprain/strain of the thoracic spine and low back pain.

18Upon review of the applicant’s submissions regarding the treatment plan dated April 26, 2023, I find that the applicant did not identify or make any specific submissions about the reasonableness and necessity of the goals of the plan, or how such goals would be met to a reasonable degree. Thus, I find that the applicant has not demonstrated on a balance of probabilities that the chiropractic treatment plan is reasonable and necessary as a result of the accident.

Chiropractic Treatment Plan dated June 21, 2023

19The applicant relies on Dr. Hyo report in which he states that the applicant is unable to perform pre-accident activities such as gripping, lifting, bending and certain flexion and adduction/abduction. Thereby recommending further treatment.

20The respondent denied the treatment plan dated June 21, 2023, on the basis that the applicant’s injury remained in the MIG. Further, the respondent denied the treatment plan on the basis that there was no evidence from her family physician suggesting that her pre-existing condition prevented her from achieving maximum medical recovery within the MIG.

21Furthermore, the respondent relies on the physiatry assessment report by Dr. Yong-Kong Michael Ko dated April 9, 2024, in which he concluded that the applicant suffered only soft tissue injuries which were minor as defined in the MIG.

22Upon review of the applicant’s submissions regarding the treatment plan dated June 21, 2023, I find that she did not identify or make any specific submissions about the reasonableness and necessity of the goals of the plan, or how such goals would be met to a reasonable degree. Accordingly, I find that the applicant has not demonstrated on a balance of probabilities that the chiropractic treatment plan is reasonable and necessary as a result of the accident.

Award

23The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. I find that the applicant is not entitled to an award as the respondent has not unreasonably withheld or delayed payment.

Interest

24Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Having concluded that no benefits are payable it follows that no payments are overdue, and no interest is payable.

ORDER

25Based on the evidence before me I find that:

i. the applicant is not entitled to $1,620.53 for the chiropractic treatment.

ii. the applicant is not entitled to $2,094.04 for the chiropractic treatment.

iii. the applicant is not entitled to an award.

iv. the applicant is not entitled to interest.