Licence Appeal Tribunal File Number: 23-011050/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:
Hua Jin
Applicant
and
Allstate Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Robert Rock
APPEARANCES:
For the Applicant:
Jiang Yu, Paralegal
For the Respondent:
Simran Walia, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Hua Jun, the applicant, was involved in an automobile accident on September 2, 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, Allstate Insurance Company of Canada, 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 $2,044.17 for other goods and services (medical marijuana), proposed by Apollo Applied Research in a treatment plan/OCF-18 (“plan”) submitted March 31, 2023?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not proven on a balance of probabilities that the treatment plan for medical marijuana is reasonable and necessary.
4As there are no overdue benefit payments, no interest is owing.
5As no benefit payment has been unreasonably withheld or delayed, the respondent is not liable to pay an award.
ANALYSIS
6To 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. To 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.
7The applicant has not proven on a balance of probabilities that the treatment plan for medical marijuana is reasonable and necessary.
8The goals of the treatment plan are to reduce anxiety and sleep disturbances to increase quality of life, functionally, mood, and participation in activities of daily living.
9The treatment plan includes 1 gram/day of medical marijuana for 3 months, medical management, instruction/support activities, and documentation.
10The applicant argues that the treatment plan is reasonable and necessary due to ongoing chronic pain and psychological impairments. The applicant relies on the clinical notes and records (CNRs) of her family physician Dr. Chu; a referral by Dr. Liu, physician, on August 12, 2019; a psychological assessment by Dr. Cook, psychologist, completed on August 21, 2019; and an assessment by Dr. Wong, physiatrist, completed March 18, 2020.
11I find that the CNRs of Dr. Chiu do not support the treatment plan being reasonable and necessary. The CNRs lack any recommendations or discussions with the applicant regarding medical marijuana. I also note that the applicant’s claim of ongoing chronic pain is not supported by the CNRs. The CNRs show no ongoing pain complaints related to the subject accident, and there are no contemporaneous claims of pain complaints related to the subject accident at the time of the treatment plan was submitted.
12I find that the psychological assessment by Dr. Cook also does not support the applicant’s claim that the treatment plan is reasonable and necessary. The assessment and the subsequent progress reports provided by Dr. Cook show that the applicant is being treated for psychological issues related to the accident. The reporting of Dr. Cook does not include a recommendation for the use of medical marijuana, nor is their any discussion of the use of medical marijuana.
13I also find that the referral by Dr. Liu does not support the applicant’s claim that the treatment plan is reasonable and necessary. Dr. Liu recommends that the applicant would benefit from visiting a psychologist, but makes no recommendation regarding the use or need from medical marijuana.
14Finally, I find that the assessment by Dr. Wong does not support the applicant’s claim that the treatment plan is reasonable and necessary. Dr. Wong recommends that the applicant be on an SSRI, sleeping pill, and medication to control pain, but also notes that the applicant refused medication fearing side effects of the medication. Dr. Wong did not suggest or recommend the use of medical marijuana.
15I find that the has not proven on a balance of probabilities that the treatment plan for medical marijuana is reasonable and necessary. The applicant has not directed me to medical evidence that supports, recommends or prescribes the use of medical marijuana beyond the treatment plan itself.
16The applicant is not entitled to the treatment plan for medical marijuana.
Interest
17Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefit payments, no interest is owing.
Award
18The 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. As no benefit payments have been unreasonably withheld or delayed, the respondent is not liable to pay an award.
ORDER
19I find that:
i. The applicant is not entitled to the treatment plan for medical marijuana.
ii. No interest is owing.
iii. The respondent is not liable to pay an award.
iv. The application is dismissed.
Released: June 19, 2025
Robert Rock
Adjudicator