Citation: Hsieh v. Security National Insurance Company, 2025 ONLAT 23-012968/AABS

Licence Appeal Tribunal File Number: 23-012968/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:

Lung Chien Hsieh

Applicant

and

Security National Insurance Company

Respondent

DECISION

ADJUDICATOR: Robert Rock

APPEARANCES:

For the Applicant: Doina Marinescu, Counsel

For the Respondent: Marim Hadi, Counsel

HEARD: By way of written submissions

OVERVIEW

1Lung Chien Hsieh, the applicant, was involved in an automobile accident on June 12, 2021, 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, Security National Insurance Company, 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 $3,500.00 Minor Injury Guideline (MIG) limit?

ii. Is the applicant entitled to $2,374.00 for chiropractic services, proposed by E Clinic United Healing in a treatment plan/OCF-18 ("plan") dated December 1, 2021?

iii. Is the applicant entitled to $1,995.00 for a psychological assessment, proposed by E Clinic United Healing in a plan dated September 30, 2021?

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

RESULT

3The applicant remains in the MIG.

4As the applicant remains in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.

5As there are no overdue benefit payments, no interest is owing.

ANALYSIS

Minor Injury Guideline (MIG)

6Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury. Section 3(1) 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."

7An 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.

Chronic Pain with a functional impairment

8The applicant has not proven on a balance of probabilities that he suffers from chronic pain with a functional impairment as a result of the accident.

9The applicant argues that he suffers from chronic pain due to ongoing pain complaints in his neck, low back, and left ankle since the subject accident. The applicant relies on the clinical notes and records (CNRs) from the Greenwood Walk-in Clinic.

10I find that CNRs of the Greenwood Walk-in Clinic do not support the applicant's claim that he suffers from chronic pain with a functional impairment. The CNRs note pain complaints with the applicant's left ankle, but these notes in the CNRs are within weeks of the accident. The CNRs note soft tissue injury and suggest over the counter medication and RICE (Rest, Ice, Compression, and Elevation) as a method to address the pain. An X-Ray dated June 30, 2021, of the applicant's left knee and ankle, both show as a normal study. An Ultrasound dated July 5, 2021, of the applicant's left ankle, shows as a normal study as well.

11The applicant has not proven on a balance of probabilities that he suffers from chronic pain with a functional impairment because the applicant has not provided medical evidence that would substantiate his claim of chronic pain with a functional impairment. The CNRs and medical testing provided do not show evidence of chronic pain, so the applicant has not met his onus.

Psychological Impairment

12The applicant has not proven on a balance of probabilities that he suffers from a psychological impairment as a result of the subject accident.

13The applicant argues that he suffers from anxiety, depression, and post traumatic stress disorder as a result of the subject accident. The applicant relies on a psychological assessment by Dr. Mrahar, C. Psych, completed on October 18, 2021.

14The psychological assessment by Dr. Mrahar, diagnosis the applicant with adjustment disorder (mixed anxiety and depression). I find, however, that Dr. Mrahar's assessment is not internally consistent. Dr. Mrahar expresses "there exists significant psychological/emotional impairments", yet the paragraph above this quote Dr. Mrahar wrote, "the applicant scored in the average range for depression, anxiety, and somatization".

15The respondent argues that the applicant has not developed a psychological impairment as a result of the accident, and it relies on a MIG determination and benefit review report completed on November 5, 2021, and an addendum report completed on January 11, 2022, from Dr. Syed, C. Psych.

16I prefer the reports by Dr. Syed because the conclusions of the report reinforce the psychometric testing results and the self reporting by the applicant. The clinical findings by Dr. Syed, showed the applicant in the clinically insignificant range based on the psychometric testing completed. Dr. Syed also notes that it is her impression that the applicant's condition appears to have improved with the natural progress of time. In the addendum report, Dr. Syed addresses the report by Dr. Mrahar, and indicates that in Dr. Syed's opinion, "the applicant does not appear to be significantly impaired psychologically as there are minimal indications that he may have any current or active depressive or anxiogenic experience". Dr. Syed reaffirmed her diagnosis that the applicant is not suffering from a psychological impairment as a result of the subject accident.

17The applicant has not proven on a balance of probabilities that he suffers from a psychological impairment as a result of the subject accident. While Dr. Mrahar's report indicates a diagnosis of adjustment disorder (mixed anxiety and depression), the testing conducted by Dr. Mrahar was not consistent with the diagnosis. In contrast, the psychometric testing completed by Dr. Syed produced similar results ranging from not clinically significant, to mild and moderate results. In totality, I find the report by Dr. Syed was more persuasive as it was more in sync with the testing and self reporting of the applicant. Additionally, I found no evidence of psychological complaints by the applicant in the CNRs of the Greenwood Walk-in Clinic that would corroborate the applicant's claim of a psychological impairment.

18I find on a balance of probabilities that the applicant has not established that he should be removed from the MIG.

19As the applicant has been found to remain in the MIG, there is no need to conduct the reasonable and necessary analysis of the disputed treatment plans.

Interest

20Interest 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.

ORDER

21I find that:

i. The applicant remains in MIG.

ii. As the applicant remains in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.

iii. As there are no overdue benefit payments, no interest is owing.

iv. The application is dismissed.