Milisavljevic v. Security National Insurance Company, 2025 CanLII 81409

Licence Appeal Tribunal

Citation: Milisavljevic v. Security National Insurance Company, 2025 ONLAT 23-010655/AABS

Licence Appeal Tribunal File Number: 23-010655/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:

Jovana Milisavljevic

Applicant

and

Security National Insurance Company

Respondent

DECISION

ADJUDICATOR:

Jeff Chatterton

APPEARANCES:

For the Applicant:

Zoran Samac, Counsel

For the Respondent:

Priyanka Monpara, Counsel

HEARD:

In Writing

OVERVIEW

1Jovana Milisavljevic, the applicant, was involved in an automobile accident on November 18, 2020, 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. Is the applicant entitled to $2,421.79 for physiotherapy services, proposed by East York Physiotherapy and Treatment Clinic, in a treatment plan / OCF-18 dated September 21, 2022?

ii. Is the applicant entitled to interest?

RESULT

3The applicant is not entitled to $2,421.79 for physiotherapy services.

4No interest is payable.

ANALYSIS

5To 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.

Are the physiotherapy services reasonable and necessary?

6I find that the applicant is not entitled to the treatment plan for physiotherapy services.

7The treatment plan dated September 18, 2022, proposed 16 physiotherapy treatment sessions. The treatment plan lists the applicant's injuries as whiplash associated, with complaints of neck pain. The stated goals were pain reduction, increased range of motion and increased strength, in order to return to the activities of normal living.

8The applicant submits that the physiotherapy services are important for both her physical and mental health because she was suffering neck pain and headaches. In her submissions, she stated that her physical and mental health were intertwined, and that denying physical therapy has had a marked impact on her mental health. To support her claim that the physiotherapy was reasonable and necessary, the applicant indicates that she would have submitted Clinical Notes and Records (CNRs) from her family physician, Dr. Lee. However, the applicant has not submitted these CNRs as evidence because they are handwritten and illegible.

9Instead, to further support her claim, the applicant has submitted the CNR's from Dr. Roussev, a neurologist. Dr. Roussev's notes are legible, and contemporaneous to the time of the treatment plan in question.

10The applicant also submitted a Functional Capabilities Evaluation from Dr. D. Surla, a chiropractor, dated March 26, 2024, and a Psychological Assessment from Psychologist Dr. Nesovic, dated June 5, 2024. Both reports contain a recommendation for ongoing physical therapy.

11The respondent is relying on a s.44 report from General Practitioner Dr. Frank Loritz, dated November 3, 2022. In the report, Dr. Loritz reports "She has completed almost two years of rehabilitative therapy for her accident-related injuries and had characterized the treatment efficacy as having reached a plateau."

12I find the applicant has not met her onus because while Dr. Roussev's notes indicate that the applicant had been receiving physiotherapy treatments, they do not recommend continued physiotherapy, but rather, contain a recommendation for medication. In addition, while the treatment plan was submitted in September 2022, the evidence of Dr. Surla and Dr. Nesovic is from 2024, and therefore I find this medical evidence is not contemporaneous with the treatment plan. Because well over a year has passed between the request for treatment and the reports of Dr. Surla and Dr. Nesovic, I put reduced weight on this evidence.

13In summary, I find that the applicant has not led me to sufficient contemporaneous corroborating medical evidence that indicates that the treatment plan for physical therapy is reasonable and necessary. The onus is on the applicant to prove her case.

14For these reasons, I find that on the balance of probabilities that the applicant has not met her onus to prove that the treatment plan is reasonable and necessary.

Interest

15Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are found to be owing, no interest is owed.

ORDER

16The application is denied.

i. The applicant is not entitled to the treatment plan in the amount of $2,421.79 for physiotherapy services.

ii. No interest is owing.