Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-012043/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:
Paul Dang
Applicant
and
Belair Insurance Company Inc.
Respondent
DECISION
ADJUDICATOR: Gordon Stencell
APPEARANCES:
For the Applicant: Yan Li, Counsel
For the Respondent: Eluxmeenah Rishihesan, Counsel
HEARD: By way of written submissions
OVERVIEW
1Paul Dang, the applicant, was involved in an automobile accident on May 4, 2022, 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, Belair Insurance Company Inc., and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in disputes 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? Note: The parties agree the MIG limits have not been exhausted and the amounts remaining are $364.86.
ii. Is the applicant entitled to $59.06 for chiropractic services, proposed by Prime + Care Health Centre in an OCF-18/treatment plan (treatment plan) dated July 29, 2022?
iii. Is the applicant entitled to $3,018.45 for chiropractic services, proposed by Prime + Care Health Centre in a treatment plan dated September 2, 2022?
iv. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Perfect Choice Psychological Services in a treatment plan dated August 2, 2022?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find as follows:
i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline?
ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664; and
iv. As no benefits are payable, the applicant is not entitled to interest.
ANALYSIS
The Minor Injury Guideline
4I find that the applicant has not demonstrated, on the balance of probabilities, that he suffers from an injury or condition that warrants removal from the MIG.
5Section 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.”
6An 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.
7The applicant submits he should be removed from the MIG on the basis of psychological impairment. The applicant relies on the clinical notes and records of family physicians, Dr. Melina Hong and Dr. Tak Keung Chan. Dr. Hong noted on April 22, 2023, that the applicant suffered from increased irritability, depressed mood, decreased concentration, low motivation, and poor sleep. Dr. Hong noted on October 16, 2023, that the applicant was still suffering from anxiety, depression, and poor sleep.
8The respondent argues that the applicant has not proven that he should be removed from the MIG. It relies on the CNRs of the applicant’s family doctors, Dr. Somasundaram, Dr. Hong, and Dr. Chan, on OCF-18 forms, and an insurance examiner’s (“IE”) psychological assessment report completed by Dr. Rubenstein, a clinical and forensic psychologist, dated July 10, 2023.
9I find there are no complaints of psychological impairment until almost a year after the accident, specifically until Dr. Hong notes in the CNRs of April 22, 2023, that the applicant suffered from increased irritability, depressed mood, decreased concentration, low motivation and poor sleep. These CNRs reference the accident and also a prior accident from May 2018 and indicate that the applicant would like a referral to a psychiatrist. Dr. Hong indicates the applicant likely has PTSD and that a referral will be made to Dr. Hong Fook.
10There is no medical evidence from Dr. Fook before me. There is a note dated May 4, 2023, from the Asian Community Psychiatric Clinic that indicates that they were unable to accept Dr. Hong’s referral because they have limited resources. A patient questionnaire that is attached indicates that the applicant reports feelings of depression. I note that part of the questionnaire is not in English and it is not translated. This self-reporting of symptoms in a questionnaire was not reviewed or assessed by Dr. Fook as the clinic did not accept the referral.
11There is also a Michael Garron Hospital Outpatient Mental Health Referral Form in evidence authored by Dr. Chan in May 2023. The Referral Form notes “Trauma” and “MVA 22 May” and also notes a current diagnosis of prostrate cancer. Dr. Chan’s CNRs dated October 16, 2023, also reference the applicant being agitated and angry with other players in his sports club and that he was not sleeping well. The notes also reference an episode of anxiety and depression after MVA. There is no medical evidence from Michael Garron Hospital in evidence before me, and the applicant’s submissions do not address the outcome of Dr. Chan’s referral.
12I find that the references in the CNRs of Dr. Hong and Dr. Chan and the applicant’s self-reporting in an undated questionnaire do not establish that the applicant has a psychological impairment that warrants removal from the MIG. As noted above, the applicant did not make any reports of psychological complaints until approximately one year after the accident. Although there are references to psychological referrals in the case record, there is no record of psychological treatment or follow up.
13Further, I find that the IE report of Dr. Rubenstein indicates that the claimant did not sustain any psychological impairment as a result of the accident. I put more weight on Dr. Rubenstein’s report than on the family physicians’ CNRs and the undated questionnaire because Dr. Rubenstein is a psychologist who reviewed the applicant’s medical records, interviewed the applicant, and administered a series of psychological tests before rendering his opinion. While I’m satisfied that the applicant sustained a mental health condition, the medical evidence as a whole does not persuade me that his mental health condition is a result of the car accident.
14Therefore, I find on a balance of probabilities, that the applicant has not demonstrated he has a psychological condition that warrants removal from the MIG.
15As I find the applicant is not removed from the MIG, I do not need to consider if the treatment plans are reasonable and necessary.
Interest
16As there are no benefits payable, the applicant is not entitled to interest.
Award
17As there are no benefits unreasonably withheld or delayed, the respondent is not liable to pay an award under s. 10 of Reg. 664.
ORDER
18I find that:
i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline.
ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664.
iv. The applicant is not entitled to interest.
Released: August 28, 2025
Gordon Stencell
Adjudicator