Citation: Shafee v. Intact Insurance Company, 2025 ONLAT 23-012091/AABS
Licence Appeal Tribunal File Number: 23-012091/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:
Shahreen Shafee
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR: Gurleen Thethi
APPEARANCES:
For the Applicant: Bianca Marinescu, Counsel
For the Respondent: Raman Pandher, Counsel
HEARD: In Writing By way of written submissions
OVERVIEW
1Shahreen Shafee, the applicant, was involved in an automobile accident on November 7, 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, Intact, 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 limit? (“MIG”)
ii. Is the applicant entitled to $2,486.00 for a psychological assessment, proposed by A&B Medical Assessments Inc., in a treatment plan/OCF-18 (“plan”) submitted on March 10, 2022?
iii. Is the applicant entitled to $2,026.55 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre Inc., in a plan submitted on March 15, 2022?
iv. Is the applicant entitled to $1,525.84 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre Inc., in a plan submitted on July 5, 2022?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant sustained minor injuries in the accident as defined under the Schedule. She remains within the MIG and is subject to the treatment limits of the MIG.
4As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
5Given there are no benefits owed or payments outstanding, the applicant is not entitled to interest pursuant to section 51 of the Schedule.
ANALYSIS
Applicability of the Minor Injury Guideline
6I find that the applicant has not demonstrated that she should be removed from the MIG.
7Section 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.”
8An 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.
9The burden is on the applicant to demonstrate, on a balance of probabilities, that her injuries fall outside of the MIG.
10The applicant is seeking removal from the MIG solely on the basis that she suffers from a psychological impairment as a result of the subject accident.
The applicant does not suffer from a psychological impairment
11The applicant has not proven on a balance of probabilities that she suffers from a psychological impairment that would warrant removal from the MIG as a result of the subject accident.
12The applicant submits that she suffers from psychological injuries as a result of the subject accident. The applicant relies on the assessment completed on April 11, 2022, by Dr. Bita Sharifzadeh, psychologist.
13Dr. Sharifzadeh supervised the assessment which was conducted via doxy.me, videoconference, and included a clinical interview with a battery of psychological tests. Dr. Sharifzadeh did not review any Clinical Notes and Records (CNR’s) or records of the applicant. She diagnosed the applicant with “Other Trauma and Stressor-Related Disorder, Major Depressive Disorder, and Somatoform Disorder.”
14I place little weight on the assessment prepared by Dr. Sharifzadeh because it appears to be largely based on subjective reporting by the applicant and did not entail a review of any of the applicant’s medical documentation to corroborate.
15Although the assessment administered several tests with built-in validity measures, the results of these checks are either absent or inadequately addressed in the report. For example, the Detailed Assessment of Posttraumatic Stress notes that the applicant’s T score, is elevated, which suggests “she may be attempting to present herself as especially symptomatic, may be randomly responding, or may be experiencing an unusual number of atypical symptoms.” Based on this, I find that the applicant’s self reports may not be reliable. Aside from this, I see no other result pertaining to validity testing. This could suggest that there was nothing out of the norm to invalidate, or that the information was not addressed. Further, I question the results of the report based on the lack of information provided with respect to validity testing.
16The applicant has not supplied any additional evidence that would support that she suffers from a psychological condition because of the subject accident.
17While the applicant did not submit any family doctor records to support her claim, the respondent submitted seven pages of CNRs from the applicant’s visit to a physician. I have reviewed these CNRs and find that they do not speak to any psychological impairments that would warrant the Applicant’s removal from the MIG. I find that a lack of supporting medical documentation from the applicant’s family doctor or a treating physician to substantiate a psychological diagnosis undermines the applicant’s claim.
18The respondent relies on an assessment completed on June 28, 2022, by Dr. Amena Syed, a psychologist, in which Dr. Syed was unable to substantiate the applicant’s subjective self report of psychological impairment. Dr. Syed noted that validity testing for the assessment suggested that the applicant may be attempting to present herself as especially symptomatic.
19I prefer Dr. Syed’s assessment over Dr. Sharifzadeh’s because it provides a thorough examination and discusses validity results in greater detail. As noted above, Dr. Sharifzadeh’s report does not adequately discuss or indicate the validity results from each of the tests conducted. Dr. Syed’s assessment was completed in-person and reviewed a list of medical documents. Though neither assessor reviewed the CNRs of the applicant, Dr. Syed reviewed a list of documents including OCF-18s and a physician assessment report. The documents reviewed are noted in Dr. Syed’s assessment. Dr. Sharifzadeh’s assessment was conducted via videoconference and there is no reference to a review of other documentation. Dr. Sharifzadeh’s assessment was also conducted by another assessor, whose work is noted to be supervised by Dr. Sharifzadeh, which I find undermines the finding in the report because the assessor is described as being a member of The Ontario Association of Mental Health Practitioners, but no other information is provided on her qualifications.
20I find that the applicant has not proven on a balance of probabilities that she suffers from a psychological impairment as a result of the subject accident.
21As such, the applicant has not established that her accident-related impairments warrant removal from the MIG.
22As I have found that the applicant remains within the MIG, it is not necessary for me to consider the reasonableness and necessity of the disputed treatment plans.
Interest
23Interest 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
24The applicant sustained minor injuries in the accident as defined under the Schedule. She is subject to the treatment limits of the MIG.
25As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
26Given there are no benefits owed or payments outstanding, the applicant is not entitled to interest pursuant to section 51 of the Schedule.
Released: October 1, 2025
__________________________
Gurleen Thethi
Adjudicator