Keyvan Mehrabi-Nejab v. Intact Insurance Company, 2026 CanLII 10327

Licence Appeal Tribunal File Number: 24-008185/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:

Keyvan Mehrabi-Nejab

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR:

Matthew Frontini

APPEARANCES:

For the Applicant:

Kameliya Stancheva, Paralegal

For the Respondent:

Kathy Conteh, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Keyvan Mehrabi-Nejab, the applicant, was involved in an automobile accident on July 14, 2023, 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 Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The case conference report and order of Adjudicator Kevin Yarde, dated November 12, 2024, listed the issues in dispute in this proceeding as comprising eight OCF-18s (“treatment plans”), an award under s. 10 of Reg. 664, and interest on any overdue benefits. The applicant’s submissions generally reference the November 14, 2024 case conference report and order and indicate that all of the listed were in dispute.

3The respondent submitted that it had agreed to fund four of the disputed treatment plans and produced correspondence to the applicant to this effect, dated June 25, 2025. The respondent further submitted that only the four remaining treatment plans, together with interest and an award, were in dispute in this proceeding. The applicant did not file any reply submissions contesting the respondent’s submissions regarding the issues in dispute.

4Given that the evidence indicates that payment for these treatment plans is no longer in dispute, which the applicant has not contested, these issues are moot and will not be considered in this decision.

5The remaining issues in dispute are:

i. Is the applicant entitled to $2,935.76 for chiropractic services, proposed by Toronto Medical Centre in a treatment plan submitted April 9, 2024, and denied April 19, 2024?

ii. Is the applicant entitled to $1,982.86 for an attendant care assessment, proposed by Toronto Medical Centre in a treatment plan submitted February 5, 2024, and denied February 6, 2024?

iii. Is the applicant entitled to $87.19 ($1,771.11 less $1,683.92 approved) for a functional ability evaluation, proposed by Toronto Medical Centre in a treatment plan submitted February 5, 2024, and partially denied February 6, 2024?

iv. Is the applicant entitled to $1,610.13 for a home site assessment, proposed by Toronto Medical Centre in a treatment plan submitted March 1, 2024, and denied March 15, 2024?

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

6I find that:

i. The applicant is not entitled to $2,935.76 for chiropractic services, proposed by Toronto Medical Centre in a treatment plan submitted April 9, 2024, and denied April 19, 2024?

ii. The applicant is not entitled to $1,982.86 for an attendant care assessment, proposed by Toronto Medical Centre in a treatment plan submitted February 5, 2024, and denied February 6, 2024?

iii. The applicant is not entitled to $87.19 ($1,771.11 less $1,683.92 approved) for a functional ability evaluation, proposed by Toronto Medical Centre in a treatment plan submitted February 5, 2024, and partially denied February 6, 2024?

iv. The applicant is not entitled to $1,610.13 for a home site assessment, proposed by Toronto Medical Centre in a plan submitted March 1, 2024, and denied March 15, 2024?

v. The respondent is not liable to pay an award under s. 10 of Reg. 664.

vi. The applicant is not entitled to interest on any overdue payment of benefits.

vii. The application is dismissed.

ANALYSIS

The applicant is not entitled to the treatment plan for chiropractic services

7I find that the applicant has not established on a balance of probabilities that the disputed treatment plan for chiropractic services is reasonable and necessary.

8To 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, in this case, a treatment plan for chiropractic services, is reasonable and necessary as a result of the accident on the basis of compelling medical evidence. To do so, the applicant’s submissions and evidence 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.

9The applicant’s submissions do not address whether the disputed treatment plan is reasonable and necessary. Instead, the applicant argues that because this treatment plan was initially denied on the basis that he was within the Minor Injury Guideline (“MIG”) limit of the Schedule, and that since he was subsequently removed from the MIG, the respondent has failed to properly consider the applicant’s need for ongoing treatment. The applicant’s submissions also emphasized that the respondent has not provided updated medical evidence to justify its denial.

10Respectfully, the applicant’s argument misapplies the burden of proof in applications before the Tribunal pursuant to the Schedule and is contrary to the binding guidance of the Divisional Court that “…the burden remains on the insured throughout to establish entitlement to the appropriate level of benefits.” Scarlett v Belair Insurance, 2015 ONSC 3635 at para 24. There is no requirement for the respondent to establish on a balance of probabilities that a disputed treatment is not reasonable and necessary.

11The applicant’s submissions do not identify any evidence to suggest that this treatment plan is reasonable and necessary. The applicant’s removal from the MIG, while necessary to access higher funding limits for rehabilitation benefits, does not, in and of itself, establish that any particular benefit is reasonable and necessary.

12Given the lack of submissions and evidence on this issue, I find that the applicant has not established on a balance of probabilities that this treatment plan is reasonable and necessary, and consequently, he is not entitled to it.

The applicant is not entitled to the treatment plan for an attendant care assessment

13I find that the applicant has not established on a balance of probabilities that the disputed treatment plan for an attendant care assessment is reasonable and necessary.

14The applicant submissions again focus on alleged flaws with the respondent’s denial of this treatment plan. The respondent’s denial was essentially that the available evidence indicated that the applicant was independent and that there was no indication of any need for attendant care.

15The applicant makes three arguments in support of his entitlement to the attendant care assessment. First, he argues that denying an assessment on the grounds that the need has not been proven prevents the very evidence needed to assess eligibility. This argument is unpersuasive. The test is whether there is compelling evidence a condition exists that would warrant an assessment. The treatment plan for an attendant care assessment alone, uncorroborated by other medical evidence, is insufficient to meet the applicant’s burden of demonstrating that a condition exists that would warrant an attendant care assessment.

16The applicant’s second argument is that the denial does not account for the applicant’s evolving condition and functional complaints that the applicant submits are “…noted elsewhere in the record.” Again, the applicant’s submissions do not meet his burden under the Schedule. Vague references in submissions to impairments and complaints without identifying the corresponding evidence are insufficient. It is not for the Tribunal to go through all of the medical documentation to make the applicant’s case for him: see Dooman v. TD Insurance Co., 2025 ONSC 184 at para. 50.

17The applicant’s third argument is that the respondent’s denial, which was based on the MIG, failed to consider that the applicant was subsequently removed from the MIG. As discussed above in relation to the treatment plan for chiropractic services, this argument does not assist the applicant in meeting his burden in applications under the Schedule.

18Given the lack of submissions and evidence on whether an assessment of attendant care services is warranted, I find that the applicant has not established on a balance of probabilities that this treatment plan is reasonable and necessary.

The applicant is not entitled to the denied portion of the treatment plan a functional ability evaluation

19I find that the applicant has not established on a balance of probabilities that he is entitled to the denied portion of the treatment plan for a functional ability evaluation. This denied portion relates to the respondent’s partial approval in the amount of $87.19 of the $200 sought for the form completion fee.

20The applicant argues that the respondent’s denial is unreasonable and further submits that the complexity of the applicant’s condition justifies the documentation fee.

21The respondent argues that the applicant has not established that the disputed cost is reasonable and necessary. The respondent notes that the applicant’s submissions regarding the complexity of his condition and its relation to the documentation efforts and fee are supported by submissions and submissions are not evidence. The applicant relies on previous Tribunal decisions, however in these decisions, the Tribunal was provided with evidence of healthcare providers that supported the complexity of the documentation efforts. Here there is no such evidence.

22I agree with the respondent. The applicant’s submissions do not identify evidence to support that the maximum amount of $200.00 permitted for form completion fees is reasonable and necessary. As such, I find on a balance of probabilities that the applicant is not entitled to the disputed portion of this treatment plan.

The applicant is not entitled to the treatment plan for a home site assessment

23I find that the applicant has not established on a balance of probabilities that the disputed treatment plan for a home site assessment is reasonable and necessary.

24As with the other treatment plans, the applicant argues that the respondent’s denials are flawed and, therefore, he is entitled to this disputed treatment plan for a home site assessment. The applicant also references the respondent’s alleged disregard of the cumulative impact of the applicant’s physical and psychological injuries, without specifically discussing any such injuries with reference to evidence or how they allegedly relate to the denied assessment.

25Given the lack of submissions and evidence on whether a home site assessment is warranted, I find on a balance of probabilities that the applicant has not established that this treatment plan is reasonable and necessary.

Interest

26As I have found that the applicant is not entitled to any overdue payments, he is not entitled to interest.

Award

27The 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.

28As I have found that the respondent did not withhold or delay any payments, the applicant is not entitled to an award.

ORDER

29I find that: