Adewusi v. Belair Insurance Company Inc., 2026 CanLII 10338

Adewusi v. Belair Insurance Company Inc.

Citation: Adewusi v. Belair Insurance Company Inc., 2026 ONLAT 24-008833/AABS Licence Appeal Tribunal File Number: 24-008833/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:

Gabriel Adewusi

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

ADJUDICATOR:

Melanie Malach

APPEARANCES:

For the Applicant:

Ivy So, Paralegal

For the Respondent:

Nisaa Khan, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Gabriel A. Adewusi, the applicant, was involved in an automobile accident on December 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, 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 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?

ii. Is the applicant entitled to services proposed by Islington North Chiropractic, as follows:

i. $113.00 ($1,300.00 less $1,187.00 approved) for physiotherapy services, in the treatment plan, dated March 16, 2022;

ii. $3,089.36 for physiotherapy services, in the treatment plan dated July 15, 2022; and

iii. $4,000.24 for physiotherapy services, in the treatment plan dated December 20, 2022?

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

RESULT

3I find the applicant's accident-related injuries are predominantly minor and he is therefore subject to treatment within the $3,500.00 limit of the MIG. The applicant is not entitled to the treatment plans in dispute or interest.

ANALYSIS

The applicant sustained predominantly minor injuries as defined under the Schedule

4I find that the applicant sustained a minor injury as a result of the accident and, therefore, is subject to the $3,500.00 funding limit on treatment.

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) of the Schedule defines a "minor injury" as "one or more of a strain, sprain, 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) of the Schedule, that they have a documented pre-existing condition combined with compelling medical evidence stating that the condition precludes maximal medical recovery if they are kept within the confines of the MIG. In all cases, the burden of proof lies with the applicant.

7In this matter, the applicant submits that he should be removed from the MIG because he suffers a psychological impairment. He relies upon the records of Dr. Saeed Kalantari, family doctor, where he complained on January 24, 2024 of anxiety, nightmares, flashbacks, and post-traumatic stress disorder ("PTSD") and was referred to a psychiatrist. He further relies upon the report of Dr. Arthur Shuster, psychiatrist, dated March 18, 2024, which diagnosed him with PTSD. Finally, he relies upon the October 17, 2022 Insurer's Examination ("IE") Physician Assessment report of Dr. Charanjit Sandu, internal medicine physician, where a Mental Health Screen was performed and the applicant reported that he suffers from depression, ongoing nightmares, flashbacks of the accident and ongoing panic attacks. The applicant submits that his psychological complaints affect his employment and driving behaviour. He claims that he did not seek help earlier due to fear of stigma of mental illness.

8The respondent submits that the applicant did not suffer a psychological impairment warranting removal from the MIG. He has provided no objective evidence of psychological impairment beyond his subjective complaints. It relies upon the Tribunal decision in Jeyaraam v. Aviva General Insurance, 2021 CanLII 11864 (ON LAT), where it found that an applicant "must show that he has an actual psychological impairment and not just symptomatology. A psychological diagnosis requires the development of ongoing, substantive and residual post-traumatic symptomology or clinically significant psychological distress" to warrant MIG removal.

9The respondent argues that with respect to the records of Dr. Kalantri, the applicant attended on an ongoing basis with complaints of soft tissue injuries and made no psychological complaints. The applicant then attended on January 24, 2024, over two years after the accident and made psychological complaints for the first time. The respondent argues that the note solely includes subjective reporting and contains no objective examination or testing and no diagnosis. Regarding, Dr. Shuster's report, the respondent submits that it was prepared almost two and a half years post-accident and provides no objective basis for his diagnosis because no objective testing was performed, and the mental status exam showed normal results. The respondent further submits that in the report of Dr. Sandu, the applicant's subjective complaints are listed but there is no objective evidence of psychological impairment indicated.

10I find that the applicant has provided insufficient medical evidence to support that he sustained a psychological impairment as a result of the accident warranting removal from the MIG.

11I agree with the respondent that for over two years post-accident, despite attending on an ongoing basis with his family physician, Dr. Kalanatri, the applicant made no psychological complaints. When he attended on January 24, 2024, he made subjective psychological complaints to Dr. Kalantri but there was no assessment performed or a diagnosis made by Dr. Kalantri. In addition, there is no evidence that the applicant followed up with Dr. Kalantri with any reports of psychological impairment thereafter.

12I further agree with the respondent that the IE report of Dr. Sandu does not support that the applicant suffered a psychological impairment. While the report notes the applicant's subjective complaints at the time, no assessment was performed and therefore no diagnosis was made. In addition, Dr. Sandu was completing a physical assessment and therefore he is not qualified to comment or make a psychological diagnosis.

13I give little weight to the report of Dr. Shuster. The report notes the applicant's subjective complaints of experiencing flashbacks and nightmares related to the accident on four or five occasions in total since the accident and mood swings while driving his car. I find that despite the applicant's mental status exam being normal with no concerns, Dr. Shuster's impression was that he suffered PTSD. However, Dr. Shuster then confirms that there is no comorbid mood or anxiety disorder, no suicidal ideation, and no concerns about driving safety and his function outside of driving is preserved. I agree with the respondent that there is no explanation provided as to how Dr. Shuster concluded that the applicant suffered from PTSD other than based on the applicant's self-reports. In addition, despite Dr. Shuster's recommendations for treatment, there is no evidence provided by the applicant that he pursued treatment and there were no treatment and assessment plans submitted for psychological treatment.

14I further find that while the applicant submits that his psychological impairment affected his employment post-accident and his ability to drive, there is no objective evidence that he suffered any limitations in the evidence submitted. Dr. Shuster confirmed that there were no concerns about the applicant's driving safely and his function outside of driving is preserved.

15For the reasons outlined above, I find on a balance of probabilities that the applicant does not suffer a psychological impairment as a result of the subject accident and therefore he is not removed from the MIG on this basis.

The applicant is not entitled to the treatment plans in dispute

16As I have found that the applicant remains within the MIG, it is unnecessary for me to consider whether the disputed treatment plans are reasonable and necessary.

Interest

17Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Given that there are no benefits owed, the applicant is not entitled to interest pursuant to s. 51 of the Schedule.

ORDER

18For the reasons outlined above, I find:

i. The applicant's accident-related injuries are predominantly minor, and he is therefore subject to treatment within the $3,500.00 limit of the MIG;

ii. The applicant is not entitled to the treatment plans in dispute;

iii. The applicant is not entitled to interest; and

iv. The application is dismissed.