Licence Appeal Tribunal File Number: 24-008437/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:
Gurwinder Dhillon
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Jeff Chatterton
APPEARANCES:
For the Applicant:
Jasmine Patel, Counsel
For the Respondent:
Justin Chan, Counsel
HEARD: In Writing
OVERVIEW
1Gurwinder Dhillon, the applicant, was involved in an automobile accident on December 10, 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, Aviva General 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:
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?
Is the applicant entitled to the services proposed by Chinguacousy Physio and Foot Clinic in treatment plans/OCF-18s (“plan”), as follows:
i. $2,503.22 for chiropractic services, in a plan submitted May 11, 2023;
ii. $798.56 for chiropractic services, in a plan submitted May 24, 2023; and
iii. $2,841.66 for physiotherapy services, in a plan submitted June 21, 2023?
- Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is being held to the Minor Injury Guideline and the $3,500 treatment limit.
4As the applicant is being held to the MIG, it is not necessary for me to do a finding of entitlement to the issues in dispute.
5Interest is not payable.
6The application is dismissed.
ANALYSIS
Minor Injury Guideline (“The MIG”) and Chronic Pain
7The applicant has not established that he should be removed from the MIG due to chronic pain.
8Section 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.”
9An 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.
10The applicant states he should be removed from the MIG due to chronic pain. To support his claim, the applicant has submitted the Clinical Notes and Records (CNRs) from his Primary Care Clinic, MedCare Clinics at Riverview Heights. The applicant submits he has made repeated complaints about chronic pain in his neck and back to his doctor, General Practitioner Rajinder Maan.
11The respondent argues the applicant has suffered minor injuries and has not established he should be removed from the MIG. To support their claim, the respondent relies on a s.44 Musculoskeletal Assessment report conducted by General Practitioner Dr. James Stewart, dated January 26, 2023.
12The respondent also submits the applicant has not met his onus. It argues he has not been diagnosed with chronic pain, nor has he submitted evidence he meets any of the six criteria for chronic pain as indicated in the American Medical Association Guides to the Evaluation of Permanent Impairment, 6th edition.
13I am not convinced by the applicant’s evidence. I make this finding because:
i. The last accident-related complaint was made on February 10, 2023, when the applicant complained of back pain and Dr. Maan recommended over-the-counter medications and physiotherapy. The next complaint of back pain was April 19, 2023, when the applicant complained about mid-back pain, which he reported started after “driving back from Niagara.” The notes also state the applicant “denies any trauma, swelling or redness.” The lack of reference to the accident on April 19, 2023 and the reference to a drive back to Niagara suggests to me the April 19, 2023 visit is not related to the accident.
ii. However, even if the April 19, 2023 visit was related, there were no follow up visits or complaints to the applicant’s family physician until July 2024, fifteen months later, when he made a complaint about general fatigue. The doctor diagnosed a potential Vitamin D deficiency. There is no reference in the CNRs to accident-related pain after July 2024.
14These clinical notes do not establish ongoing, consistent complaints of accident-related pain. Although the onus is on the applicant to establish he should be removed from the MIG, the applicant has not submitted any further medical evidence that would establish he has chronic pain that warrants removal from the MIG.
15I further note that the s.44 assessment conducted by Dr. Stewart reported that the applicant’s physical injuries are sprain and strain type injuries falling within the s. 3 definition and do not warrant removal from the MIG.
16Furthermore, as indicated above, the requirement to remove an applicant from the MIG for chronic pain is not the presence of pain itself, but “chronic pain with functional impairment.” The applicant has not submitted evidence to indicate the presence of or the nature of any functional impairment.
17In summary, I find the applicant has not made repeated or consistent complaints of chronic pain to his primary care physician. A s. 44 assessment concluded that the applicant has no significant musculoskeletal injuries, and I have not been led to further evidence from the applicant to indicate further impairments, complaints or functional limitations as a result of accident-related pain.
18For these reasons, I find the applicant has not, on a balance of probabilities, met his onus to establish he should be removed from the MIG on the basis of chronic pain with a functional impairment.
19As I have ruled that the applicant is being held to the MIG, it is not necessary for me to do a reasonable and necessary analysis on the treatment plans in dispute.
Interest
20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
ORDER
21The application is dismissed.
i. The applicant is not removed from the MIG.
ii. As the applicant is being held to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
iii. No interest is payable.
Released: February 17, 2026
Jeff Chatterton
Adjudicator