Citation: Mughal v. Intact Insurance Company, 2026 ONLAT 24-006257/AABS

Licence Appeal Tribunal File Number: 24-006257/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:

Nadia Mughal

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR:

Patrick Molloy

APPEARANCES:

For the Applicant:

Nadia Mughal, Applicant Renata Szady, Paralegal

For the Respondent:

David E.W. Koots, Counsel

HEARD: In Writing

January 16, 2026

OVERVIEW

1Nadia Mughal, the applicant, was involved in an automobile accident on August 21, 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.

2As the application in this proceeding was filed on May 16, 2024, and the case conference was conducted on October 8, 2024.

ISSUES

3The 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? Note: The parties agree the MIG limits have not been exhausted and there is $613.05 remaining

ii. Is the applicant entitled to physiotherapy services proposed by Theramax Rehab Centre, as follows:

(a) $99.00 ($1,379.95 less $1,280.95 approved), in a treatment plan/OCF-18 (“plan”) submitted May 24, 2022, and partially denied June 16, 2022; and

(b) $1,379.95, in a plan submitted September 15, 2022, and denied September 26, 2022?

iii. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Counselling and Psychological Services of Metropolitan Toronto in a plan submitted December 8, 2021, and denied May 2, 2022?

iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

RESULT

4I find applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 MIG limit. The applicant is not entitled to the benefits in dispute or interest.

ANALYSIS

MIG

5The MIG establishes a treatment framework available to injured persons who sustain a minor injury as a result of an accident. A “minor injury” is defined in the Schedule and includes sprains, strains, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. The MIG provides that a strain is an injury to one or more muscles and includes a partial tear. Under section 18 of the Schedule, injuries that are defined as minor are subject to a $3,500.00 funding limit on treatment.

6The onus is on the applicant to demonstrate that she sustained an injury that is not included in the minor injury definition outlined in section 3 of the Schedule.

7The applicant submitted the MIG is specifically designed to address injuries that are deemed minor, such as minor sprains or strains, which are usually expected to heal within a short time frame with minimal long-term impact. The applicant submits her medical evidence indicates that her injuries are more severe and persistent, including ongoing symptoms and the necessity of extensive physical therapy. Further, the applicant submits the MIG is not applicable in cases where the injury causes a substantial and enduring impact on a person’s life, as in the applicant's case. I note that the applicant did not direct the Tribunal to any medical evidence to support this assertion.

8The respondent submitted that it is the applicant’s burden to prove her injuries are outside the MIG and the applicant has not provided sufficient medical evidence to support removal from the MIG.

9Dr. Hassan Mohammed, MD, diagnosed the applicant with tendonitis and bursitis and on May 16, 2022, with sprains and strains of the cervical spine and lumbar spine, based on the ultrasound results of May 23, 2022. The applicant also complained of neck pain and had symptoms of whiplash associated disorder. No medication was prescribed, and Dr. Mohammed recommended physiotherapy. Psychological treatment for anxiety was also prescribe, however the applicant does not recall psychological treatment being prescribed according to Dr. terra Seon’s (psychologist) report.

10On May 4, 2022, ultrasound results showed a low grade intrasubstance tear of the supraspinatus, Further examination found the tear was partial, an x-ray on May 4, 2022, showed no fracture or dislocation. A further MRI was scheduled however no results have been provided.

11The applicant submitted she received psychological treatment in Pakistan; however, no documentation has been provided to support the statement.

12Dr. Gloria Fiati, Psychologist, recommended a psychological assessment in her psychological pre-screen on November 29, 2021, which relied on self reporting with little evidence of lifestyle alterations.

13Dr. Terra Seon, Psychologist, examined the applicant on February 15, 2022, and in a report dated March 2, 2022, the applicant denied having been referred to a psychiatrist or psychologist following her involvement in the subject accident and denied requiring medication prior to her involvement in the subject accident. Currently, the applicant denied requiring any prescription medication and denied having been referred to a psychiatrist or psychologist following her involvement in the subject accident. She denied having any direct contact with the health care provider listed within the treatment plan in dispute. The Treatment and Assessment Plan (OCF-18) indicated a pre-screen psychological interview was conducted with the claimant; however, it is unclear who conducted the pre-screen interview to obtain the psychological injuries sustained following her involvement in the subject accident. The applicant denied any significant tendency to socially isolate or avoid social interaction. She stated, “we have a good time when we meet up” with friends. On average, she reported that she connects with her friends on a monthly basis. She maintains a positive relationship with her roommate stating, “we have time together making dinner. We enjoy a good chat”. The emotional difficulties reported were not of the magnitude to warrant a psychological diagnosis according to Dr. Terra Seon’s report.

The s. 44 report found that the applicant’s presentation was not of the magnitude to warrant a psychological diagnosis in direct relation to the injuries sustained in the motor vehicle accident of August 21, 2021. There were no valid or objective findings to support a psychological diagnosis at the present time.

14Dr. Terra Seon’s report is thorough and clear that the applicant’s condition does not warrant a psychological diagnosis, and the applicant does not require a psychological assessment. Dr. Mohammed has clearly stated the applicant’s injuries were sprains and strains with a partial tear based on radiology reports. The applicant does not require medication and has submitted she continues to work full time and has an active social life.

15As 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 or interest in dispute. The applicant is entitled to up to $3,500 of treatment under the MIG guidelines.

ORDER

16For the reasons above, I find:

i. I have not received compelling medical information to support an injury to warrant the applicant’s removal from the MIG. The injuries incurred in the accident are predominately minor based on the evidence provided.