Citation: Sandhu v. Belair Insurance Company Inc., 2026 ONLAT 24-004000/AABS

Licence Appeal Tribunal File Number: 24-004000/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:

Puneet Sandhu

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

ADJUDICATOR:

Greg Witt

APPEARANCES:

For the Applicant:

Zehra Rizvi, Paralegal

For the Respondent:

Elisa Cogan, Counsel

HEARD: In Writing

OVERVIEW

1Puneet Sandhu, the applicant, was involved in an automobile accident on October 20, 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, 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:

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 (‘MIG’) limit? The parties agree the MIG limits have been exhausted.

ii. Is the applicant entitled to $3,610.50 for Psychological Services proposed by Complete Rehab Centre in an OCF-18/treatment plan ('plan') dated May 29, 2023?

iii. Is the applicant entitled to $5,942.52 for Physiotherapy Services proposed by Alpha Rehab in a plan dated August 10, 2023?

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

3I find that:

i. The applicant’s injuries are predominately minor and therefore subject to treatment within the $3,500.00 limit of the MIG;

ii. As the applicant is in the MIG, I do not need to consider if the treatments plan in dispute are reasonable and necessary;

iii. The applicant is not entitled to interest; and

iv. The applicant is not entitled to an award under s. 10 of Reg 664.

PROCEDURAL ISSUES

4The Case Conference Report and Order (“CCRO”) dated August 19, 2024, set out a deadline for submissions and evidence for both the applicant and the respondent. The respondent complied with the CCRO. The applicant’s final productions were to be exchanged by October 19, 2024, and submissions to the Tribunal by April 23, 2025. The respondent submits the applicant failed to meet the production exchange deadline and received the applicant’s document brief on January 9, 2025 and April 8, 2025.

5The respondent submits that the applicant should not be entitled to rely on the new documents that were not previously disclosed before the production exchange deadlines given their late production; specifically:

i. Alpha Physio Clinical Notes and Records dated November 29, 2023

ii. Dr. Dhaliwal Clinical Notes and Records dated June 26, 2023

iii. Dr. Dhaliwal Clinical Notes and Records dated October 20, 2019 to February 2, 2023

iv. OCF-3 completed by Alpha Physio dated November 11, 2022

6It is the respondent’s position that if these documents are considered, it will prejudice the respondent, as it was unable to obtain insurer examinations in response of the new evidence.

7The applicant did not make any initial or reply submissions on why the production deadline was not met.

8I find that the new documents failed to comply with the CCRO.

9I agree with the position of the respondent. Rule 9.2 of the Tribunal’s Common Rules of Practice and Procedure was implemented to ensure that parties know the case they have to meet and to allow them to prepare accordingly. Those who fail to comply with Rule 9.2 face the consequences outlined in Rule 9.3:

If a party fails to comply with any Rules, directions or orders with respect to disclosure or inspection of documents or things, or list of witnesses, that party may not rely on the document or thing as evidence, or call the witnesses to give evidence, without the consent of the Tribunal.

10The applicant should have provided the respondent with this letter by the agreed upon date so that it could have properly reviewed the letter and had an opportunity to provide it to an assessor. Furthermore, the applicant could have filed a motion in order to request the Tribunal to extend the timeline for the production exchange. Instead the applicant chose not to. I find this deprived the respondent an opportunity to mount a proper defence. As such, I have not considered the aforementioned new evidence listed in paragraph 5, that was submitted by the applicant.

11I would be remiss if I did not caution the parties that anytime there is non-compliance with a previous Order, parties risk exclusion of the submissions or evidence or both.

ANALYSIS

Applicability of the Minor Injury Guideline (“MIG”)

12Section 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.”

13An 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.

14The parties agreed that the MIG limits have been exhausted.

15It is the applicant’s burden to establish entitlement to coverage beyond the $3,500.00 cap on a balance of probabilities. The applicant submits she suffers from a psychological impairment, which is not included in the definition of a minor injury and that she has a pre-existing condition that warrants removal from the MIG. The respondent submits that the applicant has failed to establish that her injuries are not predominately minor and that the injuries can be treated within the confines of the MIG.

Physical Impairments

17I find that the evidence establishes that the applicant’s physical injuries fall within the minor injury definition.

18The onus is on the applicant to provide evidence that she suffers physical injuries that would remove her from the MIG. The submissions and the evidence of both the applicant and the respondent suggest that the applicant sustained minor soft tissue injuries, which fall squarely within the s. 3 definition of a minor injury under the Schedule.

19The applicant states that she was confined to the MIG as her initial injuries met the definition of minor injury i.e., sprains and strains only, no fracture or a serious head injury. The applicant makes no submissions on further injuries sustained.

20The respondent states that the applicant failed to prove on a balance of probabilities that she sustained a physical injury as a result of the accident that would remove her from the MIG.

21After reviewing the evidence, even though some of the new evidence the applicant relies upon was excluded for being untimely, even if I were to accept the evidence, it does not assist the applicant because I have not been pointed or directed to compelling evidence stating that physical injuries that did not meet the definition of a minor injury. I find that the applicant has not satisfied her onus to prove on a balance of probabilities that she has a physical injury resulting from the accident that would remove her from the definition of the MIG.

Psychological Impairments

22I find that the applicant has not established on a balance of probabilities that her psychological impairments justify treatment beyond the MIG.

23In order to be removed from the MIG due to psychological impairments, the applicant must show that she has a psychological impairment and not post-accident sequelae. A psychological diagnosis requires the progression of ongoing, post-accident symptomatology, or clinically significant psychological impairments.

24The applicant submits that as a result of the accident she experiences emotional distress, characterized by symptoms of depression, anxiety, and post traumatic stress. The applicant relies on the s. 25 psychological assessment of Dr. Jacqueline Brunshaw, psychologist, dated March 30, 2023, which concluded that applicant’s psychological symptoms fell outside of the MIG.

25The respondent relies on the psychological report and addendum report of Dr. Mehdi Lotfalizadeh, psychologist, dated April 21, 2023 and August 15, 2023 respectively, which concluded that the applicant’s symptoms were considered to be a minor injury. Dr. Lotfalizadeh opined that the applicant did not meet DSM-5-TR diagnostic criteria for a psychological impairments that could be attributed to the accident, it was also noted that the applicant’s symptoms were atypical, suggesting that the applicant may have exaggerated her symptoms.

26Dr. Lotfalizadeh concluded that based on the in-person assessment and full document review, the applicant’s psychological symptoms can be considered a minor injury, there was no prescription medicine, no previous psychological treatment, and the applicant remined fully independent in her personal care and ability to perform household tasks.

27After reviewing the evidence, I am not persuaded on a balance of probabilities that the applicant has demonstrated a psychological impairment warranting removal from the MIG. I put more weight on the report of Dr. Lotfalizadeh because he conducted an in-person assessment and full document review, and because his determination is consistent with the applicant’s family physician’s CNRs, which reveal no complaints of a psychological nature, no referrals for psychological treatment, and no prescriptions for psychological medication.

28Further, I find that the applicant did not provide records to corroborate her psychological impairment, and the applicant herself reported that she was capable of returning to her employment, most pre-accident activities, driving and independent self-care. There is also no record of the applicant consulting a mental health professional apart from the s. 25 psychological assessment.

29Therefore, I find that the applicant has not met her evidentiary onus to demonstrate on a balance of probabilities that she suffers from a psychological impairment that would warrant her removal from the MIG.

Pre-existing Medical Condition

30I find that the applicant has not established that she has a pre-existing condition that warrants removal from the MIG.

31The applicant submits that she has a documented history of pre-existing medical conditions, from a previous motor vehicle accident in October 2020. Here, the applicant submits medical records that was not disclosed before the production exchange deadlines.

32As a result, I find that the applicant, even though the new evidence the applicant relies upon was excluded for being untimely, even if I were to accept the evidence, it does not assist the applicant because I have not been pointed or directed to compelling evidence stating that the pre-existing condition precludes achieving maximal recovery from her injuries by being subject to the MIG.

24I find that the applicant has sustained a minor injury and is subject to the MIG, and the parties agreed the MIG has been exhausted, as a result, an analysis of whether the treatment plans are reasonable and necessary is not required.

Interest

25There are no benefits payable, therefore no interest is owing.

Award

26The 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. As no benefits have been unreasonably withheld or delayed, the applicant is not entitled to an award.

ORDER

27The application is dismissed, and I find that:

i. The applicant’s injuries are predominately minor and therefore subject to treatment within the $3,500.00 lit of the MIG;

ii. As the applicant is in the MIG, I do not need to consider if the treatment plans in dispute are reasonable and necessary;

iii. The applicant is not entitled to interest; and

iv. The applicant is not entitled to an award under s. 10 of Reg 664.