Citation: Bhatal v. Belair Insurance Company Inc., 2026 ONLAT 24-008854/AABS

Licence Appeal Tribunal File Number: 24-008854/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:

Mandeep Bhatal

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

ADJUDICATOR:

Jim Zotalis

APPEARANCES:

For the Applicant:

Yanira E. Monterozza, Paralegal

For the Respondent:

Olivia Hajdas, Counsel

HEARD:

In Writing

OVERVIEW

1Mandeep Bhatal, the applicant, was involved in an automobile accident on August 14, 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 (“MIG”) limit? Note: The parties agree the MIG limits have been exhausted.

ii. Is the applicant entitled to $1,926.60 for physiotherapy services, proposed by We Care Rehab Clinic in a treatment plan/OCF-18 (“plan”) submitted June 16, 2022?

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

RESULT

3The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the MIG.

4The applicant is not entitled to physiotherapy services proposed by We Care Rehab Clinic, nor to interest, as there are no overdue payment of benefits owing to the applicant.

PROCEDURAL ISSUES

5The respondent submitted that the applicant’s submissions exceeded the seven-page limit ordered in the Case Conference Report and Order (“CCRO”) dated November 1, 2024.

6The respondent argued that the Tribunal should disregard the additional page (i.e. the last page of the applicant’s submissions), as the applicant exceeded the 7-page limit by one page.

7The respondent directed the Tribunal to Bonilla-Lopez v. BelairDirect, 2023 CanLII 26940 (ONLAT), a case where the adjudicator stated that “submissions for both parties to this dispute were written by counsel licensed by the Law Society of Ontario, who ought to know the risks of disregarding an order issued by the Tribunal”.

8The CCRO states that the hearing adjudicator has the discretion to determine whether to consider submissions that do not comply with the Tribunal’s filing requirements.

9LAT Rule 9.3 sets out guidelines for adjudicators when dealing with a failure to comply with the rules. When determining whether to allow a document to be used as evidence, the Tribunal may consider any relevant factor, including:

i. The reasons for non-compliance;

ii. Whether a party will be prejudiced by the admission or exclusion of the evidence and the extent to which that prejudice can be mitigated by any other order;

iii. The extent to which the substance of the information or testimony lies within the knowledge of the other party;

iv. Whether the other party opposes the admission of the evidence or testimony; and

v. The relevance of the document, thing, or testimony to an issue in dispute in the proceeding.

10I have exercised my discretion and allow the extra page submission as submitted by the applicant as I find it will not prejudice the respondent and it is highly relevant to the issues in dispute.

ANALYSIS

Do the applicant’s impairments fit within the MIG framework?

11The MIG establishes a framework for the treatment of minor injuries. The term “minor injury” is defined in s. 3(1) of the Schedule 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.” The terms “strain”, “sprain”, “subluxation”, and “whiplash associated disorder” are also defined in s. 3(1). Section 18(1) limits recovery for medical and rehabilitation benefits for such injuries to $3,500.

12An 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.

13The applicant argues he should be removed from the MIG on the basis of chronic pain.

Do the applicant’s injuries fall outside of the MIG due to chronic pain?

14I find the applicant has not met his onus, on a balance of probabilities, to establish that his injuries fall outside of the MIG due to chronic pain syndrome.

15The applicant relies on the following evidence to argue that he should be removed from the MIG.

i. An application for accident benefits (OCF-1);

ii. The clinical notes and records (“CNRs”) of his family doctor, Dr. Kishore Singh;

iii. The CNRs of treating facilities, including We Care Rehab Clinic and Be Active Physiotherapy;

iv. A prescription summary; and

v. A consultation report from Dr. Aimal Sediq, consulting family physician, dated March 7, 2025.

16The respondent relies on the following evidence to argue that the applicant should remain in the MIG:

i. A physician assessment report by Dr. Charanjit Sandhu, dated March 14, 2023.

17The applicant submits that based on the length of time he has continued to have pain and limitations stemming from the injuries sustained in the accident, there is a reasonable possibility that he suffers from chronic pain syndrome (“CPS”) and therefore, he should be removed from the MIG. The applicant contends that more weight should be placed on the medical opinions of the family doctor and chronic pain specialist, who concur that the applicant is suffering from chronic pain syndrome.

18The respondent submits in the time between June 23, 2022, to October 16, 2024, there are no medical records that speak to the applicant’s level of functioning. The respondent further argues that there were no objective tests or observations noted to explain how the applicant’s family doctor, Dr. Singh, came to diagnose the applicant with chronic back pain on return to see his family doctor. Further, the respondent submits that the applicant’s family doctor was not provided with any notes from treating specialists that the applicant may have seen in that period.

19With respect to CPS, it is a broader, more severe condition than chronic pain with functional impairment where the pain is accompanied by significant psychological and behavioral dysfunction, such as depression or anxiety and impaired daily functioning. On the other hand, chronic pain with functional impairment is persistent pain lasting longer than 3-6 months, often stemming from an underlying injury or disease, which is why an applicant must demonstrate functional impairment to differentiate it from a MIG impairment.

20I find the applicant has not persuaded me that he suffers from CPS or chronic pain with functional impairment for the following reasons.

21The applicant did not direct me to medical records attesting to his functional impairments between June 23, 2022, to October 16, 2024 (approximately 28 months). In my opinion, this is an extensive gap in reporting time for which the applicant makes no mention of his functional impairments to his family doctor. I am not persuaded that the applicant suffers from CPS given this absence of reporting coupled with the fact that I have not been directed to compelling corroborating medical evidence of functional impairment during this period.

22Further, the applicant in his OCF-1, Application for Accident Benefits, stated that he “reduced (work) hours post-mva”. However, there is no reference to the number of hours and for how long this reduction took place. More significantly, the applicant reported as part of a s.44 IE assessment conducted on February 28, 2023, by Dr. Sandhu, internal medicine physician, that he was now working full hours (35-40 hours per week) as a realtor. The applicant has not submitted evidence for an accommodation due to chronic pain or impairment from the accident, nor is there reference to extensive leave from work. In my view, I have not been persuaded the applicant suffers from CPS given the change in reporting.

23I am also not persuaded that the applicant has suffered from a significant psychological and behavioral dysfunction along with impaired daily functioning to warrant removal from the MIG due to CPS. I have not been directed to compelling medical evidence to substantiate claims of psychological and behavioral dysfunction. For example, in a CNR from the family doctor, Dr. Singh, dated June 23, 2022, the entry reads as follows: “telephone call, PTSD better, sleep, physio and chiro done, stiffness back, 6 months therapy needed, FU1 monthly”. However, there are no CNRs between the first family doctor’s visit and this notation with reference to any significant psychological and behavioral dysfunction along with impaired daily function mentioned as part of the evidentiary record. Although the applicant made submissions that both the family doctor, Dr. Singh, and the consulting family physician, Dr. Sediq, concur that the applicant is suffering from chronic pain syndrome, I have not been directed to evidence to support this claim.

24For the reasons stated above, I find the applicant has not demonstrated that he suffers from CPS or chronic pain with functional impairment as a result of the accident and is therefore subject to the limits of the MIG.

Is the applicant entitled to physiotherapy services proposed by We Care Rehab Clinic?

25As I find the applicant is not entitled to be removed from the MIG, it is not necessary to consider if he is entitled to the treatment plan for physiotherapy services.

Interest

26Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that there are no overdue benefits payable to the applicant, no interest is payable.

ORDER

27The Tribunal Orders as follows:

i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the MIG;

ii. The applicant is not entitled to physiotherapy services proposed by We Care Rehab Clinic, nor to interest, as there are no overdue payment of benefits owing to the applicant; and

iii. The application is dismissed.