Licence Appeal Tribunal File Number: 24-008009/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:
Natalya Men
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Harouna Saley Sidibé
APPEARANCES:
For the Applicant:
Samia Alam, Counsel
For the Respondent:
Keisha Tucker, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Natalya Men, the applicant, was involved in an automobile accident on January 24, 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:
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?
ii. Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $400.00 per week from January 24, 2022, to date and ongoing?
iii. Is the applicant entitled to $2,452.00 for Chiropractic Services, proposed by Alliance Diagnostic in a treatment plan/OCF-18 (“plan”) dated June 27, 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?
vi. Is the respondent entitled to costs?
vii. Is the applicant entitled to costs?
3In its Notice of Motion (“NoM”) dated July 30, 2025, the respondent added a $500.00 cost claim. In her Motion Reply Submissions, the applicant has requested the same amount as Costs.
RESULT
4For the reasons below, I find that:
The applicant’s injuries are predominantly minor; therefore, the MIG monetary limit applies.
Because the applicant is bound by the MIG, it is unnecessary to consider whether the disputed treatment plan is reasonable and necessary.
The applicant is not entitled to an IRB.
The applicant is not entitled to interest or an award.
The respondent is not entitled to costs.
The applicant is not entitled to costs.
PROCEDURAL ISSUES
5The preliminary issue is whether the disputed parts of the applicant’s reply exceed the proper scope of a reply by introducing new evidence or a new argument. The respondent brings a motion to strike those portions on that basis and in accordance with procedural fairness.
6A reply is limited to responding to matters raised in the responding submissions and may not advance new issues or evidence. The question is therefore whether the challenged paragraphs of the applicant’s reply merely answer the respondent’s submissions or impermissibly raise new material.
7The respondent’s motion seeks to strike paragraphs 3–5, 7, 9–11, and 14–25 of the applicant’s reply. The respondent submits that these paragraphs contain new evidence and new legal argument not previously raised, and that allowing them would be procedurally unfair. The respondent also seeks $500.00 in costs on the basis that the motion and the resulting sur‑reply were made necessary by the applicant’s conduct.
8The respondent submits that the applicant’s reply improperly relies on clinical notes, reports, and jurisprudence not used in the main submissions, unjustly expanding the case and depriving the respondent of a fair chance to respond.
9The respondent identifies paragraphs 3–5, 7, and 9–11 as introducing new factual assertions, particularly references to additional clinical notes and records (“CNRs”) by Dr. Rita Kharonsky and the s. 44 Insurer Examination (“IE”) Report of Dr. Douglas Saunders, which was not relied upon in the initial submissions. The respondent submits that the applicant improperly refers to evidence not previously mentioned, introducing it for the first time in the reply. The respondent further submits that paragraphs 14–25 introduce new jurisprudence and new legal argument unrelated to any issues first raised in the respondent’s responding submissions.
10The respondent relies on Spence v Aviva General Insurance, 2023 CanLII 84381 (ON LAT), in which the Tribunal confirmed that a reply is not an opportunity to bolster an initial case or introduce new evidence. The respondent argues that the applicant could and should have raised the medical evidence, the psychological report of Dr. Saunders, and the case law, including Rawal v Economical Insurance, 2023 CanLII 62926 (ON LAT), and Thompson v Certas Home and Auto Insurance Company, 2025 CanLII 23466 (ON LAT), in her initial submissions.
11The applicant submits that the respondent’s motion should be dismissed because the reply contains no new evidence and no new arguments and is properly confined to responding to the respondent’s submissions. The applicant argues that all challenged references were already included in either her initial evidence brief or the respondent’s submissions.
12The applicant relies on Tribunal jurisprudence confirming that reference to existing evidence does not constitute new evidence and that case law is not evidence. The applicant cites Spence, as well as AL-Rahami v Aviva Insurance Company of Canada, 2024 CanLII 126984 (ON LAT), Dulepa v Aviva Insurance Company of Canada, 2023 CanLII 52302 (ON LAT), and Mirzaie v Intact Insurance, 2024 CanLII 123332 (ON LAT), to support the principle that reliance on previously‑filed medical records or pre‑existing documentation is permissible in a reply.
13The applicant submits that paragraphs 3–5 and 7 merely elaborate on evidence already included in the applicant’s initial brief and respond to the respondent’s challenge to her chronic pain submissions. Similarly, paragraphs 9–11 respond to the respondent’s arguments regarding Dr. Saunders’ psychological report, which appears at Tab 8 of the respondent’s own submissions. Regarding paragraphs 14–25, the applicant argues that the only new material is jurisprudence, which is not evidence and may properly be raised in reply.
14I accept the general principle that reply submissions are not an opportunity to reframe a party’s case or to introduce new evidence that should have been presented in the initial submissions. Fairness in written hearings requires that each party know the case to be met.
15Although the CNRs of Dr. Kharonsky cited in paragraphs 3 and 7 were included in the applicant’s initial evidence (Tab 1 of the applicant’s Document Brief), the question is whether the applicant’s references to them in reply respond to arguments first raised in the respondent’s submissions. In my view, the applicant’s reliance on these records in paragraphs 3 and 7 is responsive to the respondent’s position and does not advance a new argument that could have been made in the applicant’s initial submissions. Accordingly, these paragraphs fall within the proper scope of reply.
16Paragraph 5 does not respond to a new point raised by the respondent; rather, it expands the applicant’s original chronic‑pain argument. As such, it goes beyond the proper scope of reply. The reference to Rawal v. Economical is not within the scope of the reply. It is a new authority that could have been advanced in the initial submissions and does not respond to a point first raised by the respondent.
17Paragraph 9 relies on Dr. Saunders’ report (Tab 8), which the respondent filed. Although the report existed before the respondent’s submissions, the applicant’s reply responds to the way the respondent relied on that report, an issue that could not reasonably have been anticipated in the applicant’s initial submissions.
18While the applicant’s reliance on Thompson v. Certas and her post‑104‑week IRB theory clearly fall outside proper reply, they are not the only instances. As outlined above, several paragraphs introduce new jurisprudence or expand arguments that could reasonably have been raised in the initial submissions. That said, striking is a discretionary remedy, and I proceed cautiously. I do not endorse case‑splitting, but on these facts, I am not persuaded that striking is required to preserve fairness. Any reply content that exceeds the proper scope will simply not be taken into account.
19First, although the contested reply passages address the respondent’s MIG submissions on chronic pain and psychological impairment, referring to the respondent’s evidence or framing a point as a “response” does not make it a proper reply. The decisive question is whether the applicant could reasonably have advanced the underlying argument in her initial submissions. Some of the reply is legitimate rebuttal, while other portions repeat or expand arguments that were already available to her.
20Second, although the cited evidence appears in the applicant’s own evidence brief, that does not resolve the issue. The proper inquiry remains whether the applicant is now using that evidence to make arguments she could have advanced in chief. Where that occurs, the reply exceeds permissible scope. In a written hearing, fairness is preserved by simply not considering reply passages that go beyond proper rebuttal, and, where necessary, allowing a narrowly‑tailored sur‑reply.
21Third, the respondent has had a full opportunity in this motion and its sur‑reply to identify the impugned passages and explain the prejudice it alleges. While the sur‑reply assists in addressing any remaining prejudice, it does not justify allowing improper reply material to stand. I will disregard any reply content that exceeds proper scope, and I will consider only those portions of the respondent’s sur‑reply that respond to reply passages I find admissible.
22Having reviewed the parties’ submissions and the relevant jurisprudence, and applying the correct test, namely, whether the impugned points could reasonably have been raised in the applicant’s initial submissions, I find that several paragraphs of the reply approach or cross the boundary of proper reply. However, fairness can be preserved without striking. I will not take into account any reply content that should have been advanced at the first instance. Simply pointing to existing evidence or invoking case law does not cure improper reply; what matters is whether the reply is being used to introduce a substantive argument that was reasonably available earlier. To the extent it does so, it will be disregarded.
23Moreover, through this motion (and its sur‑reply), the respondent has had a full opportunity to identify the impugned reply passages and explain the prejudice it alleges. That said, a sur‑reply does not legitimize case‑splitting. I will not consider any reply content that should have been advanced in chief; only properly responsive reply material will be taken into account. This approach is proportionate and consistent with Rule 3.1’s focus on fairness and timely resolution.
24Accordingly, I find that fairness can be preserved without striking any part of the applicant’s reply. For these reasons, the respondent’s request to strike portions of the applicant’s reply submissions is denied.
ANALYSIS
Are the applicant’s injuries predominantly minor?
25I find that the applicant’s accident-related injuries are predominantly minor, and she has not demonstrated that she should be removed from the MIG.
26Section 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.”
27An 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.
28The applicant submits that she requires treatment beyond the MIG because she has documented pre‑existing conditions, including osteoporosis and anxiety, that preclude maximal recovery within the MIG, and that she suffers from chronic pain that results in functional impairment and psychological symptoms.
Pre-existing Condition
29The parties agree that the applicant had documented pre-existing conditions before the accident. The issue is whether there is compelling medical evidence that any such condition, alone or in combination, would prevent maximal medical recovery if she remains within the MIG. I find there is not.
30The applicant relies on her family physician’s CNRs and the early OCF‑3, arguing that osteoporosis, dyspepsia and anxiety interfered with recovery. Those records do not identify functional limitations or clinical findings linking any pre‑existing condition to delayed recovery from the soft‑tissue injuries at issue; osteoporosis was repeatedly noted as not requiring active treatment, and there is no opinion linking dyspepsia or anxiety to a barrier to recovery within the MIG.
31By contrast, the s. 44 assessments that directly address the MIG question are more persuasive at step‑2. Dr. Silver (GP) and Dr. John (neurology) reported examinations consistent with sprain/strain‑type injuries and found no medical basis for concluding that a pre‑existing condition would impede recovery within the MIG. The psychological IE (Dr. Saunders) did not diagnose a clinical psychological impairment or identify any pre‑existing psychological condition that would prevent recovery.
32On the totality of the record, the applicant’s materials establish the existence of pre‑existing conditions but do not provide the compelling medical evidence required to show that those conditions would prevent maximal recovery if she remains within the MIG. On a balance of probabilities, the step‑2 threshold under s. 18(2) is not met.
33The applicant’s medical records confirm diagnoses of osteoporosis and other pre‑existing conditions. However, the treating physician repeatedly noted that no active treatment was required, and the records do not indicate any functional limitations or clinical findings suggesting that these conditions would interfere with recovery from soft‑tissue injuries typically treated within the MIG.
34Similarly, the documented history of dyspepsia and intermittent gastrointestinal symptoms predates the accident, but there is no medical opinion connecting this condition to any barrier to recovery from the accident‑related musculoskeletal complaints.
35The same is true of the applicant’s long‑standing stress and anxiety symptoms. While noted in the records, they were not actively treated, and there is no evidence that they resulted in functional impairment or would otherwise hinder recovery from minor injuries within the MIG.
36The s. 44 musculoskeletal assessment by Dr. Eric Silver, dated July 12, 2022, found no compelling evidence of a pre‑existing condition that would prevent the applicant from achieving maximal recovery within the MIG's limits. Similarly, the s. 44 neurology examination by Dr. Verity John on July 26, 2022, found no pre‑existing condition that would prevent the applicant from achieving maximal medical recovery if treated within the MIG.
37I accept that the applicant had pre‑accident medical issues documented in her family physician’s records. However, the determinative issue is not whether pre‑existing conditions existed, but whether there is compelling medical evidence that these conditions precluded maximal recovery from the accident‑related minor injuries had the applicant been treated within the MIG.
38On the decisive question under s. 18(2), whether compelling medical evidence shows that the applicant’s documented pre‑existing conditions would prevent maximal recovery within the MIG, I place the greatest weight on the contemporaneous IE evidence that directly answers that question. Dr. Silver (GP) and Dr. John (neurology) reported largely normal examinations consistent with sprain/strain‑type injuries and concluded there was no medical basis to find that the applicant’s pre‑existing conditions would impede recovery within the MIG.
39The applicant points to post‑accident materials (including her family physician’s records and the Alliance psychological pre‑screening) to argue that pre‑existing osteoporosis, dyspepsia, and anxiety/stress would preclude maximal recovery. However, those records do not include an opinion linking any pre‑existing condition to a barrier to recovery from the soft‑tissue injuries at issue; notably, the family physician repeatedly noted that no active treatment for osteoporosis was required, and there is no functional‑limitation analysis tied to MIG recovery. In contrast, the respondent’s psychological IE (Dr. Saunders) found no clinical criteria for a psychological impairment and did not identify a pre‑existing psychological condition that would prevent recovery within the MIG. Taken together, the applicant’s post‑accident materials are not persuasive on step 2, and the IE suite is. Accordingly, the evidentiary record does not establish that the applicant’s pre‑existing conditions would prevent maximal recovery if she remains within the MIG.
40The applicant submits that her pre‑existing osteoporosis, dyspepsia, and anxiety interfered with her recovery, relying primarily on her family physician’s CNRs and the OCF‑3 completed shortly after the accident. However, those records do not describe any functional limitation or clinical finding suggesting that these conditions impeded her recovery from the soft‑tissue injuries sustained in the accident. Dr. Kharonsky repeatedly recorded that the applicant’s osteoporosis required no active treatment, including both before the accident and in subsequent visits, and made no finding that it affected spinal or musculoskeletal functioning relevant to MIG recovery.
41Similarly, while dyspepsia and intermittent anxiety appear in the historical CNRs, the records contain no opinion linking either condition to delayed healing or restricted capacity after the accident, and there is no documented deterioration or treatment escalation post‑accident on these points. The psychological IE conducted after the accident further found no clinical psychological impairment, undermining the suggestion that pre‑existing stress or anxiety interfered with recovery.
42On the whole, the evidence relied upon by the applicant identifies the existence of pre‑existing conditions, but it does not provide the type of compelling medical evidence required under s. 18(2) to demonstrate that those conditions would prevent maximal recovery if she remained within the MIG.
43Accordingly, on a balance of probabilities, I find that the applicant has not established that her pre‑existing conditions precluded maximal recovery under the MIG.
Chronic Pain
44I find that the applicant has not met her onus of establishing chronic pain causing functional impairment sufficient to warrant removal from the MIG.
45The applicant argues that she suffers from chronic pain syndrome and that her pain causes functional limitations requiring removal from the MIG. She relies on her family physician’s clinical notes and records (“CNRs”) documenting neck, back, and shoulder pain after the accident, including a February 2, 2022, entry reflecting these complaints, and on treatment‑provider records noting ongoing pain. She also refers to a June 19, 2023, CNR entry.
46I accept that the applicant reported pain following the accident. The February 2, 2022, CNR reports back, and shoulder pain since the accident, and these complaints were reiterated to the s. 44 assessors in July 2022.
47However, the June 19, 2023, CNR expressly links the applicant’s back and joint pain to a June 5, 2023, accident. Because it concerns a different incident, it does not support the claim that the January 24, 2022, accident produced ongoing impairments beyond the MIG. I do not rely on it for this analysis.
48The applicant submits that her pain caused persistent functional impairment, including disturbed sleep, mobility limitations, and restrictions in activities of daily living. However, the contemporaneous records she relies on do not document ongoing, accident‑related functional limitations beyond the acute phase. The February 2, 2022, CNR records note pain but otherwise show normal findings, and there is no sustained contemporaneous evidence linking post‑accident pain to restrictions in activities of daily living. The s. 44 musculoskeletal IE (Dr. Silver, July 12, 2022) identified uncomplicated sprain/strain‑type injuries and found no objective evidence of ongoing musculoskeletal impairment. The s. 44 neurology IE (Dr. John, July 26, 2022) similarly concluded that the injuries were minor and treatable within the MIG, with no evidence of radiculopathy or myelopathy. These assessments directly address the MIG question and do not diagnose chronic pain or functional impairment attributable to the subject accident.
49On this record, I accept that the applicant experienced post‑accident pain, but she has not established, on a balance of probabilities, chronic pain causing functional impairment as a result of the January 24, 2022, accident. The contemporaneous CNR and the s. 44 IE suite does not support ongoing, accident‑related functional limitation beyond the acute period, and the June 19, 2023, CNR concerns a different accident. Accordingly, she is not removed from the MIG on the basis of chronic pain.
Psychological Impairments
50I find that the applicant has not established that she sustained accident-related psychological impairments that warrant removal from the MIG.
51The applicant submits that she developed psychological impairments following the accident, including increased anxiety and stress, poor sleep, irritability, concentration and memory issues, low motivation, and emotional distress. She says these symptoms worsened over time and, together with her physical pain, impaired her daily and work functioning.
52The respondent disputes that the applicant sustained a psychological impairment outside the MIG. It relies on the s. 44 psychological examination, which concluded that the applicant exhibited at most mild accident‑related psychological symptoms that did not meet clinical diagnostic criteria. The respondent submits that any psychological sequelae fall within the MIG framework.
53The evidence also shows that the applicant had pre‑existing stress and anxiety before the accident. Her family doctor’s records include repeated discussions, well before January 2022, about relaxation strategies for “stress and anxiety symptoms that [she] has always had.” These records confirm that these symptoms pre‑dated the accident and were not newly arising conditions.
54The April 4, 2022, Psychological Pre‑Screening Report recommends a formal psychological assessment and notes the applicant’s motivation to return to her pre‑accident level of functioning. However, it relies almost exclusively on the applicant’s subjective reports, includes no psychometric testing, and provides no DSM‑5 diagnosis. Therefore, it does not establish a psychological impairment.
55The June 21, 2022, follow‑up pre‑screening again recommends a comprehensive assessment without objective testing or a diagnostic conclusion. It notes interest in counselling but does not diagnose an impairment or link symptoms to functional restrictions. These pre‑screenings support only the need for further assessment, not proof of psychological impairment.
56In contrast, the s. 44 psychological examination (Dr. Saunders, November 17, 2022) included standardized objective tests, namely the PAI, DSM‑5 Depression Adult Scale, and MAQ, along with a structured clinical interview. Dr. Saunders concluded that the applicant’s presentation involved mild emotional symptoms that did not meet the diagnostic criteria for a psychological impairment.
57I accept that the applicant experiences stress and anxiety. However, the issue is whether she has an accident‑related psychological impairment that removes her from the MIG. The pre‑screening reports do not diagnose such an impairment, and s. 44 IE explicitly concludes that she does not meet the clinical criteria for impairment.
58As the applicant has not adduced diagnostic evidence of a psychological impairment and as Dr. Saunders’s 44 examination stands unrebutted, I accept his conclusion that no psychological impairment is present.
59Although a pre‑existing condition does not preclude MIG removal, the applicant must show that the accident caused a psychological impairment that is more than minor. The record here does not establish that causation.
60I also accept Dr. Saunders’ view that the applicant’s psychological symptoms are consistent with mild emotional reactions commonly associated with recovery from minor injuries and that these symptoms are properly addressed within the MIG.
61Accordingly, on a balance of probabilities, I find that the applicant has failed to meet her burden of establishing a psychological impairment that warrants removal from the MIG. The MIG therefore applies.
Is the applicant entitled to the disputed treatment plan?
62As I have found that the applicant remains within the MIG, it is unnecessary for me to determine whether the disputed treatment plan is reasonable and necessary.
Is the applicant entitled to an IRB?
63For the reasons set out below, I find that the applicant is not entitled to an IRB.
64The applicant submits that she is entitled to IRB from January 24, 2022, to date and ongoing, covering both pre‑104‑week (section 5) and post‑104‑week (section 6) entitlements. She seeks $400/week from shortly after the accident to the 104‑week mark, and $185/week thereafter.
Pre-104 Week IRB
65To receive payment for an IRB under s. 5(1) of the Schedule, the applicant must be employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffer a substantial inability to perform the essential tasks of that employment. The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them. The applicant bears the burden of proving, on a balance of probabilities, that they meet the test.
66The applicant submits that she met the pre-104-week test, relying principally on the March 10, 2022, OCF‑3 completed by Dr. Larysa Mikhailova (chiropractor), which states that accident‑related impairments substantially prevented her from performing essential duties; she says those impairments persisted and later crossed into the post‑104‑week period.
67The respondent submits that the applicant did not meet the pre-104-week requirements. It relies on s. 44 IE evidence (Dr. Eric Silver, GP; Dr. Douglas Saunders, psychology) finding no substantial physical or psychological inability, together with the applicant’s own Examination Under Oath (“EUO”) admissions that she returned to work within days of the accident, at similar hours (approximately 20–25 hours/week), and later took a second job with Akiva Food. The respondent also argues that an OCF‑3 alone is insufficient to establish the legal test and points to income records showing increased earnings post‑accident.
68On the medical record, I give significant weight to the s. 44 findings. Dr. Silver (GP) reported a normal examination and concluded there was no substantial physical inability to perform essential cleaning tasks. Dr. Saunders concluded the presentation did not meet clinical criteria for a psychological impairment amounting to a substantial inability.
69On the employment record, the applicant’s EUO evidence confirms that she returned to her cleaning job shortly after the accident, worked roughly the same hours (20–25 per week) by pacing, and later added weekday hours with Akiva Food (approximately 9:00 a.m. to 3:00 p.m., Monday to Friday). Income records produced show increasing net self‑employment and employment income into 2024. I give this objective evidence considerable weight in assessing functional capacity during the first 104 weeks.
70I accept that an OCF‑3 can be a starting point; however, on this record, the OCF‑3 speaks at a high level to “substantial inability” and contemplates a return to modified work, which is in fact what occurred. There is no persuasive contemporaneous medical analysis tying specific essential tasks of the cleaning job to functional restrictions that substantially prevented their performance over the 104‑week window, despite sustained work activity and additional hours at a second job.
71On a balance of probabilities, I am not satisfied that the applicant proved a substantial inability to perform the essential tasks of her pre‑accident employment within the first 104 weeks.
Post-104 Week IRB
72To receive payment for a post-104-week IRB under s. 6 of the Schedule, the applicant must demonstrate on a balance of probabilities that they suffer from a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience.
73In the case of Paesano v. Coseco Insurance Co., 2025 CanLII 3245 (ONSC), the Divisional Court confirmed that an insured individual seeking IRB after the first 104 weeks must apply for and demonstrate the necessary disability within those initial 104 weeks. The court established a stricter standard for ongoing entitlement beyond this period. If the threshold for the pre-104 weeks is not met, there is no need to assess entitlement for the post-104 weeks. Since the applicant did not establish entitlement during the pre-104-week period, it is unnecessary to further consider the post-104-week benefits.
74Accordingly, for the foregoing reasons, the applicant has not met her onus of proving entitlement to an IRB.
Interest
75Interest applies to the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are payable in this decision, no interest is owing.
Award
76The applicant requests an award under s. 10 of O. Reg. 664/90. An award is discretionary and requires proof that the insurer’s withholding or delay was unreasonable, not merely that benefits were disputed. Here, I have determined that the disputed benefits are not payable and that the respondent acted on the basis of insurer examinations and the available record. In these circumstances, the s. 10 threshold is not met. The request for an award is denied.
Costs
77The respondent seeks $500 in motion costs, arguing that the applicant breached procedural fairness and acted in bad faith by introducing new evidence, arguments, and authorities in reply submissions. On that basis, it requests that costs be awarded against the applicant.
78The applicant opposes the request and asks that no costs be ordered, maintaining that her reply properly addressed the respondent’s submissions and that striking and costs are unwarranted in a written hearing on the scope of the reply.
79In exercising discretion regarding costs, I am guided by the Tribunal’s procedural principles of fairness, proportionality, and timely resolution, as set out in the CCRO.
80The motion concerned the proper scope of the reply. The record shows that both parties used the motion process appropriately: the respondent identified the specific reply paragraphs it considered improper and explained the alleged prejudice, and the applicant responded within the Tribunal’s timelines. Nothing in the motion record establishes unreasonable, vexatious, or bad‑faith conduct by either party.
81In these circumstances, a costs award would be neither fair nor proportionate. The respondent’s request for $500 is denied. To the extent the applicant sought her motion costs, that request is likewise denied.
ORDER
82For the above reasons, it is ordered that:
i. The applicant’s injuries are predominantly minor; therefore, the MIG monetary limit applies.
ii. Because the applicant is bound by the MIG, it is unnecessary to consider whether a disputed treatment plan is reasonable and necessary.
iii. The applicant is not entitled to an IRB.
iv. The applicant is not entitled to interest or an award.
v. The respondent is not entitled to costs.
vi. The applicant is not entitled to costs.
Released: February 23, 2026
__________________________
Harouna Saley Sidibé
Adjudicator