Citation: Ohaniss v. Intact Insurance Company, 2026 ONLAT 24-007846/AABS

Licence Appeal Tribunal File Number: 24-007846/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:

Waroshan Ohaniss

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR:

Jeff Chatterton

APPEARANCES:

For the Applicant:

Kameliya Stancheva, Paralegal

For the Respondent:

Robbie Brar, Counsel

HEARD: In Writing

OVERVIEW

1Waroshan Ohaniss, the applicant, was involved in an automobile accident on January 25, 2023, 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 Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issue(s) in dispute is/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 $58.95 ($1,300.00 less $1,241.05 approved) for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan/OCF-18 (“plan”) submitted May 27, 2023?

iii. Is the applicant entitled to $1,525.84 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a plan submitted September 14, 2023?

iv. Is the applicant entitled to $3,622.31 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a plan submitted February 17, 2023?

v. Is the applicant entitled to $2,023.03 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a plan submitted July 24, 2023?

vi. Is the applicant entitled to $87.19 ($200.00 less $112.81 approved) for the completion of an OCF-3, submitted on March 20, 2023?

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

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

RESULT

3The applicant has not met his onus to prove he should be removed from the Minor Injury Guideline.

4As the applicant is being held to the MIG, it is not necessary for me to do a reasonable and necessary analysis on the disputed treatment plans.

5Interest is not due.

6The application is dismissed.

ANALYSIS

Is the applicant held to the Minor Injury Guideline?

7The applicant has not met his onus to demonstrate he should be removed from the Minor Injury Guideline and is therefore subject to the $3,500.00 treatment limit.

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 submits that his injuries are severe enough that he should be removed from the MIG. To support his claim, he relies on the OCF-18s for the disputed treatment plans, as well as Clinical Notes and Records (“CNRs”) from his family physician, Dr. Azhar Toma.

11I have carefully reviewed the evidence submitted by the applicant, and I see a single visit to Dr. Toma, approximately one week after the subject accident. Dr. Toma noted right knee pain, right leg shaking and coccygeal pain. He prescribed Tylenol and told the applicant to consider Physiotherapy.

12There were no further references to any further or ongoing visits to Dr. Toma for accident-related injuries included in the applicant’s evidence.

13The applicant also did not lead me to any specific evidence in the OCF-18s that provided evidence of a non-minor injury. Rather, the applicant states that he has “persistent musculoskeletal impairments and functional limitations warranting continued chiropractic care.”

14The respondent disagrees, and argues the applicant’s injuries are minor. To support their claim, the respondent relies on the s.44 Insurers Examination conducted by General Practitioner Dr. Seung-Jun Lee, dated April 17, 2024. Dr. Lee reports that they were unable to “identify any ongoing accident-related musculoskeletal impairments that would necessitate chiropractic therapy or massage therapy.”

15The applicant objects to Dr. Lee’s report, stating that it was conducted 7 months after the disputed treatment plans were denied and is therefore not timely or contemporaneous to the issues in dispute at the hearing.

16In summary, I have been presented with medical evidence that does not indicate that the applicant has suffered anything beyond a minor injury. The CNR’s from the family physician do not reference a non-minor injury, nor do the OCF-18s refer to any non-minor injuries.

17The respondent’s IE assessor, Dr. Lee, is stating that there are no musculoskeletal impairments that would necessitate chiropractic therapy or massage therapy. Although Dr. Lee does not reference the MIG, I find that his report does not contain evidence that would indicate the applicant has sustained a non-minor injury. And while I note the objection to the inclusion of Dr. Lee’s report, the onus to demonstrate entitlement to be removed from the MIG lies with the applicant, and his evidence does not establish a non-minor injury.

18Put another way, even if Dr. Lee’s report were to be excluded, in the absence of supporting medical information from the applicant, I would still find that the evidence presented by the applicant does not show evidence of anything more severe than sprain or strain type injuries. The onus is on the applicant to demonstrate he should be removed from the MIG, and the applicant has still not met his onus.

19For these reasons, I find on the balance of probabilities that the applicant has not met his onus to prove he should be removed from the Minor Injury Guideline.

20As I have ruled that the applicant is being held to the MIG, it is unnecessary for me to do a reasonable and necessary analysis on the treatment plans in question.

Interest

21Interest 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

22The application is dismissed.

i. The applicant is being held to the MIG.

ii. As 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 question.

iii. No interest is payable.