Citation: McLorraine Dibi v. TD General Insurance Company, 2026 ONLAT 24-015481/AABS

Licence Appeal Tribunal File Number: 24-015481/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:

Bossoma McLorraine Dibi

Applicant

And

TD General Insurance Company

Respondent

DECISION

ADJUDICATOR:

Rebecca Hines

APPEARANCES:

For the Applicant:

Michael Ferrante, Paralegal

For the Respondent:

Tiffany Lan, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Bossoma McLorraine Dibi, the applicant, was involved in an automobile accident on June 6, 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, TD 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:

1. 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 not been exhausted and that $2,400.00 has been paid to date.

2. Is the applicant entitled to the treatment plans (“OCF-18s”) for physiotherapy services, proposed by Physiomed Hurontario, as follows:

(a) $2,916.00 in a plan dated June 12, 2024; and

(b) $1,098.00 in a plan dated September 23, 2024?

3. Is the applicant entitled to $3,902.04 for chiropractic services, proposed by Health One Markham Inc. in a OCF-18 dated July 22, 2024?

4. Is the applicant entitled to $2,200.00 for a psychological assessment proposed by Canadian Active Rehabilitation Centre in a OCF-18 dated December 27, 2023?

5. Is the applicant entitled to $2,460.00 for a chronic pain assessment proposed by Health One Markham Inc. in a OCF-18 dated August 23, 2024?

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

3The applicant withdrew a OCF-18 for an occupational therapy assessment and her entitlement to an award as issues in dispute. Consequently, these issues will not be addressed in this decision.

RESULT

4After reviewing both parties’ submissions and all of the evidence, I find that the applicant sustained a minor injury and is subject to treatment within the MIG. She is not entitled to the OCF-18s in dispute or interest.

ANALYSIS

The applicant sustained a minor injury which is treatable in the MIG.

5Section 18(1) of the Schedule sets out that medical and rehabilitation benefits are limited to $3,500.00 if the insured person sustains an impairment that is predominantly minor in accordance with the MIG. 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.”

6An insured person may successfully be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, pursuant to s. 18(2), that they have a documented pre-existing injury or condition combined with compelling medical evidence stating that the condition prevents recovery if they are kept within the MIG. The Tribunal has also determined that chronic pain with functional impairment or a diagnosed psychological condition may justify removal from the MIG. The applicant bears the onus of proving on a balance of probabilities that her accident-related impairments fall outside of the MIG.

6The applicant argues that she should be removed from the MIG because she has been diagnosed with chronic pain. She also submits that she sustained a psychological impairment which warrants MIG removal. In support of her position, she relies on the clinical notes and records (“CNRs”) of Dr. Abeysinghe, family doctor, a disability certificate (“OCF-3”) prepared by Dr. Pavacic, chiropractor dated June 20, 2023, and chronic pain report of Dr. Getahun, orthopaedic surgeon dated April 9, 2025.

7The respondent argues that the applicant’s accident-related impairments fall within the definition of a minor injury. It submits that the applicant has not met her onus in proving that she should be removed from the MIG as a result of chronic pain or a psychological impairment. It relies on the insurer examination (“IE”) reports of Dr. Kassam, medical doctor and Dr. Lotfalizadeh, psychologist dated July 4, 2024, who determined that the applicant sustained a minor injury from a physical and psychological perspective.

Chronic Pain

8I find that the applicant has not proven that she suffers from chronic pain or chronic pain syndrome as a result of the accident for the following reasons.

9First, I do not find the CNRs of the applicant’s family doctor persuasive because they support that she visited her family doctor on June 7, 2023 (the day following the accident) where she reported arm, leg and back pain. I find this single CNR does not establish that the applicant suffers from chronic pain or chronic pain syndrome as a result of the accident. In fact, I find this note supports that she sustained a minor injury. Further, there is no evidence of any functional impairments in this CNR, which is required to be removed from the MIG due to chronic pain. In the same vein, the OHIP summary does not assist in supporting that the applicant saw any other practitioners for any accident-related complaints and if this information was there, it was not obvious to this reader.

10Second, I do not find the report of Dr. Getahun persuasive because I find the conclusions rendered by the doctor are based on the applicant’s self-reports about pain and functional limitations as opposed to any objective medical evidence. Dr. Getahun opines that the applicant meets more than three criteria to satisfy a diagnosis of chronic pain syndrome set out in the AMA Guides. For example, he concludes that she has excessive dependence on family members because she continues to rely on her sister for household chores; she has physical deconditioning due to disuse and/or fear, avoidance of physical activity to pain because she had restrictive range of motion of the lumbar spine based on his physical examination; she has withdrawn from work, family, recreational and social contact because she had not returned to her pre-accident employment; she has failed to restore pre-accident function; and has developed psychosocial sequalae.

11I do not find Dr. Getahun’s opinion or diagnosis to be supported by the medical record before me and as a result I give this report little weight. In addition, Dr. Getahun’s conclusions about the applicant’s inability to return to work are inconsistent with her reports to the IE assessors that she had returned to work as a brand ambassador at the golf club which involved standing, walking, carrying and lifting. She also reported independence with self-care and household activities. Further, I do draw an adverse inference from the applicant’s failure to produce her employment file as per the Tribunal’s case conference report and order. I find it likely that this evidence would not assist her position that she has ongoing functional limitations because of any accident-related impairments.

12Third, I give little weight to the various injuries/sequalae listed on the OCF-3 and OCF-18 forms because they are not supported by the medical record before me.

13In contrast, the respondent relies on the IE reports of Dr. Kassam who conducted a physical examination which was normal and concluded that the applicant sustained soft tissue injuries which can be treated in the MIG. I prefer Dr. Kassam’s opinion because it is consistent with the medical record before me.

14For the above-noted reasons, I find the applicant has not met her onus in proving on a balance of probabilities that she suffers from chronic pain or chronic pain syndrome as a result of the accident which removes her from the MIG.

Psychological Impairment

15I find that the evidence does not support that the applicant suffers from a psychological impairment as a result of the accident for the following reasons.

16First, the applicant relies on the above noted report of Dr. Getahun who recommended that she undergo a psychological assessment. I find the fact that Dr. Getahun recommended a psychological assessment does not establish that she sustained a psychological impairment as a result of the accident which would remove her from the MIG. Moreover, as noted above, I have given this report little weight because Dr. Getahun does not link any of his conclusions or recommendations to objective medical evidence.

17Second, the applicant made no psychological complaints to her family doctor and the OHIP summary is unhelpful as far as documenting any psychological impairments or treatment. As noted above, I find the sequalae/injuries listed on the OCF-3 and OCF-18 insufficient evidence as far proving that the applicant an accident-related psychological impairment.

18Third, the respondent relies on the IE report of Dr. Lotfalizadeh who completed a clinical interview, reviewed medical documents and administered psychometric tests and concluded that there was no diagnoseable psychological impairment. Important to the doctor’s opinion was that there were validity issues with the psychometric tests which meant the results could not be accurately interpreted. In the absence of sufficient evidence to refute this opinion, I conclude that the applicant has not met her onus in proving that she sustained a psychological impairment as a result of the accident which removes her from the MIG.

OCF-18s in Dispute

19The applicant is not entitled to the OCF-18s in dispute because they all seek treatment outside of the MIG and as of the date of the case conference only $1,100 remained in the MIG limit. This does not preclude the applicant from seeking treatment within the MIG limit.

Interest

20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. The applicant is not entitled to interest as I have not determined that any benefits are overdue.

ORDER

21For the above-noted reasons, I order as follows:

1. The applicant sustained a minor injury and is subject to treatment within the MIG limit. She is not entitled to the OCF-18s in dispute or interest.

2. The application is dismissed.