Licence Appeal Tribunal File Number: 24-010761/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:
Ajaydeep Khehra
Applicant
and
Definity Insurance Company
Respondent
DECISION
ADJUDICATOR:
Sarah Guergis
APPEARANCES:
For the Applicant:
Daniella Cohen, Paralegal
For the Respondent:
Ainsley Shannon, Counsel
HEARD: In Writing
OVERVIEW
1Ajaydeep Khehra, the Applicant, was involved in an automobile accident on April 10, 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, Definity 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? Note: The parties agree the MIG limits have been exhausted.
ii. Is the Applicant entitled to $2,460.00 for a psychological assessment, proposed by A&B Medical Assessments in a treatment plan/OCF-18 (“plan”) submitted August 24, 2022, and denied September 7, 2022?
iii. Is the Applicant entitled to $2,486.00 for a chronic pain assessment, proposed by A&B Medical Assessments in a plan submitted June 13, 2023, and denied July 18, 2023?
iv. Is the Applicant entitled to interest on any overdue payment of benefits?
3The Applicant withdrew the issue of income replacement benefits from this application. This is reflected in the list of issues above.
RESULT
4I find that the Applicant is not removed from the MIG.
5As the Applicant remains within the MIG, an analysis of the reasonableness and necessity of the treatment plans in dispute is not required.
6As no treatment plans are payable, no interest is owing.
ANALYSIS
Minor Injury Guideline
7I find that the Applicant is not removed from the MIG.
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 the physical and psychological injuries sustained as a result of the collision remove him from the purview of the MIG. The Applicant further submits that their injuries include persistent neck, back, bilateral shoulders, upper and lower back, and knee pain, along with psychological symptoms such as anxiety, depression, sleep disturbances, and emotional distress.
11The Applicant relies on the following evidence to support his removal from the MIG on these grounds:
i. An acute concussion evaluation from Heads Up Clinicians dated April 23, 2022. However, this evaluation is challenging to read due to illegibility and there is no service provider information. Nor is there a diagnosis of a concussion. Nor did the Applicant submit that they should be removed from the MIG due to a concussion.
ii. Clinical notes and records dated July 11, 2024, where the Applicant attended Ray Lawson Medical Clinic and saw Dr. Omotunde Shittu. Dr. Shittu wrote, “continue physio, analgesia, safety netted, patient understands all instructions given, if not better to return to visit the closest emergency department.” The Applicant was prescribed an NSAID (anti-inflammatory).
iii. On August 9, 2025, the Applicant was seen by Dr. Satbir Singh from Huron Crossing Medical Centre. At this appointment, he reported difficulties with sleep, daytime fatigue, and continued intermittent headaches. As a result, he was referred to a sleep study at Kitchener Peak Sleep.
iv. Then, on April 28, 2026, Chiropractor Dr. Leanne Burgin-Ball from Health Medica, completed a Disability Certificate (OCF-3) for the Applicant. Dr. Burgin-Ball diagnosed the Applicant with neck pain, numbness on both hands, headache, low back pain, and a right sprain shoulder.
v. The Applicant then sought ongoing treatment at Health Medica and A&B Medical. He attended Health Medica from April to September 2022, where he received physical therapy, interferential current therapy (IFC), and laser treatments.
12The Respondent submits that the Applicant only attended a doctor for accident-related complaints on one occasion in the three years since the accident. Further, that he does not take medication, has not received treatment in three years and returned to his activities of daily living, including manual labour employment shortly after the accident. To the extent he suffered any injuries, they were soft tissue in nature and resolved quickly with very little intervention.
13The Respondent further submits that the Applicant led Dr. Singh to believe that his sleep issues and headaches were accident-related, which is not true. It submits that the day before the Dr. Singh assessment, the Applicant had been diagnosed with extremely severe sleep apnea which accounts for his sleep issues. Less than a month later, on October 7, 2025, he reported headaches recurrent for two years, well before the accident, and these headaches were noted to be a symptom of his sleep disorder.
14The Respondent opposes the Applicant’s removal from the MIG and relies on:
i. A June 27, 2022, s. 44 functional abilities evaluation report with Dr. Ikonomakis, chiropractor. This report concluded that the Applicant is independent in his personal care and had returned to driving. Dr. Ikonomakis noted several inconsistencies between formal testing, where the Applicant showed significant limitation, and informal observation, in which the Applicant demonstrated full functional abilities. Dr. Ikonomakis opined that the test results were therefore not reliable as informal function suggested a higher level of function than on formal testing.
ii. An October 31, 2022 s. 44 report by Dr. Platnick, GP, concluded that the Applicant’s injuries were minor within the meaning of the Schedule.
15I considered the parties’ submissions. As it is the Applicant’s onus to establish that their injuries fall outside the definition of the MIG, I find that they have not met their onus. The injuries reported by the Applicant include soft tissue injuries which fall within the definition of the MIG. While I acknowledge the Applicant experienced some sleep disturbances and headaches, I find this was the result of a diagnosis of sleep apnea. I find that I was not pointed to evidence which demonstrates these issues being related to the subject accident, as required by the Schedule.
16Therefore, I find on a balance of probabilities that the Applicant is not removed from the MIG.
17As the Applicant remains within the MIG, an analysis of the reasonableness and necessity of the treatment plans in dispute is not required.
Interest
18As no treatment plans are payable, no interest is owing.
ORDER
19I find that the Applicant is not removed from the MIG.
20As the Applicant remains within the MIG, an analysis of the reasonableness and necessity of the treatment plans in dispute is not required.
21As no treatment plans are payable, no interest is owing.
Released: March 3, 2026
Sarah Guergis
Adjudicator