Licence Appeal Tribunal File Number: 24-002536/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:

Pierre Manshury

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

ADJUDICATOR:

Sofia Ahmad

APPEARANCES:

For the Applicant:

Pierre Manshury, Applicant Dayana Soto Santana, Paralegal

For the Respondent:

Robbie Brar, Counsel

HEARD: In Writing

By way of written Submission

OVERVIEW

1Pierre Manshury, the applicant, was involved in an automobile accident on July 13, 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, BelairDirect 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 as therefore subject to treatment within the $3,500.00 Minor Injury (“MIG”) limit? The parties agree the MIG limits have been exhausted.

ii. Is the applicant entitled to $2,241.00 for chiropractic, acupuncture and massage services, proposed by 101 Physio in an OCF-18/treatment plan (“treatment plan”) dated February 16, 2024;

iii. Is the applicant entitled to $2,204.69 for chiropractic, acupuncture and massage services, proposed by 101 Physio in a treatment plan dated November 16, 2023;

iv. Is the applicant entitled to $3,848.98 for chiropractic, acupuncture and massage services, proposed by 101 Physio in a treatment plan dated January 4, 2024;

v. Is the applicant entitled to $2,361.02 for chiropractic, acupuncture and massage services, proposed by 101 Physio in a treatment plan dated July 26, 2023;

vi. Is the applicant entitled to $2,460.00 for a psychological assessment plan dated August 21, 2023;

vii. Is the applicant entitled to $2,460.00 for an orthopedic assessment plan dated October 13, 2023; and

viii. Is the applicant entitled to interest on any overdue payments?

RESULT

3Based on the evidence before me, I find:

i. The applicant has not demonstrated that his accident-related impairments warrant removal from the MIG.

ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.

iii. Interest is not payable.

4The application is dismissed.

ANALYSIS

Applicability of the MIG

5Section 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 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 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 impairment may warrant removal from the MIG. The applicant bears the onus of proving that his injuries should not be subject to the MIG limits.

7The applicant submits that the following factors remove him from the MIG:

i. chronic pain; and

ii. psychological impairment as a result of the accident.

8The respondent submits that the applicant has not met his burden to prove that he suffers from more than minor injuries, that he has chronic pain or psychological impairment, as a result of the accident.

Does the applicant have chronic pain as a result of the accident?

9The applicant does not suffer from chronic pain that would warrant removal from the MIG.

10The applicant submits that he did not seek immediate medical treatment post accident. Three days later he visited the Scarborough General Hospital where he was administered an injection and prescribed pain medication by the emergency room physician.

11The applicant further submits that on July 19, 2025, he visited his family physician, Dr. Ibrahim at Elllesmere Family Health, which is five days after the accident. His primary complaints were of neck and back pain. The applicant was prescribed Vimovo (naproxen, a nonsteroidal anti-inflammatory with esomeprazole, a proton pump inhibitor for stomach protection) for pain and inflammation and baclofen (muscle relaxant) for muscle spasms.

12The respondent submits that the applicant reported to the IE Assessor(s) November 23, 2023, that he did not notice any immediate pain after the collision. The applicant further mentions to the IE Assessor, Dr. Marc Mandel, Psychologist that the two medications prescribed, he was no longer taking at the time of the psychological assessment.

13The respondent further submits that the applicant was referred to 101 Physiotherapy on the recommendation of a friend.

14The applicant sought follow-up care at Ellesmere Family Health on several occasions after the initial visit of July 19, 2025. There is mention of neck, shoulder upper and lower back pain, back spasms and lower extremity numbness.

15I find that the medical evidence pointed to by the applicant does not support a finding that the applicant has accident-related chronic pain, or that he has a functional impairment related to his chronic pain. There is not sufficient medical evidence submitted by the applicant to suggest chronic pain. The medical documentation of behalf of the applicant is not consistent. The applicant continued to care for his son and he returned to work full time. I do not find the applicant’s arguments to be persuasive since not consistent evidence of chronic pain a functional impairment.

16Further, I find that the respondent’s evidence does not indicate that the applicant has chronic pain with a functional impairment. The respondent relies on the report of Dr. Fathi Abuzgaya, the IE Orthopedic Assessor dated June 12, 2024, which diagnosed the applicant with cervical sprain, thoracic sprain and lumbosacral sprain. Dr. Fathi Abuzgaya further notes that these injuries are predominantly minor as a result of the accident. The assessor opined that the applicant had reached maximum medical recovery as a result of the injuries sustained in the accident and that there is no objective evidence of residual musculoskeletal impairment. He further notes that the applicant demonstrated near normal range of motion of his cervical and lumbar spine. I find the respondent’s evidence to be persuasive because the objective findings support this argument, and I agree with the respondent.

17The IE report of Dr. Ahmad Belfon, family physician, dated March 20, 2024, states the applicant sustained “uncomplicated soft tissue injuries” as a result of the accident. He further opined that further facility-based treatments are not likely to provide benefit beyond that of a home-stretching and exercise program.

18I agree with the respondent that these injuries fall under the directives of the MIG because the objective findings do not support the applicant being removed from the MIG. I find on a balance of probabilities that the applicant has not demonstrated that he suffers from chronic pain with a functional impairment that warrants removal from the MIG.

Does the applicant have a psychological impairment as a result of the accident?

19The applicant does not suffer from a psychological impairment as a result of the accident that would warrant removal from the MIG.

20The applicant relies on the findings of Dr. Konstantinos Papazoglou, PhD, set out in the psychologist report dated September 27, 2023. I do not find the report of the report of Dr. Papazoglou to be persuasive as the conduct of the applicant is not consistent with the report itself.

21The applicant submits the report of Dr. Konstantinos Papazoglou. He describes the applicant as having emotional distress, an adjustment disorder with mixed anxiety and depressed mood and sleeping difficulties as a result of the accident. He further recommends counseling, cognitive behavioural therapy, mindfulness-based strategies, clinical hypnosis and psycho-educational technique training. The applicant does not seek any of these treatments which suggests that he does not have a psychological impairment.

22The respondent submits the IE Psychological report of Dr. Marc Mandel. He states that the applicant returned to work following the accident. The applicant worked regular hours and continued his normal duties. At the time of the assessment, the applicant was working full-time. He received no assistance in his housekeeping duties. The applicant was caring for his son. Dr. Marc Mandel concludes that there was a lack of consistent objective evidence that would suggest a substantial psychological impairment or disability as a direct result of the accident.

23The applicant further submits the notes of his family physician at Ellesmere Family Health dated October 12, 2023, several months after the subject accident. The symptoms of fatigue, lethargy, decreased appetite, mental anguish and sleep interruptions are described. There is no mention of any psychological issues at the initial visit at the Scarborough General Hospital, three days post accident and the several following visits with his family physician. Only several months after the accident are psychological symptoms mentioned This suggests that these symptoms may not be related to the accident.

24The applicant does not attend seek psychological treatment, even though Dr. Konstantinos Papazoglou’s report suggested counseling, cognitive behavioural therapy, mindfulness-based strategies, clinical hypnosis and psycho-educational technique training. Furthermore, the applicant is not taking any medication for anxiety, depression or insomnia. The lack of treatment and medication suggests that the applicant does not have psychological impairments as a result of the accident. There is not sufficient and consistent medical documentation submitted on behalf of the applicant to suggest a psychological impairment as a result of the accident.

25After carefully examining the evidence from both sides, I find on a balance of probabilities that the applicant does not have a psychological impairment as a result of the accident to warrant removal from the MIG.

26As the applicant is in the MIG, it is not necessary to consider whether the treatment plans in dispute are reasonable and necessary.

Interest

27Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no benefits payable, therefore no interest is payable under s. 51.

ORDER

28I order as follows:

i. The applicant has not demonstrated that his accident-related impairments warrant removal from the MIG.

ii. As the applicant is in the MIG, it is not necessary to consider if the six treatment plans in dispute are reasonable nor necessary.

iii. Interest is not payable.

29The application is dismissed.