Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 24-010368/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:
Jeenaraj Gulasingham
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR: Ulana Pahuta
APPEARANCES:
For the Applicant: Clayton Allen, Counsel
For the Respondent: Jessica Telfer, Counsel
HEARD: By way of written submissions
OVERVIEW
1Jeenaraj Gulasingham, the applicant, was involved in an automobile accident on March 8, 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 Insurance Company of Canada, 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. Is the applicant entitled to $3,149.75 for chiropractic services, proposed by Solaleh Pourbagher of Caspian Rehab in a treatment plan/OCF-18 dated July 8, 2024?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
i. the applicant is partially entitled to the OCF-18 dated July 8, 2024, plus interest; and
ii. The respondent is not liable to pay an award.
PROCEDURAL ISSUES
4The respondent filed a Notice of Motion on August 19, 2025, requesting that updated clinical notes and records (“CNRs”) of the applicant’s family doctor, attached to the applicant’s reply submissions, be excluded as evidence at this hearing. The Tribunal set this motion to be heard at this written hearing.
5The respondent’s request to exclude the family doctor’s updated CNRs is denied.
6The respondent submits that the applicant failed to comply with the Case Conference Report and Order (“CCRO”) provisions on document exchange. It argues that the parties were to exchange within 60 days of the case conference (February 3, 2025), any documents not previously disclosed which they intended to rely upon at the hearing. However, the applicant did not provide the updated CNRs until August 15, 2025, the date of his reply submissions. In its Notice of Motion, the respondent requested either an order excluding the updated CNRs or permission to serve sur-reply submissions. However, in its reply motion submissions, the respondent now claimed that a sur-reply would not properly cure the prejudice created by the late-served evidence, since the respondent would have sought an additional addendum report to address the medical records, and the respondent is now simply seeking to have the records excluded.
7The applicant submits that he requested the updated CNRs of his family doctor on January 10, 2025, which would have been within the production deadline, and followed up on his request on April 14, 2025 and July 8, 2025. He submits that he received the CNRs on August 14, 2025 and served them forthwith on the respondent the following day. The applicant argues that it is outside of his control whether a treating physician will promptly respond to a production request. He submits that the updated CNRs are highly relevant to the issue in dispute and that a sur-reply would mitigate any prejudice to the respondent.
8Rule 9.3 of the Licence Appeal Tribunal Rules, 2023, states that if a party fails to comply with any Rule or Order with respect to disclosure, that party may not rely on the document as evidence, without the permission of the Tribunal. When making its determination, the Tribunal may consider any relevant factor, including:
i. The reasons for non-compliance;
ii. Whether a party will be prejudiced by the admission or exclusion of the evidence and the extent to which that prejudice can be mitigated by any other order;
iii. The extent to which the substance of the information or testimony lies within the knowledge of the other party;
iv. Whether the other party opposes the testimony; and
v. The relevance of the document, thing, or testimony to an issue in dispute in the proceeding.
9While I agree with the respondent that the applicant did not meet the document exchange deadline in the CCRO, I exercise my discretion under Rule 9.4 and allow the CNRs to be entered into evidence. The applicant has provided evidence that the first request to the family doctor was made well-within the document exchange deadline. Two additional follow-up attempts were made to obtain the updated CNRs, and they were provided to the respondent upon receipt. Pursuant to s. 15(1) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22, the Tribunal may admit any document relevant to the subject matter of the proceeding. I find the family doctor’s records to be highly relevant to the issues in dispute. The applicant further consented to the respondent’s request to provide sur-reply submissions, although the respondent appears to have withdrawn that request.
10While I agree with the respondent that it has suffered prejudice by the late production of evidence, the applicant would also suffer significant prejudice if the highly relevant evidence was excluded for the purposes of this hearing, as the evidentiary onus rests with him to demonstrate entitlement to the benefits in dispute. Further, the consumer protection mandate of the Schedule, is best served by hearing all submissions from applicants whenever reasonable and whenever possible. Accordingly, the respondent’s request to exclude the updated CNRs is denied.
ANALYSIS
OCF-18 in the amount of $3,149.75 for chiropractic services
11I find that the applicant is partially entitled to the OCF-18 dated July 8, 2024.
12To receive payment for a treatment plan under sections 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify that the goals of treatment are reasonable, how the goals would be met to a reasonable degree and that the overall cost of achieving them are reasonable.
13The applicant submits that since the accident, he has suffered from chronic back, neck and knee pain, necessitating the ongoing chiropractic treatment. He relies on the CNRs of his family physician Dr. Jayashankar to establish that since the accident, the applicant has consistently reported accident-related pain. Dr. Jayashankar noted the applicant’s chronic pain over the years, and continued to recommend ongoing massage and physiotherapy.
14The respondent submits that the treatment plan in dispute is not reasonable and necessary. It relies on the s. 44 General Practitioner assessment report of Dr. Pravesh Jugnundan dated August 29, 2024 and the addendum dated December 27, 2024. Dr. Jugnundan found that the applicant had sustained soft tissue injuries as a result of the accident, and that given that it was now two and a half years post-accident, the applicant has reached maximum medical improvement and has received appropriate treatment. Dr. Jugnundan found that a self-directed exercise program would be appropriate. The respondent further submits that the applicant’s family physician Dr. Jayashankar has never recommended chiropractic treatment, which is the treatment sought in the OCF-18 in dispute.
15I find that the applicant is partially entitled to the treatment plan. The OCF-18 proposes ten sessions each of chiropractic treatment, massage and acupuncture sessions. The treatment goals included pain reduction, increase in strength and increased range of motion.
16I agree with the applicant that the CNRs of Dr. Jayashankar establish the applicant’s ongoing chronic pain post-accident. The applicant’s family doctor noted throughout 2022-2024 that the applicant continued to report pain in his low back, knees and neck. The applicant attended rehabilitative treatment from March 2022 to March 2023 until treatment was denied by the respondent. The applicant reported to Dr. Jayashankar that he gets relief from physiotherapy and medication.
17While I agree with the applicant that Dr. Jayashankar recommended continued massage and physiotherapy throughout 2022-2024, I further agree with the respondent that the applicant has not established that his family physician also recommended chiropractic treatment. The applicant submits that Dr. Jayashankar has recommended a wide range of physical therapy, and that it cannot be inferred that he did not recommend chiropractic treatment, simply because it was not explicitly listed.
18From my review of Dr. Jayashankar’s CNRs, he consistently recommended physiotherapy and massage in the years post accident. However, I do not agree with the applicant that it can be inferred that Dr. Jayashankar also recommended chiropractic treatment. Rather, in a number of CNR entries, other rehabilitative measures were specifically recommended. On October 29, 2024 and January 9, 2025, in addition to recommending ongoing massage and physiotherapy, Dr. Jayashankar also recommended acupuncture, exercise, stretching, aquafit and warm water exercises. However, the applicant does not direct me to any CNR entry where his family doctor, or any treating physician, recommended chiropractic treatment.
19Accordingly, I find that the applicant has not established that the chiropractic treatment proposed in the OCF-18 dated July 8, 2024 is reasonable and necessary. However, I find that the applicant has met his onus to prove, on a balance of probabilities, that the 10 sessions of massage and acupuncture treatment are reasonable and necessary, together with the $200.00 form completion fee.
Interest
20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
Award
21Under s. 10 of Reg. 664, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. The applicant did not provide any specific submissions as to why an award is warranted in this case. Accordingly, I find that the applicant has not established grounds for an award.
ORDER
22I find that:
i. the applicant is partially entitled to the OCF-18 dated July 8, 2024, plus interest; and
ii. The respondent is not liable to pay an award.
Released: March 9, 2026
Ulana Pahuta Adjudicator