Licence Appeal Tribunal File Number: 24-008219/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:
Gagandeep Singh
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Georgina Blanas
APPEARANCES:
For the Applicant:
Bianca Marinescu, Counsel
For the Respondent:
Kamil Podleszanski, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Gagandeep Singh, the applicant, was involved in an automobile accident on September 17, 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, Security National, 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 limit (“MIG”)?
ii. Is the applicant entitled to $3,958.70 for chiropractic services, proposed by New Flow Medical Clinic Inc. in a treatment plan/OCF-18 (“plan”) submitted December 15, 2022?
iii. Is the applicant entitled to $3,529.79 for chiropractic services, proposed by New Flow Medical Clinic Inc. in a plan submitted May 17, 2023?
iv. Is the applicant entitled to $3,227.03 for chiropractic services, proposed by New Flow Medical Clinic Inc. in a plan submitted August 31, 2023?
v. Is the applicant entitled to $2,486.00 for a psychological assessment, proposed by A & B Medical Assessments Inc. in a plan submitted May 1, 2023?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant remains in the MIG. As a result, it is not necessary for me to consider the treatment plans in dispute.
4As there are no benefits owed, there is no entitlement to interest.
5The application is dismissed.
ANALYSIS
Psychological Impairment
6I find that the applicant has not proved on a balance of probabilities that he suffers from a psychological injury that would remove him from the MIG.
7Section 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, confusion, abrasion, laceration or subluxation and includes any clinically associated sequalae to such an injury.”
8An insured maybe removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, under section 18(2), that they have a document 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.
9To date the remaining balance for the applicant’s medical and rehabilitation benefits is $72.19 remaining.
10The applicant submits that he sustained a psychological injury as a result of the accident. He relies primarily on the section 25 psychological assessment conducted on May 30-31, 2023, conducted by Ms. Mandeep Singh, Psychological Associated, which diagnosed Adjustment Disorder with Mixed Anxiety and Depressed Mood, Major Depressive Disorder, and Somatic Symptom Disorder. He also relies on the disputed OCF-18 dated May 1, 2023, which was submitted by A&B Medical Assessments Inc.
11The respondent submits that the applicant has not met his onus to prove his injuries are not predominantly minor and that there is no psychological impairment requiring treatment outside of the MIG. The respondent submits that all of his accident related injuries are soft tissues sprain/strain injuries, and his ongoing complaints are clinically associated sequelae of minor injuries. In addition to the section 44 insurer’s psychological examination report by Dr. Terra Seon, Psychologist dated April 13, 2023, and her addendum report dated August 30, 2023, the respondent also relies on the contemporaneous family medicine records, the OHIP summary, which it argues features no psychological treatment or referrals, and minimum medication history, and the section 44 physiatry examination report by Dr. Yon-Kyong Michael Ko dated January 30, 2023, which found no functional impairment independence in activities of daily living, and continued employment and concluded that the applicant’s injuries fall with the MIG.
12The respondent submits that Dr. Seon opined that the applicant did not meet DSM-5 criteria for any accident related psychological disorder. Dr. Seon recorded that the applicant denied significant anxiety, depression, post traumatic stress symptoms, avoidance behaviour, or functional impairment and concluded that any initial emotional response to the accident had resolved.
13I place less weight on the section 25 psychological assessment conducted by Ms. Mandeep Singh on May 30-31, 2023, relied upon by the applicant. The assessment was reported to be conducted virtually and did not note any of the applicant’s clinical notes and records to be reviewed, or assessed, relying largely on the applicant’s self reporting. I place more weight on Dr. Seon’s insurer examination report which was conducted earlier, included an in person interview and psychometric testing and reviewed the available medical information. Dr. Seon opined that there were no indications of psychological impairment or need for psychological treatment.
14I also note that the contemporaneous medical evidence closest in time to the accident, namely the October 12, 2022, All Med Health visit did not support the existence of a psychological impairment. The applicant did not attend hospital following the accident. At the October 12, 2022, visit, the applicant was seen by a family medicine physician at All Med Health(whose name is not identified in the record) documenting normal range of motion, a normal spine and that the applicant appeared well. Further the OHIP summary and family medicine records from the date of the accident through May 24, 2023, which included Dr. Mark Churchman, Family Physician, Dr. Jabril Dorar, Family Physician, All Med Health, and Barrie Family Medicine Clinic, show limited physician visits and contain no records documenting psychological complaints and no referrals to psychology or psychiatry, no psychotropic medication use, and no psychological treatment. These records do not corroborate the psychological diagnosis in the section 25 assessment.
15I also considered the applicant’s pharmacological history. The medical records show that the applicant was advised to use over the counter Tylenol following the accident. The applicant later filled a single prescription of an NSAID (Ketorolac/Toradol on August 28, 2024, approximately two years after the accident). There is no evidence of psychotropic medication use, including antidepressants, or sleep medication, and no prescriptions form a psychiatrist or psychologist. There is no consistent evidence of escalating or sustained medication use for a psychological diagnosis. There is minimal medication history and as a result I find it does not support a psychological impairment arising from the accident.
16For these reasons, I find the applicant has not met his burden of proving, on the balance of probabilities that he sustained a psychological injury arising form the accident that would remove him from the MIG.
17As the applicant is found to be in the MIG, there is no need for me to analyse the treatment plans and assessment that are in dispute.
Interest
18As there are no benefits owing, the applicant is not entitled to interest of any overdue benefits pursuant to s. 51 of the Schedule.
ORDER
19The applicant has been found to be in the MIG and is not entitled to any of the plans or assessments in dispute:
i. No interest is payable.
ii. The application is dismissed.
Released: March 10, 2026
Georgina Blanas
Adjudicator