Citation and Parties
Licence Appeal Tribunal File Number: 24-006407/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:
Michael Choi
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Bruce Stanton
APPEARANCES:
For the Applicant:
Maria Papadopoulos, Paralegal
For the Respondent:
Anju Sharma, Counsel
HEARD:
In Writing
OVERVIEW
1Michael Choi, the applicant, was involved in an automobile accident on August 1, 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 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. Is the applicant entitled to the treatment plans (OCF-18s) proposed by Humber Civic Care Centre, as follows:
a. $3,024.62 for chiropractic services dated January 12, 2023;
b. $2,629.85 for chiropractic services dated April 25, 2023; and
c. $2,409.46 for chiropractic services dated September 26, 2023.
ii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The application is granted.
4The disputed treatment plans are reasonable and necessary. The applicant is entitled to payment of them, including interest on any overdue payments.
PROCEDURAL ISSUES
Exclusion of the clinical notes and records (“CNRs”) of Dr. Pinnaduwage into evidence
5In its submissions, the respondent seeks the exclusion of the CNRs of Dr. Pinnaduwage, the applicant’s family physician, between August 1, 2019 and December 6, 2023, claiming that they were not previously disclosed. Alternatively, the respondent submits, given they were disclosed in an untimely manner, and it had no opportunity to review or respond to them, they should be assigned little or no evidentiary weight.
6I note that the respondent’s written submission and evidence were received on June 6, 2025. The applicant had an opportunity to file a reply-submission by June 13, 2025, however; no reply-submission was received by that date. The applicant’s position on the respondent’s request is therefore unknown.
7I deny the request of the respondent to exclude the subject CNRs.
8It is difficult to understand why the respondent is alleging the non-disclosure of these records only upon receipt of the applicant’s submissions of May 21, 2025.
9A review of the documents to this matter reveals that the applicant appended a list of the documents he intended to refer to in this dispute in Schedule A to the application to the Tribunal. Schedule A includes the subject CNRs as items 5, 6 and 7 as follows:
Clinical Notes and Records of Dr. Pinnaduwage dated August 1, 2019 to October 27, 2022;
Clinical Notes and Records of Dr. Pinnaduwage dated October 28, 2022 to August 9, 2023;
Clinical Notes and Records of Dr. Pinnaduwage dated August 10, 2023 to December 6, 2023;
10The applicant included “Schedule A attached to the LAT Application” in his Case Conference Summary (“CCS”) filed for the case conference in this matter that occurred on September 25, 2025, under the title of Documents & Things; List of documents and things in the party’s possession which the party intends to rely on at the hearing. The applicant notes in his CCS that the documents referred to were disclosed to the respondent on August 13, 2024.
11The parties participated in a case conference on September 25, 2025. The Case Conference Report and Order (“CCRO”) arising from it reveals at paragraph 9, that “… each party confirmed that they were not requesting any further documents from the other party.”
12I find the respondent should have been aware of the existence of the subject CNRs because they were listed in Schedule A to the LAT application and referred to in the applicant’s CCS. The applicant declared in his CCS that the documents in Schedule A were disclosed on August 13, 2024. If, by the date of the case conference, the respondent was not then in receipt of them, it could have used its participation in the case conference to request that they be disclosed prior to the hearing. It appears, from the CCRO, that no such request was made.
13Accordingly, I deny the respondent’s request to exclude the above noted CNRs because it appears the respondent was informed of their existence (and the intention of the applicant to refer to them in the hearing) approximately four months prior to the case conference and if, at the case conference it was not in receipt of them, it could have used that occasion to request they be disclosed or seek a production order from the Tribunal that they be disclosed.
ANALYSIS
14I find the applicant has demonstrated that the disputed treatment plans are reasonable and necessary.
15To receive payment for a treatment and assessment plan under s. 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 the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
16The applicant submits the three treatment plans are reasonable and necessary as a consequence of his accident injuries. The three treatment plans are generally similar in their goals and proposed treatments. Their goals include pain reduction, increased range of motion, increase in strength, returning to the activities of daily living and to improve muscular strength and endurance.
17The applicant first attended his family physician, Dr. Lakmini Pinnaduwage, on October 27, 2022, approximately three months post-accident. He attended one additional appointment with her in November 2022, then five appointments throughout 2023. Dr. Pinnaduwage’s CNRs across all seven appointments reveal persistent pain complaints associated with the accident; including low back pain, left shoulder pain, and neck pain.
18During the first six appointments from October 2022 to July 27, 2023 (nearly one year post-accident), Dr. Pinnaduwage recommended Tylenol for pain relief and that the applicant continue with physiotherapy.
19Due to ongoing and worsening back pain, Dr. Pinnaduwage referred the applicant for an MRI on July 27, 2023. The MRI was conducted on October 24, 2023. It revealed mild broad-based posterior disc protrusion with annular tear, ligamentum flavum hypertrophy at L-4 to L-5, no significant spinal stenosis. At L-5 to S1, a mild, broad-based posterior protrusion.
20The applicant arranged for and underwent three s. 25 assessments:
Functional abilities evaluation by Dr. Mario Curcio, chiropractor, July 21, 2023;
Neurology assessment by Dr. Viachislav Prigozhikh, neurologist, October 10, 2023; and
Chronic pain assessment by Dr. Khal Efala, October 21, 2023.
21It is notable that each of the s. 25 assessors confirm the applicant’s pain symptoms were persisting into the 11 to 14 months since the accident, each generally diagnosed him with chronic pain and injuries to his cervical and lumbar spine, and each recommended the continuation of physical therapy. I note that the timeline for the assessments is contemporaneous with the period of treatment being sought in the disputed treatment plans – January to September 2023.
22The assessors’ reports are also consistent with the CNRs of Dr. Pinnaduwage in respect to reports of ongoing pain and recommendations to continue physiotherapy.
23The applicant submits that the chiropractic treatment should be approved because of his medical team’s opinions and consistent recommendations for ongoing physiotherapy in conjunction with the goals of the OCF-18s. He submits that his ongoing pain is also demonstrated by the objective MRI results. He seeks approval of the three disputed treatment plans and interest on the unpaid amounts.
24The respondent submits that the disputed treatment plans are not reasonable and necessary for the following reasons:
The applicant’s report of the 3-week delay in the onset of back pain following the accident undermines the connection between his current complaints and the accident. It refers me to a November 1, 2022 X-ray that reveals multi-level degenerative disc disease which it contends is suggestive of pre-existing injuries unrelated to the accident;
The applicant’s cancellation of an MRI appointment scheduled for February 21, 2024 is indicative of a lack of urgency for someone who claims to be is such distress. It submits his lack of follow-through calls into question the credibility and severity of his injuries;
Dr. Pinnaduwage made no recommendations for chiropractic treatment and therefore such care was not deemed medically necessary;
The applicant has not advanced any evidence demonstrating that the treatments he attended for a period post-accident was beneficial or resulted in any measurable improvement;
Four s. 44 insurer examination (“IE”) assessments support its contention that the treatment plans are not reasonable and necessary:
i. An IE conducted by Dr. I Manhas, GP family medicine, February 8, 2023, assessed the applicant’s injuries as minor and made no recommendations for chiropractic care;
ii. The IE conducted by Ms. D. Li, occupational therapist, August 31, 2023, reveals findings and observations that illustrate an absence of impairment suffered by the applicant;
iii. The IE of Dr. Ahmad Belfon, GP family medicine, on October 17, 2024, found the applicant provided conflicting statements and recollections of the events following the accident. Dr. Belfon also reported that the applicant denied pre-accident injuries to or issues with, his neck, back and joints. The respondent submits these contradictions call the applicant’s credibility into question and that he is an unreliable historian;
iv. The IE report of Dr. Garry Moddel, neurologist, dated October 17, 2024, concluded the applicant’s shoulder and back issues were muscular in nature and found the treatment plan (issue 2(1)(c)) not reasonable and necessary; and
- The s. 25 report of Dr. Prigozhikh specifically advised against passive treatment modalities, which would include chiropractic care. The respondent notes that Dr. Prigozhikh advised that active interventions that are movement based or that address psychosocial contributors to pain are preferrable to passive interventions, home or supervised exercise therapy. In summary, the respondent submits Dr. Prigozhikh’s recommendations are contrary to the applicant’s claim for chiropractic care.
25I interpret these submissions to mean that the respondent is unconvinced that the applicant’s pain complaints are as severe as they are purported to be, it questions whether the complaints are even caused by the accident, and it does not believe the claimed treatments (chiropractic services) are necessary or that the applicant has demonstrated they will achieve the desired outcome.
26I find on a balance of probabilities that the treatment plans are reasonable and necessary.
27All three OCF-18s contemplate the same treatments (therapy on multiple body sites, functional exercise, manipulation of the spine, and personal exercise program). They have common goals of reducing pain, improving muscular strength, and returning to the activities of daily living.
28Although the applicant has not specifically engaged the question of how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable, the Additional Comments section of the OCF-18s that the applicant referred me to details the treatments that are intended to achieve the plans’ goals. They include chiropractic manipulation, muscle release therapy, physiotherapy modalities, and functional exercises. The costs listed in OCF-18s appear to be consistent with the Professional Services Guideline – Superintendent’s Guideline No. 3/14 September 2014 (“Guideline”). For example, chiropractor services are rated at the Guideline rate of $112.81 per hour, massage therapists at the Guideline rate of $58.19 per hour. It appears that the costs of achieving the goals are reasonable.
29I am persuaded by the applicant’s submissions, and the recommendations contained in his supporting CNRs and s. 25 reports, that he should pursue physical therapy to address his persistent pain. I acknowledge that the applicant’s s. 25 assessors were not in exact alignment on the specific types of therapies recommended, but on balance, each recommended physical therapy that would address his ongoing, and what ultimately was diagnosed as, chronic pain. Some recommended rehabilitation treatments of both conventional passive and active physical modalities. I note that both modalities are contained in the proposed treatment plans.
30I am not persuaded by the respondent’s submissions regarding the applicant’s inabilities as a historian or contradictions in his recollections of events following the accident because more than two years had passed at the time of the assessments (Dr. Belfon and Dr. Moddel) that reported these observations.
31I am also not persuaded by the respondent’s suggestion that the applicant’s pain complaints were not accident-related (and may have been due to previous injuries) because the applicant reported that the injuries he sustained in a 2019 accident were minor and had completely resolved, and the back injury he sustained while at a university co-op placement had also completely resolved. Although the date of the injury at co-op placement was not provided, it appears that both events pre-date the accident by more than three years.
32Moreover, there is no evidence before me to suggest the applicant was experiencing back and shoulder pain before the accident. The X-ray referred to me by the respondent of November 1, 2022, reports “no relevant recent study” to compare against which suggests there were no recent X-rays of his lumbar spine and SI joints. The applicant’s claim there were no pre-accident injuries is supported in Dr. Pinnaduwage’s CNRs, which associate his current pain complaints with the accident, and in Dr. Prigozhikh’s s. 25 report, in which the applicant claims to have been in good health prior to the accident.
33I give more weight to the applicant’s s. 25 reports than the respondent’s IE reports on the subject of the severity of the applicant’s injuries because the s. 25 assessors’ reports were consistent with the applicant’s physician’s observations and findings. By contrast, Dr. Li’s observations that, in August 2023, there is an absence of impairment in the applicant, runs contrary to the reports of Dr. Pinnaduwage, Dr. Curcio, Dr. Prigozhikh, and Dr. Efala generally around the same time.
34Accordingly, and for reasons discussed above, I find on a balance of probabilities that the disputed treatment plans are reasonable and necessary.
Interest
35Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found the disputed treatment plans are reasonable and necessary, they are payable. Therefore, the applicant is entitled to interest on the overdue payment of these benefits pursuant to s. 51.
ORDER
36I order the following:
i. The applicant is entitled to the treatment plan proposed by Humber Civic Care Centre for chiropractic services in the amount of $3,024.62;
ii. The applicant is entitled to the treatment plan proposed by Humber Civic Care Centre for chiropractic services in the amount of $2,629.85;
iii. The applicant is entitled to the treatment plan proposed by Humber Civic Care Centre for chiropractic services in the amount of $2,409.46; and
iv. The applicant is entitled to interest on the overdue payment of benefits in accordance with s. 51 of the Schedule.
Released: January 12, 2026
Bruce Stanton
Adjudicator
