Licence Appeal Tribunal File Number: 24-007725/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:
Anthony Broomfield
Applicant
and
Belair Insurance Company Inc.
Respondent
DECISION
ADJUDICATOR: Jeff Chatterton
APPEARANCES:
For the Applicant: Bianca Marinescu, Paralegal
For the Respondent: Nisaa Khan, Counsel
HEARD: In Writing
OVERVIEW
1Anthony Broomfield, the applicant, was involved in an automobile accident on February 9, 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, Belair Insurance Company Inc., and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
- 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?
- Is the applicant entitled to $1,920.52 for a psychological assessment, proposed by Inline Rehabilitation Centre Inc. in a treatment plan/OCF-18 (“plan”) submitted July 18, 2022, and denied February 8, 2023?
- Is the applicant entitled to $2,519.00 for psychological services, proposed by Inline Rehabilitation Centre Inc. in a plan submitted October 13, 2022, and denied February 8, 2023?
- Is the applicant entitled to $3,421.65 for physiotherapy services, proposed by Inline Rehabilitation Centre Inc. in a plan submitted September 6, 2022, and denied September 21, 2022?
- Is the applicant entitled to $4,217.71 for physiotherapy services, proposed by Inline Rehabilitation Centre Inc. in a plan submitted May 16, 2022, and denied June 12, 2022?
- Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant’s injuries are predominantly minor and he remains subject to the $3,500.00 the MIG limit.
4As the applicant remains within the MIG, it is not necessary for me to do a reasonable and necessary analysis on the treatment plans in dispute.
5Interest is not payable.
ANALYSIS
Is the applicant eligible to be removed from the MIG based on a psychological injury?
6The applicant has not established that he is entitled to be removed from the MIG based on psychological grounds.
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, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
8An 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.
9The applicant submits he should be removed from the MIG because he has been diagnosed with a DSM-5 criteria of driving/passenger anxiety. To support his claim, he refers to a Psychological Assessment conducted by Ms. Sabrina Simmons (MA) under the supervision of Psychologist Dr. Valery Kleiman, conducted July 25, 2022.
10The respondent disagrees that the applicant has suffered a psychological injury. To support its claim, the respondent relies upon a s.44 Insurers Examination conducted by Psychologist Dr. Amena Syed conducted December 8, 2022. In the report, Dr. Syed concluded that the applicant had not suffered any psychological injury.
11I put more weight on the respondent’s evidence, for a number of reasons:
i. First, the July 25, 2022 Psychological Asessment was authored by Ms. Sabrina Simmons while under the supervision of Dr. Valery Kleiman. While I am alive to the fact that Dr. Kleiman was supervising the work, the report does not indicate the nature of such supervision. For this reason, I give more weight to the s. 44 IE report which was authored solely by Dr. Syed, a Psychologist.
ii. Secondly, the applicant’s s.25 report indicates those tests were conducted over an online video platform, and the report does not indicate the duration of testing. I give more weight to the IE report because the testing was conducted in person, and the report clearly indicates that the testing was thorough, taking place over two hours and forty-five minutes.
iii. I note that the applicant’s report scores indicate a ‘normal’ level of anxiety, a mild level of depression, and a moderate level of stress in the Depression Anxiety and Stress Scale (DASS) and the Patient Health Questionnaire (PHQ-9). It is not indicated in the July 2022 report why the applicant meets the level of a DSM-5 criteria for driving phobia.
iv. Finally, I do note that Dr. Syed authored an addendum report after reviewing the applicant’s report. Dr. Syed’s opinion remained unchanged in the face of the applicant’s evidence.
12I was not led to other supportive evidence, such as Clinical Notes and Records from his family physician or follow up treatment reports.
13For these reasons, I find that on a balance of probabilities, the applicant has not met his onus to prove entitlement to removal from the MIG on the basis of psychological injury.
Has the applicant established he should be removed from the MIG on the basis of physical injury or chronic pain?
14The applicant has not met his onus to prove he should be removed from the MIG on the basis of physical injury.
15The applicant is requesting physical therapy to mitigate his injuries. To support his claim, the applicant is relying on the OCF-18’s themselves.
16While the onus is on the applicant to prove chronic pain, I was not led to further supportive medical evidence such as a a diagnosis of chronic pain, or an analysis of the AMA Guide to Chronic Pain.
17Furthermore, the Tribunal has long established that chronic pain in and of itself is not sufficient to remove one from the MIG. Rather, the Tribunal’s jurisprudence has determined that the applicant must demonstrate “chronic pain with functional impairment.”
18Again, although the onus is on the applicant to prove he should be removed from the MIG, he has not submitted evidence or provided submissions to indicate a functional impairment.
19For this reason, I find the applicant has not, on the balance of probabilities, met his onus to merit removal from the MIG on the basis of physical injury.
20As I have ruled that the applicant is subject to the MIG, it is not necessary for me to conduct a reasonable and necessary analysis for the treatment plans in dispute.
Interest
21Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
ORDER
22The application is dismissed.
i. The applicant is being held to the Minor Injury Guideline and the $3,500 treatment limit.
ii. As the applicant is being held to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
iii. No interest is payable.
Released: January 14, 2026
Jeff Chatterton
Adjudicator