Licence Appeal Tribunal File Number: 24-006520/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:
Mohammed Shahen
Applicant
and
Heartland Farm Mutual Inc.
Respondent
DECISION
ADJUDICATOR: Ulana Pahuta
APPEARANCES:
For the Applicant: Malcolm Zoraik, Counsel
For the Respondent: Laura Zeleznik, Counsel
HEARD: By way of written submissions
OVERVIEW
1Mohammed Shahen, the applicant, was involved in an automobile accident on August 5, 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, Heartland Farm Mutual Inc., and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant did not provide his written hearing submissions by June 11, 2025, the deadline stipulated in the Case Conference Report and Order dated October 23, 2024. The applicant subsequently filed his submissions and a Notice of Motion on July 4, 2025 seeking an extension of time to file his submissions.
3By way of a Motion Order dated July 7, 2025, the Tribunal granted the applicant’s motion and extended the deadline for the applicant to file his written hearing submissions to July 4, 2025. The respondent was also permitted to file new responding submissions if it chose to do so. As such, both the applicant’s written hearing submissions and the respondent’s responding submissions will be considered at this written hearing.
ISSUES
4The 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 (“MIG”) limit?
ii. Is the applicant entitled to a non-earner benefit of $185.00 per week from March 25, 2024, to ongoing?
iii. Is the applicant entitled to $4,959.75 for psychological services, proposed by Dr. Leon Steiner in a treatment plan dated November 23, 2023?
iv. Is the applicant entitled to $4,959.75 for psychological services, proposed by Dr. Leon Steiner in a treatment plan dated August 16, 2024?
v. Is the applicant entitled to $2,486.00 for a psychological assessment, proposed by Dr. Leon Steiner in a treatment plan dated July 19, 2023?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5The applicant’s accident-related impairments are predominantly minor, and he is therefore subject to treatment within the $3,500.00 limit of the MIG.
6The applicant is not entitled to non-earner benefits, the treatment plans in dispute or interest.
ANALYSIS
Minor Injury Guideline
7Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured person 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 person 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.
The applicant has not established accident-related impairments that warrant removal from the MIG
9The applicant submits that as a result of the accident, he has sustained serious physical and psychological injuries. He argues that he suffers from ongoing left-sided neck, shoulder and back pain, and that he attended rehabilitation treatment until the respondent terminated his benefits, due to the MIG funding limits. The applicant also argues that as a result of the accident, he was diagnosed with major depressive disorder with anxious distress, post-traumatic stress disorder, and somatic symptom disorder, relying on the s. 25 psychological assessment report of Dr. Leon Steiner, psychologist, dated October 23, 2023.
10The respondent submits that the applicant has failed to provide any evidence to support his claim that his injuries are not minor. It relies on the s. 44 psychological assessment report of Dr. Johan Reis, psychologist, dated January 8, 2024. Dr. Reis found that the applicant’s symptoms did not meet the diagnostic criteria for a DSM-5 psychological condition, and that the applicant’s symptoms were below the threshold of clinical concern.
11I find that the applicant has not proven on a balance of probabilities that he has sustained non-minor injuries as a result of the accident.
12The bulk of the applicant’s submissions and evidence relate to psychological impairments. The applicant relies on the psychological assessment report of Dr. Steiner, dated October 23, 2023, to argue that he was diagnosed with major depressive disorder with anxious distress, post-traumatic stress disorder, and somatic symptom disorder. However, the applicant has not directed me to any additional medical evidence in support of an accident-related psychological impairment.
13The applicant has not provided the clinical notes and records (“CNRs”) of his family physician, hospital records, or records of any treating doctor, to establish accident-related injuries or to corroborate his claim of psychological impairments. He does not direct me to any evidence that post-accident he reported psychological symptoms to a treating physician, or that he sought treatment for psychological impairments. Rather, the applicant solely relies on the s. 25 report of Dr. Steiner and the OCF-18 forms themselves. However, as part of his assessment I note that Dr. Steiner did not review any medical documentation, outside of the OCF-18 form and his own psychological pre-screen.
14The respondent’s s. 44 assessor Dr. Reis found that the applicant’s symptoms were below the threshold of clinical concern and his symptoms did not meet the diagnostic criteria for a DSM-5 psychological condition. Dr. Reis further found that there were validity concerns with the applicant’s psychometric responses and that the assessment results should be interpreted with considerable caution. Without any additional medical evidence to corroborate Dr. Steiner’s conclusions, I find that the applicant has not met his onus to prove, on a balance of probabilities, that he sustained psychological impairments as a result of the accident.
15With respect to the additional grounds for removal from the MIG, the applicant has not provided submissions or directed me to evidence of non-minor physical impairments or chronic pain. The applicant cites the treatment records from his physical rehabilitation clinic to argue that post-accident he sought treatment for lower back, neck and shoulder pain. However, the applicant does not direct me to any chronic pain diagnosis by a treating physician, or evidence of ongoing pain reports to his family doctor. Nor has the applicant provided prescription summaries to establish the ongoing use of pain medication post-accident. The only other medical evidence provided by the applicant is an MRI of the thoracic spine, dated January 18, 2023. The MRI found multilevel degenerative changes, and two intradural extramedullary masses, or cysts. However, the applicant has not directed me to any medical opinion stating that these results were linked to the subject accident. Rather, the MRI report stated that this was a “known extramedullary” and that there was “no adverse change compared to June 20, 2013”. Accordingly, I find that the applicant has not established that he has sustained chronic pain or a non-minor physical impairment as a result of the accident.
16As I have found that the applicant has not established that his accident-related impairments warrant treatment beyond the MIG limits, it is unnecessary for me to consider the reasonableness and necessity of the disputed treatment plans.
Non-Earner Benefits
17I find that the applicant has not established entitlement to non-earner benefits (“NEBs”).
18Section 12(1) of the Schedule provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident, if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391, which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities.
19I find that the applicant has failed to prove on a balance of probabilities that he suffers from a complete inability to carry on a normal life.
20The applicant has not provided any details of his pre-accident activities or demonstrated how his participation in those activities has been limited as a result of the accident. There are no submissions on which activities were most important to him, how he is prevented from engaging in the activities he normally engaged in pre-accident or evidence of the frequency and time commitments of his pre-accident activities, as required by Heath and in many NEB cases at the Tribunal, such as 16-003141 v. Aviva Insurance Canada, 2017 CanLII 46352 (ONLAT). In the absence of this information, I cannot compare the applicant’s pre and post-accident capabilities with respect to the activities he ordinarily engaged in or valued.
21The applicant further does not direct me to any medical opinion or medical evidence that he suffers a complete inability to carry on a normal life. Although he submits an OCF-3 prepared by Dr. Jayesh Mistry, chiropractor, which notes a complete inability to carry on a normal life, I note that an OCF-3 alone does not establish whether an applicant has met the test for entitlement to NEBs. Rather additional objective medical evidence is required. The applicant has not provided any clinical notes and records from any family physician or treating doctor, to establish his accident-related impairments, and how these impairments prevented him from engaging in his pre-accident activities.
22I find the applicant has not provided sufficient submissions or evidence to allow me to assess any potential changes to his pre-and post-accident activity levels. As such, I find that the applicant has not established entitlement to NEBs for the period in dispute.
Interest
23Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are payable, the applicant is not entitled to interest.
ORDER
24I find that:
i. The applicant’s accident-related impairments are predominantly minor, and he is therefore subject to treatment within the $3,500.00 limit of the MIG.
ii. The applicant is not entitled to non-earner benefits, the treatment plans in dispute or interest.
iii. The application is dismissed.
Released: January 9, 2026
Ulana Pahuta Adjudicator