Citation: Novis v. Aviva General Insurance Company, 2026 ONLAT 24-002390/AABS
Licence Appeal Tribunal File Number: 24-002390/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:
Jeremeh Novis
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Sarah Guergis
APPEARANCES:
For the Applicant:
Maria Papadopoulos, Paralegal
For the Respondent:
Kathleen Mertes, Counsel
HEARD:
In Writing
OVERVIEW
1Jeremeh Novis, the Applicant, was involved in an automobile accident on June 3, 2021, 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 General 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 $3,592.45 for chiropractic services, proposed by Humber Civic Care Centre in a treatment plan/OCF-18 (“plan”) dated October 8, 2021?
ii. Is the Applicant entitled to $2,629.85 for chiropractic services, proposed by Humber Civic Care Centre in a plan dated February 10, 2022?
iii. Is the Applicant entitled to interest on any overdue payment of benefits?
3In the Applicant’s submissions, they state that all of the other issues listed in the Case Conference Report and Order dated July 18, 2024, were withdrawn.
RESULT
4I find that the Applicant is not entitled to either treatment plan.
5I find the Applicant is not entitled to interest as the treatment plans in dispute are not payable.
ISSUES
Is the Applicant entitled to $3,592.45 for chiropractic services, proposed by Humber Civic Care Centre in a treatment plan dated October 8, 2021? And, is the Applicant entitled to $2,629.85 for chiropractic services, proposed by Humber Civic Care Centre in a plan dated February 10, 2022?
6I find that these treatment plans are not payable.
7To 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.
8The Applicant submits that he is entitled to these two treatment plans for chiropractic services and interest as he experiences chronic pain, and the goals of chiropractic treatment will address this.
9The Applicant submits that the goals of both treatment plans are pain reduction, increasing range of motion, increasing strength, a return to activities of normal daily living and a return to pre-accident work activities. In both treatment plans, it was noted that there have been mild to moderate improvements in range of motion. However, the Applicant continues to experience pain and discomfort in the above-mentioned regions. Further, that he also lacks muscular endurance and strength. The additional comments on the treatment plans confirm that the treatment will include, chiropractic manipulation/ mobilization/ muscle release therapy/ treatments, one to two times per week for 9 weeks.
10The Applicant relies on a chronic pain assessment completed by Dr. Michael Gofeld, MD, on November 22, 2022. Dr. Gofeld noted the health assessment scores revealed a moderate degree of general disability and impact on the clients functioning. Dr. Gofeld determined that the Applicant suffers from episodic headaches, chronic neck pain, chronic low back pain, and adjustment disorder with anxiety. Dr. Gofeld recommended that the Applicant should continue physical rehabilitation at the discretion of his therapist and functional restoration should include individual and group treatment sessions with health care practitioners.
11The Applicant also relies on clinical notes and records from their treating physicians from 2021 and 2022 which refers to their ongoing low back pain. The Applicant points me to CNRs from:
i. December 6, 2021 where he complained of back pain, indicating that his back is still tense, but now his neck is bothering him more.
ii. March 23, 2022 he mentioned issues of back pain and persistent adjustment disorder. His doctor recommended considering a pain clinic and the Applicant was referred to social work for further counselling.
12On February 9, 2024, CNRs from the family doctor report that the Applicant got a massage recently and was told his spine wasn't aligned. The Applicant requested a referral for back pain for physiotherapy or a chiropractor.
13The Respondent submits that the disputed treatment plans were both denied on the basis that the Applicant was assessed by s. 44 IE assessor, Dr. Eric Silver, physician, who determined both plans to be not reasonable or necessary.
14The Respondent relies on Dr. Silver’s musculoskeletal assessment from November 22, 2021. The report concluded that there was no compelling evidence of ongoing accident-related impairments. During the assessment. Dr. Silver found that the Applicant’s accident-related injuries have largely or completely resolved and that his current complaints are myofascial in nature.
15The Respondent notes that there have been no formal referrals for any form of physical therapy made by any of the treating physicians seen by the Applicant post-MVA. Nor were there any complaints of headaches, right hip pain, or dizziness to any of his treating physicians. Further, that as there is no mention of the Applicant being advised to remain off work in the clinical notes of the Ariana Clinic on June 8, 2021, it would appear that the Applicant was advised to not return to work solely by the staff at Humber Civic Care Centre, a walk-in clinic.
16The Respondent submits that the CNRs of Humber Civic Care Centre, are largely illegible and where they are legible, do not appear to show any clear indication of progress being made by the Applicant throughout the treatment process. Further, that the only indication in the Applicant’s CNRs regarding progress, in regard to the treatment in dispute, is from the Applicant’s own self-reporting.
17The Respondent relies on Tribunal decision PBM v. Aviva Insurance Company, 2020 CanLII 27385 (ONLAT), which holds that “a treatment plan or OCF-18 on its own is not sufficient or compelling evidence to prove entitlement to the treatment or that the treatment is reasonable and necessary”.
18Further, that in Ekelman v Co-operators General Insurance Company, 2023 CanLII 52352 (ONLAT), Adjudicator Pahuta also relies on the fact that, as in the within matter, the Applicant’s treating physician had not made any recommendations for the proposed treatment and that no progress reports were provided from the treating clinic to describe the Applicant’s progress in meeting the stated goals.
19Finally, the Respondent submits that it is not liable for payment of the two incurred treatment plans in dispute as several treatment sessions took place prior to the submission of the OCF-18 for the Respondent’s consideration.
20I acknowledge that in the Applicant’s assessment from Dr. Gofeld, there is a diagnosis of ongoing anxiety, chronic neck pain, chronic low back pain, and adjustment disorder with anxiety, and that when asked about treatment, he wrote “the client shall continue physical rehabilitation at the discretion of the therapist”. However, in the chronic pain report, Dr. Gofeld also states that the Applicant “did not exhibit pain behaviour.”
21Further, the Applicant has not directed me to any CNR entries where formal referrals for chiropractic treatment were made by any of the treating physicians seen by the Applicant post-MVA.
22I acknowledge there is a note in a CNR from January 10, 2022 where Dr. Novis wrote, ”should continue seeing physio” and that the Applicant submits physical treatment is helpful. However, there are no progress reports or treatment records showing that the treatment goals were being met.
23Further, the plans in dispute are for chiropractic treatment and the evidence primarily refers to physiotherapy.
24I agree with the Respondent that it is challenging to assess whether this ongoing treatment is assisting the Applicant’s treatment goals without medical evidence describing the Applicant’s progress in meeting the stated goals.
25I do not find the Applicant has met their onus to establish the reasonableness or necessity of these plans for chiropractic treatment. Therefore, on a balance of probabilities, I find that the Applicant is not entitled to either treatment plan.
Interest
26Pursuant to s. 51 of the Schedule, as no plans are payable, no interest is owing.
ORDER
27I find that the Applicant is not entitled to either treatment plan.
28I find the Applicant is not entitled to interest as the treatment plans in dispute are not payable.
Released: January 9, 2026
Sarah Guergis
Adjudicator```