Licence Appeal Tribunal File Number: 24-012568/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:
Zachary Fleming
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Nadia Mauro
APPEARANCES:
For the Applicant:
Naman Nanda, Counsel
For the Respondent:
Elisa Cogan, Counsel
HEARD:
By way of Written Submissions
OVERVIEW
1Zachary Fleming, the applicant, was involved in an automobile accident on April 27, 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, Intact 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:
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 the treatment plans (“OCF-18”) proposed by Prime Health Care Inc., as follows:
i. $3,342.39 for Physiotherapy Services, in an OCF-18 dated June 13, 2022?
ii. $1,836.16 for Physiotherapy Services, in an OCF-18 dated February 17. 2023?
iii. $1,563.72 for Physiotherapy Services, in an OCF-18 dated March 8, 2023?
iv. $2,660.00 for a Chronic Pain Assessment, in an OCF-18 dated January 24, 2023?
Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
Is the applicant entitled to interest on any overdue payment of benefits?
3The applicant confirms in his submissions that he withdraws issue 2 as listed on the Case Conference Report and Order, dated February 18, 2025.
RESULT
4The applicant’s accident-related injuries are predominantly minor as defined by the Schedule.
5As the applicant is in the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary. He is not entitled to interest or an award.
ANALYSIS
Minor Injury Guideline
6I find that the Applicant has not met his onus to demonstrate that his accident-related impairments warrant removal 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, 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