Licence Appeal Tribunal File Number: 24-010121/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:
Rollen Mallari
Applicant
and
Allstate Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Gary Harvey
APPEARANCES:
For the Applicant:
Jasmine Patel, Counsel
For the Respondent:
Oliver Gorman-Asal, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Rollen F Mallari, the applicant, was involved in an automobile accident on June 30, 2023, 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, Insurer, 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. 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? Note: The parties agreed the MIG limits have been exhausted.
ii. Is the applicant entitled to $2,460.00 for a Psychological Assessment, proposed by A and B Medical Assessments in an OCF-18/treatment plan (“plan”) dated November 28, 2023?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not demonstrated on a balance of probabilities that she sustained a psychological condition as a result of the accident that warrants removal from the MIG.
4The applicant is not entitled to $2,460.00 for a Psychological Assessment.
5No interest is payable.
PROCEDURAL ISSUES
Respondent’s request to exclude the applicant’s Psychological Assessment Report for a breach of Rule 10.2 of the Tribunal’s Rules
6The respondent submits that Mandeep Singh, Supervising Psychological Associate who completed the applicant’s Psychological Assessment at AB Medical Assessments breached rule 10.2 of the Tribunal Common Rules of Practice and Procedure (Common Rules) by not completing and submitting an Acknowledgement of Expert Duty form. They argue that as a result of failing to submit the form that her report cannot be regarded as an expert report.
7Although the applicant did not file any reply submissions to address this matter, I disagree with the respondent. Rule 10.1 refers to experts witnesses that are testifying in a videoconference hearing and not written submissions hearing format as is in this satiation.
ANALYSIS
The applicant remains within the Minor Injury Guideline (“MIG”)
8I find that the applicant has not established on a balance of probabilities that she suffers from an accident-related injury or condition that warrants removal from the MIG or a documented pre-existing condition that precludes recovery if kept within the confines of the MIG.
9Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 of 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 any clinically associated sequelae top such injury.”
10An 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 condition combined with compelling medical evidence stating that the condition combined with compelling medical evidence 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.
11In all case, the burden of proof lies with the applicant.
The applicant does not have a psychological condition that would remove her from the MIG
12The applicant submits that on June 30, 2023, the same day as the accident that the applicant was examined by Dr. Shilpa Sethi, Family Physician where she reported being involved in a collision. She complained of pain in her neck, lower back and shoulder reporting that it “feels like she has whiplash”. This pain was also reported to treatment providers at Healthmedica Wellness Centre where the applicant attended for physiotherapy, TENS/IFC treatment, heat therapy, massage, and chiropractic treatment. In addition to the treatments the applicant was also taking medications as prescribed and directed by her physicians including over-the-counter Tylenol and Advil as required.
13The applicant submits that Chiropractor, Dr. Ranjit Sohal described the injuries in a Disability Certificate (OCF-3) dated July 14, 2023, as “Other headache syndromes; whiplash associated disorder with complaint of neck pain with musculoskeletal signs: low back pain; pain in thoracic spine; other anxiety disorders, nonorganic sleep disorders”.
14The applicant submits that they rely on the s. 25 Psychological Assessment Report dated December 20, 2023, where the applicant was diagnosed with Post-Traumatic Stress Disorder and Major Depressive Disorder, Single Episode, Moderate by Mandeep Singh, Psychological Associate. During the assessment the applicant reported experiencing vehicular anxiety along with being nervous while driving and as a passenger, anxious, tense, overly alert and worried while driving.
15The applicant submits that the applicant’s injuries with a diagnosed psychological impairment is outside of the MIG.
16The respondent submits that the applicant attended her family doctor’s office, Health Plex Medical, on the date of the accident where she was diagnosed whiplash associated disorder. The respondent further submits that there is no mention of the accident in the applicant’s medical records after her June 30, 2023, visit. On January 22, 2024, the applicant attended her family doctor’s office for an unrelated medical matter with respect to test results and was advised that she would hear back from the hospital.
17Two days later, on January 24, 2024, the applicant reported to her family physician that she was “very anxious”. The respondent argues that it is clear that the applicant was anxious about her test results, and not anything related to the accident. The respondent further submits that the applicant attended Healthmedica Wellness Centre for physical treatment related to the accident from mid-July 2023 until January 2024. The respondent argues that the medical records from Healthmedica Wellness Centre confirm that the applicant’s injuries were soft tissue in nature, and the applicant does not report any kind of psychological complaints to her clinicians.
18A Psychological Assessment was completed on the applicant by Mandeep Singh dated December 20, 2023. The respondent submits that on page 3 of the report it indicates that the report was supervised by Mandeep Singh, but that part of the assessment was completed by Psychotherapist, Stacy Yong. The respondent argues that it is unclear what part of the interview each of these professionals conducted and that in the interview the applicant rated her physical injuries pain a 3-5/10. They further submit that in the assessment the applicant denied concerns with her activities of daily life or self-care and stated that she was able to drive though she does get nervous when driving. The respondent acknowledges that the report diagnosed the applicant with PTSD and Major Depressive Disorder, Single Episode, Moderate and argues that it is unclear whether Ms. Singh or Ms. Yong completed that section. They further submit that the prognosis of those conditions was noted to be undetermined.
19The respondent submits that the report indicates that the accident is the sole source of the applicant’s psychological issues, however it argues that the report makes no mention of the applicant’s other medical issue and calls into question its findings with regards to causation. In the assessment it is indicated that no medical reports were provided for review in preparation of the report.
20The respondent submits that the applicant attended a s.44 Psychological Assessment on January 29, 2024, with Dr. Dumitrascu, Psychologist. His report consisted of a document review, clinical review and psychometric testing. The report notes that the applicant returned to work as a dental receptionist, had resumed her normal housekeeping tasks but with breaks, and had no difficulty with self-care tasks. It also noted that the applicant had resumed spending most of her time outside of work with family and she attends dancing classes once per week. Dr. Dumitrascu also noted that the applicant prefers to drive less but is still able to do so in order to go shopping, attend appointments, etc., and that the applicant denied any significant emotional symptoms with regards to the accident, describing her mood as normal and that she does not worry excessively. Dr Dumitrascu opined that the applicant’s nervousness while driving is subclinical and that her symptoms did not meet the DSM-5 criteria for a psychological disorder as a result of the accident, concluding that the applicant’s injuries belong in the MIG.
21The respondent submits that the applicant attended Brampton Civic Hospital on February 14, 2024, for a consultation concerning unrelated treatments and that the consultation report’s section on past medical history describes the applicant’s past medical history as unremarkable and notes that she is not taking any medication.
22The respondent submits that the applicant has failed to establish that her accident-related injuries fall outside of the MIG, or that she is entitled to the issues in dispute.
23I place little weight on the s. 25 Psychological Assessment conducted by Sarah Yong, Psychotherapist and Mandeep Singh, Supervising Psychological Associate. Although the assessment was signed off by Ms. Singh it is unclear what parts of the assessment were conducted by each of the assessors or if Ms. Singh took part in the entire assessment. It is indicated in section 3 – Qualifications that part of the assessment was completed by Ms. Yong, but it is unclear if Ms. Singh was present during Ms. Yong’s portion(s). In the s. 44 assessment it is noted that the applicant told Dr. Dumitrascu that the assessment was conducted over the telephone by Stacy Yong and that she has not received any other phone calls. It is also unclear who provided the opinions in the report although the report is signed off by Ms. Singh. I am persuaded that Psychotherapists are able to diagnose mental health conditions, so as a result I place little weight on the s. 25 assessment.
24I also find inconsistencies in the two assessments submitted by the two different assessors in the way that the applicant has responded to some of the self reporting questions with respect to portions of her daily life and psychological issues being assessed. In the s. 25 Assessment the applicant reported vehicular anxiety along with being nervous while driving and as a passenger, anxious, tense, overly alert and worried while driving. The applicant is also noted as advising that she has a “depressed mood, and anxiety since the accident as well as a loss of interest in activities that previously brought her pleasure”. Whereas in the s. 44 Assessment the responses are noted differently with the applicant’s mood being normal “my mood is fine”, that she does not worry excessively, along with the applicant indicating that she attends dance classes once per week. The self-reporting responses contradict one another.
25In the s. 25 Psychological Assessment completed by Ms. Singh and Ms. Yong the applicant in section 12 Psychological Impact and Current Psychological Status of the report indicates that she denied any sleep concerns and nightmares, and not living with any sleep-related disorders prior to the accident. Then in section 13 Test Results, the applicant indicates that she sleeps somewhat less than usual. Section 14 Clinical Opinion the report indicates that she continues to experience physical pain and symptoms of emotional distress as a direct result of the accident, despite the length of time that has lapsed. It also states that the applicant’s physical pain impedes her daily activities and her ability to function/work to her full capacity.
26Whereas in the s. 44 Insurer Examination Psychologist’s Report conducted by Dr. Dumitrascu it is reported that the applicant is experiencing pain in the neck, left shoulder and lower back on the left side as a result of the subject accident. It is also noted that the applicant reported pain with bending and lifting heavy items and that she walks slower than usual due to her pain and possibly because of her age. She reported being able to complete housekeeping and home maintenance duties with taking breaks and no difficulties with self-care. However, in the section of the report headed Current Reported Psychological Complaints the applicant describes her mood as “fine” and does not worry excessively other than about her children and their safety. The applicant also reported that she spends most of her time with family, attends dancing classes once per week and walks to work but becomes nervous in vehicles when other vehicles come too close or when her husband brakes suddenly. It is also noted that the applicant did not report experiencing symptoms of anxiety and/or depression.
27In considering the weight I have placed on the two assessments, I also considered the type of testing administered and the documentation reviewed in preparation ahead of the assessments.
28Accordingly, the applicant has not established on a balance of probabilities that she has a psychological impairment as a result of the subject accident that would remove her from the MIG.
Is the applicant entitled to $2,460.00 for a Psychological Assessment
29As the applicant Is not removed from the MIG and the MIG limits have been exhausted there is no need for me to consider the Psychological Assessment in dispute.
Interest
30Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since no benefits are owing, interest does not apply.
ORDER
31For the reasons outlined above, I find that:
i. The applicant shall remain within the MIG;
ii. As the applicant is in the MIG, it is not necessary to consider if the assessment in dispute is reasonable and necessary; and
iii. The applicant is not entitled to interest.
Released: March 25, 2026
Gary Harvey
Adjudicator