Citation: Nguyen v. Intact Insurance Company, 2026 ONLAT 24-015283/AABS

Licence Appeal Tribunal File Number: 24-015283/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:

Thanh Thi Xuan Nguyen

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR:

Jeff Chatterton

APPEARANCES:

For the Applicant:

Chaitanaya Ghai, Counsel

For the Respondent:

Mahroze Khan, Counsel

HEARD:

In Writing

OVERVIEW

1Thanh Nguyen, the applicant, was involved in an automobile accident on July 1, 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:

1. 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?

2. Is the applicant entitled to $3,739.91 for physiotherapy services, proposed by Total Wellness Clinic in a treatment plan/OCF-18 (“plan”) submitted December 2, 2022?

3. Is the applicant entitled to $2,245.20 for psychological services, proposed by Total Wellness Clinic in a plan submitted October 12, 2022?

4. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

5. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant is being held to the Minor Injury Guideline (‘the MIG”) and the $3,500 treatment limitation.

4The application is dismissed.

PROCEDURAL ISSUES

5The applicant argues that the respondent should be barred from entering a s.44 IE from Dr. Sharleen McDowall into evidence because it was submitted after the Document Exchange deadlines outlined in the Case Conference Report and Order.

6Given my finding that the applicant has not met her onus, I did not consider the report of Dr. McDowall, so the procedural issue is moot.

ANALYSIS

Is the applicant removed from the MIG on the basis of pain?

7The applicant is not removed from the MIG on the basis of pain.

8Section 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.”

9An 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.

10While the applicant’s submissions are not entirely clear, her arguments reference pain, and she appears to be seeking to be removed from the MIG on the basis of pain. As noted above, this requires that she establish that she has chronic pain causing functional impairment.

11Specifically, the applicant states that she should be removed from the MIG on the basis of “persistent and debilitating pain.” To support her claim, the applicant relies on the OCF-18 identified as issue number 2, for physiotherapy services, proposed by Total Wellness Clinic, and the Clinical Notes and Records from her family physician, Dr. Sherif Paul Nessim.

12The respondent argues that the Clinical Notes and Records do not support the narrative of a patient suffering from accident-related pain. They also rely on an Insurer’s Examination conducted March 23, 2023, by GP Dr. Ahmed Mian, which concluded that the patient’s injuries were minor, benign, and transient in nature.

13I have reviewed the applicant’s evidence, and do not find it meets the onus to establish she should be removed from the MIG on the basis of pain. I note there is a lack of complaints to her family physician regarding accident-related pain. Although the onus remains with the applicant, I have not been led to evidence indicating that the applicant is suffering chronic pain, with a functional impairment.

14For these reasons, I find the applicant has not, on the balance of probabilities, met her onus to be removed from the MIG on the basis of pain.

Should the applicant be removed from the MIG on the basis of psychological injury?

15The applicant has not met her onus to prove she should be removed from the MIG on the basis of psychological injury.

16The applicant argues she should be removed from the MIG due to a diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood. To support her argument, the applicant relies upon a s. 25 Psychological Assessment which was authored July 9, 2025 by Psychologist Dr. Ana Bodnar and Psychometrist Andrea Dawson.

17The respondent counters that the applicant has not met the onus to prove she should be removed from the MIG. The respondent states that the applicant’s examination was conducted primarily through self-reporting, subjective assessment tools, and the respondent has expressed concern that the applicant may be exaggerating her symptoms. To support its argument, the respondent relies on a s.44 Insurer’s Examination conducted by Psychologist Dr. Charlotte Gooden on March 1, 2023. Dr. Gooden’s report concludes the applicant has not suffered any psychological injury.

18I find the respondent’s assessment carries more weight. This is because the examination of the applicant was conducted in person, versus the s. 25 assessment, which was conducted virtually. I find the applicant’s assessment relies on four self-reported questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Symptom Checklist 90-Revised and Travel Anxiety Questionnaire), whereas the respondent’s report relies upon more objective test results, such as the Miller Forensic Assessment of Symptoms, and the Clinical Assessment of Depression. And finally, I note that the applicant’s assessment was authored and signed by Psychometrist Andrea Dawson. It is unclear to me what role either Ms. Dawson or Dr. Bodnar had in the testing and reporting of results, whereas Dr. Gooden examined the applicant (in person) directly.

19I have not been led to further supporting evidence to support a claim of psychological injury, such as complaints of a psychological concern to her family physician or other health professionals.

20For these reasons, I find the applicant has not, on the balance of probabilities, met the onus to establish she should be removed from the MIG on the basis of psychological injury.

21As the applicant is being held to the MIG, it is not necessary for me to assess the treatment plans to determine if they are reasonable or necessary.

Interest

22Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.

Award

23The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. As the insurer has not unreasonably withheld or delayed benefits, I find that no award is payable.

ORDER

24The application is dismissed.

i. The applicant is being held to the MIG and the $3,500 treatment limit.

ii. As the applicant is held to the MIG, it is not necessary to determine if the treatment plans are reasonable and necessary.

iii. Neither interest nor an award are payable.