Oraha v. Co-operators General Insurance Company, 2026 CanLII 29549

Citation: Oraha v. Co-operators General Insurance Company, 2026 ONLAT 24-008608/AABS

Licence Appeal Tribunal File Number: 24-008608/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:

Robert Oraha

Applicant

and

Co-operators General Insurance Company

Respondent

DECISION

ADJUDICATOR:

Dagmar Boettcher

APPEARANCES:

For the Applicant:

Kateryna Vlada, Counsel

For the Respondent:

Julianne Brimfield, Counsel

Ethan Edwards, Counsel

HEARD:

By Way of Written Submissions

OVERVIEW

1Robert Oraha, the applicant, was involved in an automobile accident on February 2, 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, Co-operators 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:

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 limit? Note: The parties agree the MIG limits have been exhausted.

2. Is the applicant entitled to $4,150.21 for Physiotherapy treatment, proposed by HealthBridge Physio in a treatment plan/OCF-18 (“plan”) dated June 5, 2022?

3. Is the applicant entitled to $4,023.89 for Physiotherapy treatment, proposed by HealthBridge Physio in a treatment plan dated March 21, 2023?

4. Is the applicant entitled to $2,200.00 for a Psychological Assessment, proposed by HealthBridge Physio in a treatment plan dated February 24, 2023?

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

RESULT

3I find that the applicant has not met his burden of demonstrating that his injuries fall outside the definition of a “minor injury” as defined in s. 3 of the Schedule and he is therefore subject to treatment within the $3,500.00 MIG limit.

4As a result of finding the applicant to be within the MIG, it is not necessary to determine if the treatment plans are reasonable and necessary.

5No interest is payable.

6The application is dismissed.

ANALYSIS

The injuries are predominantly minor and the MIG applies

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 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 prevents maximal medical recovery of the minor injury sustained in the accident if they were 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.

9The applicant submits that he is not subject to the $3,500.00 MIG limit on benefits as he has been diagnosed with multiple, permanent psychological impairments. In support of his position, the applicant relies upon the clinical notes and records (“CNRs”) of the family doctor, Dr. Sameera Benjamin, a Psychological Assessment report dated April 19, 2023 by Dr. Sarvin Sabet Ghadam, the CNRs of HealthBridge Physio, and a Disability Certificate completed June 21, 2022 by Dr. Jessica Pludwinski, Chiropractor.

10The respondent submits that the applicant has not met his burden to prove, on a balance of probabilities, that his injuries should be treated outside the MIG and relies upon the applicant’s submissions and relevant case law.

11For the reasons that follow, I find that the applicant has not demonstrated that his impairments warrant removal from the MIG.

Does the medical evidence support a diagnosis of psychological impairments resulting from the motor vehicle accident?

12I find that the applicant has not provided persuasive evidence to support a diagnosis of psychological impairments that warrant removal from the MIG.

13The applicant submits that he has sustained psychological impairments as a result of the motor vehicle accident, including but not limited to anxiety, depressed mood, and emotional distress. In support of his submission, the applicant points me to the CNRs of Dr. Benjamin, the family doctor.

14The applicant also directs me to the Psychological Assessment report and submits that Dr. Ghadam notes that the applicant suffers from substantial psychological impairments as a result of the motor vehicle accident including diminished concentration, memory issues, planning and organizational issues and sleep disruption, resulting in a decline in his daily functioning and quality of life. The applicant submits that the report confirmed the diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood as well as features of Somatic Symptoms Disorder with Predominant Pain, Moderate. I am also pointed to the OCF-3 in which Dr. Pludwinski notes the applicant suffers from other anxiety disorders.

15The respondent submits that the CNRs of the family doctor, Dr. Benjamin are largely illegible, and although the applicant was ordered to provide transcribed copies of the CNRs from April 1, 2022 to the case conference date, they were not provided. The respondent further submits that the CNRs provided do not show evidence that the applicant ever complained of or was diagnosed with a psychological impairment. The respondent states that the CNRs indicate that the applicant was not referred to a psychiatrist or psychologist, or any post-accident counselling, and did not submit an OCF-18 for psychological treatment.

16The respondent also points me to the CNRs of HealthBridge Physio in which the applicant self-reports that he did not experience any sleeping difficulties or anxiety. The respondent also directs me to the psychological pre-screening of Dr. Ghadam included within the CNRs of HealthBridge Physio and submits that the pre-screen is based entirely on subjective self-reported symptoms.

17The respondent maintains that the psychometric testing performed by Dr. Ghadam is questionable as it was undertaken in a virtual format and Dr. Ghadam did not provide an explanation as to how the integrity of the testing was maintained in a virtual format. The respondent refers me to Odebiyi v Belair Insurance Company Inc., 2025 CanLII 39304 (ON LAT) in which the Tribunal found that Psychological Assessment report less persuasive as the assessment was completed virtually and the assessor did not review the CNRs.

18The respondent submits further that it did not obtain a s. 44 assessment report as there is insufficient corroborating medical evidence to support a psychological impairment and points me to a number of Tribunal decisions including Dooman v TD Insurance Co., 2025 ONSC 184 in which the applicant appealed a Tribunal decision which concluded the applicant did not have chronic pain, despite an unrebutted s. 25 assessment. The respondent submits that corroborating medical documentation is required to prove a psychological impairment and also points me to Xie v Allstate Insurance Company of Canada, 2021 CanLII 30275 (ON LAT) in which the Tribunal found that a psychological diagnosis in a s. 25 report was not enough to remove an applicant from the MIG in the absence of other supporting objective medical evidence. The respondent also refers to Velautham v Allstate Insurance Company, 2021 CanLII 19429 (ON LAT) in which the assessor had not reviewed the medical records, and H.I. v Belairdirect, 2020 CanLII 69930 (ON LAT) in which the Tribunal found a lack of psychological complaints in the CNRs of the family doctor.

19I have placed less weight on the applicant’s submissions and prefer the submissions put forward by the respondent because I was provided with only two CNRs showing the applicant visited his family doctor post-accident, on March 31, 2022 and on August 25, 2022. The CNRs were largely illegible, although the Case Conference Report and Order dated November 25, 2024 required the applicant to provide transcribed CNRs from the family doctor from April 1, 2022 to the case conference date. I agree with the respondent that the CNRs appear to concern lab work rather than a reference to the motor vehicle accident.

20Although the applicant points me to a Tribunal decision 17-007527 v Aviva Insurance Canada, 2018 CanLII 110948 (ON LAT) and submits that the Tribunal has found an applicant can be removed from the MIG if they demonstrate a psychological impairment, I find this decision does not apply in this instance. The applicant in the decision referred to above was removed from the MIG on the basis of a pre-existing condition supported by CNRs of the family doctors, an assessment, and an OCF-18 for psychological treatments. The applicant also directs me to consider the Tribunal findings within 17-005791 v Aviva Insurance Canada in which the applicant was removed from the MIG on the basis of psychological impairments. However, in this decision, the applicant’s submissions were again supported by CNRs of the family doctor.

21I also find by the decisions referred to by the respondent more persuasive, including YWC v Allstate Insurance Company, 2020 CanLII 27386 (ON LAT), in which the Tribunal found that there was no corroborating or continuous evidence of psychological symptoms in the medical records. The respondent submits that there are compelling Tribunal decisions which have found that the Tribunal is free to accept all, some, or none of the evidence tendered, and assign appropriate weight.

22With regard to the Psychological Assessment report of Dr. Ghadam, I note that the assessment was completed virtually, that the applicant completed the forms by himself and then underwent an interview. I also note that the assessor stated that the most relevant documents he reviewed to complete the Psychological Assessment report were the imaging results of the chest x-ray. Although, the report recommended 18 sessions of cognitive-behavioural psychotherapy, no OCF-18 was submitted for this treatment, and I find this to be inconsistent with a submission of psychological impairments.

23I also find that the CNRs of HealthBridge Physio concern, almost exclusively, physical symptoms and concerns. The only reference to anxiety disorders is within the OCF-3 completed June 21, 2022 by Dr. Pludwindski, Chiropractor. I was not pointed to any other CNRs referencing psychological impairments, and as the applicant’s submission regarding removal from the MIG is based solely on psychological impairments, I am not persuaded by the medical evidence to which I was pointed.

24For the above reasons, I find insufficient evidence advanced by the applicant to persuade me that, on a balance of probabilities, the applicant suffers from psychological impairments as a result of the motor vehicle accident.

25As I have found that the applicant is not entitled to funding beyond the MIG limit, it is unnecessary for me to consider whether the treatment plans are reasonable and necessary.

Interest

26As there is no overdue payment of benefits, the applicant is not entitled to interest pursuant to section 51 of the Schedule.

ORDER

27I order the following:

i. The applicant remains within the MIG and is subject to the $3,500.00 funding limit;

ii. The applicant is not entitled to the treatment plans in dispute;

iii. The applicant is not entitled to interest; and

iv. The application is dismissed.