Citation: Mahshan v. Belair Insurance Company Inc., 2026 ONLAT 24-012944/AABS

Licence Appeal Tribunal File Number: 24-012944/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:

Muhammad Mahshan

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

VICE-CHAIR:

Julian DiBattista

APPEARANCES:

For the Applicant:

Kameliya Stancheva, Paralegal

For the Respondent:

Mark Esteireiro, Paralegal

HEARD: In Writing

OVERVIEW

1Muhammad Mahshan, the applicant, was involved in an automobile accident on September 28, 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, Belair Insurance Company Inc., 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?

ii. Is the applicant entitled to $1,356.35 for chiropractic services, proposed by Toronto Medical Centre in a treatment plan/OCF-18 (“plan”) submitted January 8, 2024, and denied March 20, 2024?

iii. Is the applicant entitled to $87.19 ($1,102.52 less $1,015.33 approved) for chiropractic services, proposed by Toronto Medical Centre, in a plan submitted February 26, 2024, and denied March 6, 2024?

iv. Is the applicant entitled to $1,748.05 for a biopsychosocial assessment, proposed by Toronto Medical Centre in a plan submitted November 14, 2023, and denied December 1, 2023?

v. Is the applicant entitled to $1,995.32 for a psychological assessment, proposed by Dr. Svetlana Gabidulina in a plan submitted March 13, 2024, and denied April 2, 2024?

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

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

RESULT

3The applicant has not proven injuries which warrant removal from the MIG.

4As the applicant is in the MIG, it is not necessary to consider if the treatment plans and remaining balance in dispute are reasonable and necessary.

5The applicant is entitled to treatment up to the MIG limits.

6There is no entitlement to interest.

ANALYSIS

The applicant remains subject to 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 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.

9The applicant submits that he has sustained both physical and psychological impairments as a result of the accident which warrant removal from the MIG.

10Specifically, the applicant points to a clinical note and record dated August 14, 2024 where Dr. M. Hum, physician, notes that the applicant has complained of chronic pain since the accident and has been scared to drive.

11The applicant also submits the disability certificate (OCF-3) completed on October 20, 2023 by Dr. S. Jahandideh, chiropractor. This OCF-3 and the singular note from Dr. Hum are the entirety of the medical evidence adduced in support of the applicant’s claim.

12The respondent submits two section 44 assessments in support of their position. A medical assessment conducted by Dr. M. Lamine, physician, on April 24, 2024 and a psychological assessment conducted by Dr. K. McCutcheon, psychologist, on May 23, 2024.

13The respondent further submits the OHIP summary of the applicant which shows that the only medical attention sought by the applicant between the date of the accident and June 3, 2024 was for a shoulder dislocation that occurred in January of 2024. It is agreed in submissions that this injury was not related to the accident.

14Dr. Lamine, did not diagnose or indicate the presence of any impairments which would warrant removal from the MIG.

15Dr. McCutcheon found that the applicant’s symptoms of anxiety and depression are subclinical and that these symptoms fall within the MIG.

16A singular clinical note from a visit with a walk in clinic, almost 11 months after the accident, does not convince me that the applicant suffers from chronic pain or a psychological impairment. In this note, Dr. Hum documents the applicant’s complaints, makes no formal diagnosis and recommends the applicant seek physiotherapy and psychotherapy.

17Added to this is the fact that the applicant did not seek OHIP funded medical care for the injuries he sustained in the accident from the date of the accident to June 3, 2024. This fact supports the findings of Dr. Lamine and Dr. McCutcheon.

18For these reasons, on the balance of probabilities, I find that the applicant has not satisfied their burden of proving they suffer from either chronic pain with a functional impairment or a psychological impairment as a result of the accident.

19Therefore, I find that the applicant has not proven injuries which warrant removal from the MIG.

The applicant is entitled to treatment up to the MIG limit

20Having determined that the applicant remains within the MIG, an analysis of the reasonableness and necessity of the disputed treatment plans and remaining balance is not required. The applicant is entitled to funds for treatment up to the $3500 limit of the MIG.

Interest

21Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, there is no entitlement to interest.

ORDER

22For the reasons above, I order that:

i. The applicant remains within the MIG;

ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans and remaining balance in dispute are reasonable and necessary;

iii. The applicant is entitled to treatment up to the MIG limits; and

iv. There is no entitlement to interest.

23This application is dismissed.