Citation: Carreiro v. Wawanesa Mutual Insurance Company, 2026 ONLAT 24-011299/AABS
Licence Appeal Tribunal File Number: 24-011299/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:
Nicole Carreiro
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR: Roderick Walker
APPEARANCES:
For the Applicant: Felicia Moutinho, Counsel
For the Respondent: Jonathan Heeney, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Nicole Carreiro, the applicant, was involved in an automobile accident on August 14, 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 Wawanesa Mutual Insurance Company, the respondent 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. Is the applicant entitled to $1,305.00 for chiropractic services, proposed by Multi Rehabilitation Services Inc. in a treatment plan submitted on September 13, 2024?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is not entitled to $1,305.00 for chiropractic services.
No interest or award are payable.
Is the applicant entitled to $1,305.00 for chiropractic services, proposed by Multi Rehabilitation Services Inc.?
4To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
5The applicant is not entitled to the above treatment plan.
6The applicant relies on a Disability Certificate (OCF-3) submitted by Chiropractor, Dr. M. Rodrigues, dated November 11, 2022. Dr. Rodrigues diagnoses the following: Cervical strain/sprain, Thoracic strain/sprain, lumbar strain/sprain, headaches, and concussion. Dr. Rodrigues opines that the applicant suffers a complete inability to carry on a normal life and has sustained an impairment that continuously prevents her from engaging in recreational activities, hobbies, exercising and house chores such as cleaning, cooking, and grocery shopping.
7The applicant also relies on the Clinic Notes and Records (CNRs) from her family doctor, Dr. Akhtar. Dr. Akhtar diagnosed the applicant with concussion/head injury with head aches, visual disturbances, dizziness, neck pain, nausea, anxiety, low mood, and irritability. On August 19, 2022, the applicant was seen by Dr. Akhtar as her concussion symptoms appear to have worsened. Akhtar prescribed Naproxen for her ongoing pain and Sumatriptan for her ongoing headaches.
8The applicant also relies on the CNRs from Multi-Rehab College Clinics and Bloor Park Physio and Rehabilitation. The applicant has attended on a bi-weekly basis. The applicant then attended Multi- Rehab/College Chiropractic clinics on or about October 2022 and has continued to do so.
9The applicant states that she attended treatment once per week since the accident. and has received sessions of physiotherapy, massage therapy, and chiropractic treatments. Her treatments included passive modalities, TENs, IFC, heat and ice therapy, ROM exercises, strengthening exercises, mobilizations, and SMT. The applicant submits that she found the rehabilitation programs helpful in alleviating her pain for brief periods; however, it has not provided long-term improvement in her symptoms and functionality.
10The applicant argues that her ability to carry out her day-to-day functioning is limited, the applicant submits that she has become socially withdrawn and is debilitated by her ongoing pain. She experiences persistent physical pain and concussion-related symptoms. The applicant submits that she has been persistent in her quest for seeking pain relief, along with the consistent treatment recommendations as provided by her treatment providers.
11The respondent submits the claim for chiropractic services in September 2024, is not reasonable and necessary. The applicant has not produced sufficient evidence to support the plan is reasonable and necessary.
12The respondent states that the applicant’s plan does not rely on medical evidence beyond November 2022. The respondent suggests that no evidence has been submitted to support the need for further physical therapy in September 2024, more than 2 years after the accident. The respondent also relies on the s. 44 assessor Dr. Lee, General Physician and his report dated November 11, 2024. The applicant reported 70 to 80% improvement since the accident. During Dr. Lee’s assessment of the applicant, the applicant advised Dr. Lee she was independent with all of her self-care activities prior to the accident.
13Dr. Lee reviewed the medical documentation, interviewed the applicant, and did a physical examination. He found that the applicant had muscle injuries in the neck and lower back, called sprains or strains. He did not comment on the head injury because a neurologist should review that part. During the physical examination, there were no signs that the applicant still has injuries from the accident. Dr. Lee says that the injuries from the August 14, 2022, accident were mostly minor, and that these injuries have now healed. Because of this, Dr. Lee found the treatment plan in question is not reasonable or necessary. I agree.
14I find that, more than four years following the accident, the applicant has not established that the proposed treatment plan is reasonable and necessary. The applicant has not submitted any further medical evidence demonstrating a continued need for chiropractic services beyond August 2022.
15The August 24, 2022, clinical note from the applicant’s family physician, Dr. Akhtar, indicates that the applicant’s concussion symptoms were mild and improving, with no reported nausea or vomiting, no thunderclap headaches, no change in level of consciousness, and no loss of visual fields or deficits. Importantly, this clinical entry does not recommend or reference any need for ongoing chiropractic care.
16I further note that there have been no documented accident-related complaints since August 2022. In the absence of objective medical evidence supporting continued chiropractic treatment, I find that the applicant has not met the burden of proving entitlement to the proposed plan.
17Dr. Lee’s physical examination of the applicant revealed that there were no signs that the applicant still has injuries from the accident. Dr. Lee found that the injuries from the accident were mostly minor and that these injuries have now healed. The applicant has not directed me to evidence to refute Dr. Lee’s findings. Accordingly, I agree with Dr. Lee’s findings that the plan in dispute is not reasonable or necessary because the applicant’s injuries from the accident have already healed.
18For the above reasons, I find that the applicant has not meet her onus and on a balance of probabilities, the treatment plan is not reasonable and necessary.
Award
19Pursuant to section 10 of Regulation 664, the Tribunal may award up to 50% of the total benefits payable plus interest if it determines that the insurer unreasonably withheld or delayed the payment of benefits. I find that since no benefits are payable, no benefits have been unreasonably withheld or delayed. The applicant is not entitled to an award.
Interest
20No interest is payable as no benefits are due.
ORDER
21On the totality of the evidence, I find that:
i. The applicant is not entitled to the treatment plan in dispute.
ii. There is no interest, and the respondent is not liable to pay an award.
iii. The application is dismissed.
Released: April 1, 2026
__________________________
Roderick Walker
Adjudicator