Citation: Singh v. Unifund Assurance Company, 2026 ONLAT 24-011971/AABS

Licence Appeal Tribunal File Number: 24-011971/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:

Sukhmanpreet Singh

Applicant

and

Unifund Assurance Company

Respondent

DECISION

VICE-CHAIR:

Julian DiBattista

APPEARANCES:

For the Applicant:

Ilia Estrah, Counsel

For the Respondent:

Ryan Jeffries, Paralegal

HEARD: In Writing

OVERVIEW

1Sukhmanpreet Singh, the applicant, was involved in an automobile accident on November 4, 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, Unifund Assurance 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 $1,981.69 ($2,344.58 less $362.89 approved) for physiotherapy, proposed by Vital Care Physiotherapy in a treatment plan/OCF-18 ("plan") dated June 9, 2024?

3. Is the applicant entitled to the medical services proposed by Inline Rehabilitation Centre, as follows:

i. $1,920.52 for a Psychological Assessment, in a plan dated March 23, 2023;

ii. $4,210.82 ($4,217.71 less $6.89 approved) for Chiropractic, Massage and Occupational Therapy Services, in a plan dated April 13, 2023; and

iii. $2,519.00 for a Psychological Services, in a treatment plan dated July 6, 2023?

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

RESULT

3The applicant has not proven an injury that would warrant removal from the MIG.

4As the applicant is in the MIG, it is not necessary to consider if the treatment plans and balances are reasonable and necessary. The applicant is not entitled to interest.

ANALYSIS

The applicant remains subject to the MIG

5I find that the applicant has not suffered a psychological condition which warrants removal from the MIG.

6Section 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."

7An 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.

8The applicant submits a s.25 psychological assessment report of Mr. V. Kleiman, clinical psychologist, who found that the applicant suffers from a DSM-5 diagnosis of Specific Phobia (driving related).

9The respondent submits two s.44 psychological assessment reports. One from Mr. M Lotfalizadeh, and one from Dr. S. Mor, both clinical psychologists. Both found that the applicant did not meet the standard of a DSM-5 diagnosis.

10The section 25 assessment occurred on March 28, 2023. The applicant was assessed by Ms. M. Simmons who interviewed the applicant and administered psychometric testing under the clinical supervision of Mr. Kleiman.

11The respondent submits that there are several issues with the s.25 report and asks the Tribunal to give it limited weight.

12Firstly, the report does not highlight what the professional qualifications of Mr. Kleiman and Ms. Simmons have. I partially disagree with this submission with respect to Mr. Kleiman who is identified as a clinical psychologist, which is a regulated profession within the province of Ontario. However, I agree with their assessment of Ms. Simmons. The only evidence of any education or professional qualifications for Ms. Simmons is the presence of the "MA" post-nominal letters following her name. There are no further specifics given as to her professional qualifications.

13Secondly, the respondent notes that the interview and testing was conducted by Ms. Simmons "under the supervision" of Mr. Kleiman, and that there is no evidence that Mr. Kleiman met or had firsthand observations of the applicant. I agree with the respondent's position on this point.

14Lastly, the respondent notes that there was no review of any medical documentation or clinical history of the applicant by either Ms. Simmons or Mr. Kleiman. Again, I agree, the report does not indicate that any records or documentation have been reviewed as part of the assessment.

15The applicant was assessed by Mr. Lotfalizadeh on May 30, 2023 and by Dr. Mor on August 26, 2024.

16The applicant takes issue with the opinion in Dr. Mor's assessment as it does not reflect that the applicant scored within the severe ranges on both the Beck Depression Inventory and the Beck Anxiety Inventory. I agree with the applicant on this point.

17I place highest weight on the report of Mr. Lotfalizadeh over that of Dr. Mor and Mr. Kleiman because Mr. Lotfalizadeh's qualifications are identified, he reviewed the medical records, and he assessed the applicant before rendering his opinion.

18Mr. Lotfalizadeh administered both the Beck Depression Inventory II and the Beck Anxiety Inventory. The applicant scored within the asymptomatic range of depression and in the minimal range of anxiety. These results are corroborated with those of Mr. Kleiman whose psychometric testing using the Depression Anxiety Stress and Scale found that the applicant exhibited normal levels of depression, anxiety and stress.

19In further support of their position, the applicant has submitted the clinical notes and records of Dr. Y. Dhaliwal, the applicant's family physician and Dr. H. Bajaj, a physician who assessed the applicant for a pain consult.

20Dr. Bajaj indicates in his notes that the applicant denies any anxiety. He advised that the applicant could consider a pain psychologist, but this is the extent of Dr. Bajaj's comment on psychological issues.

21While the applicant has submitted Dr. Dhaliwal's clinical notes and records in whole as evidence, I have not been pointed to a specific notation that would support a psychological impairment. Having reviewed the records myself, I have not been able to find a reference to the applicant's psychological condition.

22As noted above, I give the most weight to the assessment conducted by Mr. Lotfalizadeh who found that the applicant does not suffer from any psychological impairment as per the DSM-5 as a result of the accident.

23The results from the psychometric testing administered by Mr. Lotfalizadeh are corroborated by the results of psychometric testing administered by Ms. Simmons.

24In addition, the finding that the applicant does not have an accident-related psychological impairment is further supported by the clinical notes and records of Dr. Bajaj who noted that the applicant denies anxiety and those of Dr. Dhaliwal who did not note any psychological complaints or symptoms.

25Therefore, I find on a balance of probabilities that the applicant has not proven a psychological impairment that would warrant removal from the MIG.

The applicant is entitled to treatment up to the MIG limit

26Having determined that the applicant remains within the MIG, an analysis of the reasonableness and necessity of the disputed treatment plans and balances is not required.

Interest

27Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, there is no entitlement to interest.

ORDER

28For the reasons above, I find that:

i. The applicant remains subject to the MIG;

ii. As the applicant is in the MIG, it is not necessary to consider if the treatment plans and balances are reasonable and necessary. The applicant is entitled to treatment within the MIG limits; and

iii. There is no entitlement to interest.

29This application is dismissed.