Citation: Sothilingam v. Definity Insurance Company, 2026 ONLAT 24-013296/AABS

Licence Appeal Tribunal File Number: 24-013296/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:

Selvakumar Sothilingam

Applicant

and

Definity Insurance Company

Respondent

DECISION

VICE-CHAIR: Julian DiBattista

APPEARANCES:

For the Applicant: Patrick D'Aloisio, Counsel

For the Respondent: Camilla Oblak, Counsel

HEARD: In Writing

OVERVIEW

1Selvakumar Sothilingam, the applicant, was involved in an automobile accident on January 6, 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, Definity Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2On the application, the applicant has listed the date of the accident as January 6, 2024. However, I note that in the Case Conference Report and Order, as well as all submissions including the applicant’s, the date of the accident is agreed to be January 6, 2022. I will therefore proceed with this hearing for injuries sustained in a January 6, 2022 accident.

ISSUES

3The 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 $3,673.38 for physiotherapy services, proposed by Canadian Active Rehabilitation, in a treatment plan/OCF-18 (“plan”) submitted on September 9, 2024 and denied on October 15, 2024?

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

RESULT

4The applicant has not proven injuries outside the MIG.

5As the applicant is in the MIG, it is not necessary to consider if the disputed treatment plan is reasonable and necessary.

6The applicant is not entitled to interest.

ANALYSIS

The applicant has not proven injuries outside the MIG

7I find the applicant has not proven an injury or impairment which warrants removal from the MIG.

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.

10The applicant has made the following submissions on their position within the MIG:

Following the motor vehicle accident, the Applicant advised his family doctor that he was stopped at a red light and was rear ended. The bumper on his vehicle was broken.

[an image of the clinical note has been excluded]

At Tab 1 is a copy of a disability certificate dated June 23, 2022. This document states that the applicant could not return to a normal life. He was off work due to back and shoulder pain following the subject accident. Unfortunately, he was involved in a subsequent accident on February 7, 2022.

The insurer has denied physiotherapy treatment and has refused and/or neglected to remove the Applicant from the MIG. The medical evidence clearly states that the Applicant could not return to work and could not return to a normal life.

At Tab 2 is a copy of a report from Trillium Physiotherapy dated February 17, 2022 recommending further physiotherapy. The insurer conducted and IE and stated it was not reasonable or necessary.

11The remaining pages of the applicant’s submissions summarize various pieces of case law, without connecting them to the facts in this application.

12The note from the unnamed family physician indicates that the applicant has had pain in his neck, upper and lower back since the accident. It was written on January 15, 2022, shortly after the accident. The applicant has not identified their family physician and has cut off the signature from the note. These injuries and general complaints of pain all fall within the MIG.

13The report from Trillium Physiotherapy further corroborates the fact that the applicant’s injuries fall within the MIG. In the report, Dr. A. Alechina, chiropractor, notes that the applicant “was diagnosed with sprain/strain injuries of his cervical and lumbar spines as well as the left thumb.” These injuries fall squarely within the s. 3 definition of a minor injury.

14The OCF-3 disability certificate was completed by Dr. Alechina on June 23, 2022. The following injuries and sequelae were listed:

i. Suspected right L4 injury;

ii. Sprain and strain of cervical spine;

iii. Sprain and strain of lumbar spine;

iv. Sprain and strain of sacroiliac joint; and

v. Headache.

15These injuries and sequalae do not indicate an injury or impairment that would fall outside of the MIG.

16While the applicant did make reply submissions, the submissions applicable to the MIG dispute consist solely of the definition of a minor injury.

17The respondent submits that the medical evidence submitted by the applicant shows only minor injuries and that none of the applicant’s case law has been connected to the applicant’s condition.

18I agree with the respondent. Based on the very limited medical evidence adduced by the applicant, there is no indication that the applicant sustained anything other than an injury that falls within the MIG. Further, while I am alive to the applicant’s reports of pain, there is no diagnosis of chronic pain in the records before me, and no discussion of how this pain is of a severity or nature that it is causing functional impairment sufficient to warrant removal from the MIG.

19The applicant has not pointed me to any medical evidence which would support his submission that he could not return to work and could not return to a normal life.

20The case law cited by the applicant was not helpful to adjudicating this dispute as the applicant did not connect it to the facts and evidence before me. Even if he did, there is no evidence before me that he sustained an injury that falls outside of the s. 3 definition under the Schedule.

21Therefore, I find that the applicant has not met their burden to prove, on the balance of probabilities, an injury which warrants removal from the MIG.

22Having determined that the applicant remains within the MIG, an analysis of the reasonableness and necessity of the disputed treatment plan is not required. The applicant is entitled to treatment within the confines of the MIG.

Interest

23Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, no interest is payable.

ORDER

24For the reasons above, I find that:

i. The applicant has not proven injuries that warrant removal from the MIG;

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

iii. There is no entitlement to interest.

25This application is dismissed.