Sapna v. Intact Insurance Company, 2026 CanLII 29577

Citation: Sapna v. Intact Insurance Company, 2026 ONLAT 24-011943/AABS

Licence Appeal Tribunal File Number: 24-011943/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:

Sapna Sapna

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR: Amar Mohammed

APPEARANCES:

For the Applicant: Linda Spurrell, Paralegal

For the Respondent: Aaron Weinroth, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Sapna Sapna, the applicant, was involved in an automobile accident on July 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, Intact 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:

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 $2,858.17 for chiropractic services, proposed by Inspire Massage and Fitness in a treatment plan/OCF-18 (“plan”) dated August 22, 2022?

iii. Is the applicant entitled to $1,300.00 for physiotherapy services, proposed by Wanless Rehab in a treatment plan dated January 29, 2024?

RESULT

3The applicant has not established chronic pain with a functional impairment warranting removal from the MIG. Since the applicant is subject to the MIG, an analysis of whether the plans in dispute are reasonable and necessary is not warranted.

ANALYSIS

The applicant is subject to the MIG

4I find that the applicant has not established she has chronic pain with a functional impairment warranting removal from the MIG.

5Section 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.”

6An 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.

7The applicant argues that she should be removed from the MIG because she has chronic pain with a functional impairment. In support, the applicant refers to her family doctor and treating physiotherapist’s recommendations for continued physiotherapy. Further, that this treatment is required to alleviate pain that she experiences on a daily basis which has reduced her tolerance for prolonged sitting, walking, bending, reaching, lifting and going up the stairs. The applicant notes that three years have passed since the accident, and her pain has potential to become chronic.

8The respondent’s position is that the applicant suffered only uncomplicated soft tissue injuries and is therefore subject to the MIG. The respondent relies on a section 44 report of physician Dr. Ahmed Mian, dated June 27, 2023, opining the applicant’s injuries are within the definition of the MIG. Dr. Mian reiterated this opinion in an addendum report dated August 29, 2023.

9The applicant has not led evidence of a diagnosis of chronic pain. Although a diagnosis of chronic pain is not required, the applicant’s submissions also do not establish any particulars regarding the pain that would address, with evidence, that the applicant has pain accompanied by functional impairment such that it is more than sequalae of the applicant’s minor injury covered by the MIG. Counter to this threshold, the respondent argues that the applicant has returned to work as a personal support worker.

10Further, I find that the applicant’s reference to her treating physiotherapist’s opinion in an OCF-18 that the applicant’s injuries are not a minor injury under the MIG is not supported by any reference to chronic pain by the provider or the applicant’s family doctor. I also note that experiencing pain or having a reduced tolerance as argued by the applicant does not on its own meet the threshold of severe or disabling pain outside the definition of a minor injury. Lastly, I note that OCF-18s are not medical evidence in and of themselves and require the claims made to be established through corroborating evidence.

11I find, on a balance of probabilities, that the applicant has not established she has chronic pain with a functional impairment warranting removal from the MIG.

12Since the applicant is subject to the MIG, an analysis of whether the plans in dispute are reasonable and necessary is not warranted. Further, the parties identified $945.18 remaining under the MIG, available to the applicant at the time of submissions. The applicant is entitled to treatment up to the MIG limits.

Interest

13The applicant is not entitled to interest because interest applies on the payment of overdue benefits pursuant to s. 51 of the Schedule. There are no overdue benefits payable.

ORDER

14For the reasons above, I make the following orders:

i. The applicant does not have chronic pain with a functional impairment warranting removal from the MIG.

ii. Since the applicant is subject to the MIG, an analysis of whether the plans in dispute are reasonable and necessary is not warranted.

iii. There are no overdue benefits payable to which interest applies.