Licence Appeal Tribunal File Number: 24-010924/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:
Brian King
Applicant
and
Allstate Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Aric Bhargava
APPEARANCES:
For the Applicant:
Bianca Crocetti, Paralegal
For the Respondent:
Colleen Mackeigan, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Brian King, the applicant, was involved in an automobile accident on March 24, 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, Allstate Insurance Company of Canada, and applied to the Licence Appeal Tribunal — Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
Are the applicant’s injuries predominantly minor as defined in section 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline (“MIG”) limit?
Is the applicant entitled to chiropractic services proposed by Mackenzie Medical Rehabilitation Centre Inc. in a treatment plan/OCF-18s (“plan”), as follows:
i. $3,622.73, in a plan submitted April 21, 2023;
ii. $2,023.03, in a plan submitted August 25, 2023; and
iii. $1,691.73, in a plan submitted April 21, 2023?
Is the applicant entitled to interest on any overdue payment of benefits?
Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?
RESULT
3The applicant is subject to the MIG.
4As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
5The treatment plans are not payable pursuant to section 38.
6As there are no overdue benefits, the applicant is not entitled to interest.
7The applicant is not entitled to an award under section 10 of Regulation 664 because no payments were unreasonably withheld or delayed.
ANALYSIS
Application of the Minor Injury Guideline
8I find the applicant’s injuries are predominantly minor injuries subject to treatment within the MIG.
9Section 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 of subluxation and includes any clinically associated sequelae to such an injury.”
10The applicant may be removed from the MIG if he can establish his accident-related injuries fall outside of the MIG or, under section 18(2), that he has a documented pre-existing condition combined with compelling medical evidence stating that the condition precludes maximal recovery if he is kept within 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.
11The applicant summarizes that he is not subject to the $3,500.00 limit on benefits due to a concussion, psychological impairment, and chronic pain. The applicant relies on the clinical notes and records (“CNRs”) of Trillium Health Hospital Emergency Department, the