Licence Appeal Tribunal File Number: 25-005354/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:
Levan Aladashvili
Applicant
and
Definity Insurance Company
Respondent
DECISION
ADJUDICATORS:
Steve Gilchrist Michael Beauchesne
APPEARANCES:
For the Applicant:
Levan Aladashvili, Self-represented
For the Respondent:
Earl Murtha, Counsel
Interpreter:
Olga Sirazhdinova (Russian)
HEARD by Videoconference:
March 3, 2026
OVERVIEW
1Levan Aladashvili (the “applicant”) was involved in an automobile accident on August 12, 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 Definity Insurance Company (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant was self-represented at the hearing. The applicant had earlier retained counsel but at the request of former counsel, on December 17, 2025, the Tribunal issued an order removing former counsel as the representative of record.
3At the commencement of the hearing, the applicant indicated that he had been unable to secure new counsel but indicated he was ready to proceed self-represented.
ISSUES
4The 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 a non-earner benefit (“NEB”) of $185.00 per week from September 9, 2023, to ongoing?
3. Is the applicant entitled to $142.14 ($1237.34 less $1,095.20 approved) for physiotherapy treatment, proposed by New Flow Medical Clinic Inc., in a treatment plan (“OCF-18”) dated December 22, 2023?
4. Is the applicant entitled to $3,648.83 for psychological treatment, proposed by New Flow Medical Clinic Inc., in an OCF-18 dated June 12, 2025
5. Is the applicant entitled to $2,996.75 for a chronic pain assessment, proposed by Ontario Independent Assessment Centre Inc., in an OCF-18 dated September 17, 2024?
6. Is the applicant entitled to $2,295.33 for a psychological assessment, proposed by New Flow Medical Clinic Inc., in an OCF-18 dated April 23, 2025?
7. Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?
8. Is the applicant entitled to interest on any unpaid benefits?
RESULT
5The applicant remains in the MIG.
6The applicant is not entitled to an NEB.
7As the applicant is in the MIG, it is not necessary to consider if the treatment plans are reasonable and necessary.
8As no benefits are payable, no interest is payable.
9The respondent is not liable to pay an award.
ANALYSIS
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 limit?
10We find the applicant has not shown he should be removed from the MIG.
11Section 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”.
12An 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.
13In this case, the applicant seeks to be removed from the MIG because of a psychological impairment and chronic pain.
Should the applicant be removed from the MIG due to psychological injury?
14We find that the applicant has not shown he sustained a psychological injury as a result of the accident that warrants removal from the MIG.
15The applicant testified that he has developed psychological issues, including difficulty sleeping, as a result of the accident. He further testified that the psychological issues created an inability to obtain work.
16The applicant testified that the bulk of his accident-related complaints were made to his rehabilitation therapist, however, the applicant supplied no CNRs from the New Flow Medical Clinic (“New Flow”) to support his position.
17The applicant relies on a psychological assessment report completed by Dr. Konstantinos Papazoglou (psychologist) on June 12, 2025 to support his claim.
18Dr. Papazoglou diagnosed the applicant with adjustment disorder, vehicle passenger phobia, and somatic symptom disorder. He bases these conclusions on the applicant’s presentation (i.e., behavioural observations) and self-reporting on a series of psychometric tests. For example, the applicant told Dr. Papazoglou that his psychological symptoms are worsening and endorsed feelings of sadness, low mood, guilt, irritability, agitation and forgetfulness.
19There is no indication in the report that Dr. Papazoglou reviewed the CNRs of the applicant’s family doctor, Dr. Irena Yelenbaugen, or any other medical records to inform his assessment or corroborate the applicant’s presentation and recollection. The significance of this is underscored by Dr. Papazoglou’s acknowledgement during his testimony that any information not made available might have changed his medical opinion.
20We place little weight on Dr. Papazoglou’s evidence. We find that relying on the applicant’s own report of his medical history hampers the persuasiveness of Dr. Papazoglou’s opinion. This is because the applicant’s reports to Dr. Papazoglou during his assessment in May 2025 about his cognitive and affective functioning are not supported by Dr. Yelenbaugen’s CNRs since the time of the accident in August 2023.
21The applicant provided the CNRs of Dr. Yelenbaugen, however, the applicant did not direct us to any psychological complaints made to Dr. Yelenbaugen at any point after the accident and up to the nearly two years that elapsed before his assessment with Dr. Papazoglou. We find that despite numerous visits to Dr. Yelenbaugen during this post-accident period to receive medical assistance with a wide variety of ailments, Dr. Yelenbaugen’s CNRs do not yield evidence of psychological complaints of anxiety, stress, or phobias. Further, there are no referrals for psychological assessment or treatment offered by Dr. Yelenbaugen.
22In fact, the CNRs suggest diametrically contrary diagnoses by Dr. Yelenbaugen. In each entry in the CNRs of Dr. Yelenbaugen, which span from August 21, 2023 to May 23, 2025, Dr. Yelenbaugen includes the assessment: “Psychiatric: Normal”. On only one occasion, on April 22, 2024, does the doctor note the applicant complaining of headaches, but even that CNR shows a “normal” psychiatric assessment.
23The applicant’s testimony failed to reconcile the discrepancies between his disclosures to Dr. Papazoglou and lack of corresponding complaints to his family physician. The applicant offered only that he did not disclose accident-related injuries and impairments to his family physician because he was undertaking rehabilitation for his physical injuries at a separate clinic.
24The applicant testified we should place no weight on the psychological assessments of Dr. Yelenbaugen, as she is a family doctor and not a psychologist. As the medical practitioner from whom the applicant sought advice on a wide variety of ailments, we reject the suggestion that the CNRs of Dr. Yelenbaugen do not provide the best evidence of the psychological and physical state of the applicant, post-accident.
25The applicant is also relying on a disability certificate (“OCF-3”) completed by Dr. John Bare (chiropractor) on September 7, 2023. In addition to physical ailments, the OCF-3 listed psychological injuries, including: Disorders of Initiating and Maintaining Sleep (Insomnias), other anxiety disorders, state of emotional shock and stress (unspecified), malaise and fatigue, and dizziness and giddiness.
26The respondent noted that psychological diagnoses fall outside the legal scope of practice for chiropractors in Ontario. The applicant made no submissions to contradict this point.
27The OCF-3 records symptoms reported by the applicant to a chiropractor that are inconsistent with the contemporaneous CNRs of Dr. Yelenbaugen, which record the applicant’s symptomology over an extended post-accident period. Therefore, for that reason and because psychological issues fall outside the scope of practice for chiropractors, we find the OCF-3 offers no probative value for determining psychological injury.
28Finally, we were provided a decoded Ontario Health Insurance Plan (“OHIP”) summary which listed the applicant’s visits, in 2025, to a methadone clinic operated by Dove Medical Centre. During each visit, there is a reference to “partial” psychological assessments but they do not assist the applicant’s case. This is because the records of these assessments were not produced as evidence by the applicant to show the purpose of these assessments or any nexus to accident-related psychological symptomology.
29When we take all this evidence together on a balance of probabilities, we are satisfied that the applicant has not established accident-related psychological impairment. We therefore do not agree the applicant should be removed from the MIG on this basis.
Should the applicant be removed from the MIG for chronic pain with a functional impairment?
30We find the applicant has not shown he suffers chronic pain with functional impairment arising from the accident that warrants removal from the MIG.
31To demonstrate he should be removed from the MIG, the applicant must show he sustained chronic pain with functional impairment that is more than sequalae from his accident-related injuries.
32The applicant submits that, after the subject accident, he developed pain in his back, cannot stand for long periods of time, and finds it painful to bend over.
33The applicant is relying on the disability certificate (OCF-3) prepared by Dr. Bare. The OCF-3 lists physical injuries that include a series of sprains and strains and lower back pain. During the hearing, the applicant emphasized that the thrust of his claim relates to his backpain. However, while Dr. Bare attributed difficulties performing housekeeping and home maintenance activities to these injuries and pain—which we accept as being consistent with functional impairment—Dr. Bare estimated that the time for the applicant to completely recover from these injuries was 9-12 weeks.
34The applicant testified that he made his complaints of physical injury to his treating physiotherapist at New Flow, but, again, he has not submitted CNRs from New Flow into evidence.
35We find the applicant’s pain-related impairments most likely resolved within the time frame predicted by Dr. Bare. The applicant testified that he received treatment at New Flow for his accident-related physical injuries that consisted of physiotherapy and massage therapy. The applicant said he started this treatment at the New Flow medical clinic “a couple of days after the accident,” and that he took treatments over the course of 3-4 months—a time frame we find is consistent with Dr. Bare’s estimate of a 12-week recovery period. The applicant did not point to evidence of any further physical treatment since that time.
36Taken together, we find that the evidence related to the OCF-3 and the treatments the applicant claims to have undergone at New Flow are consistent with accident-related sequelae and do not support the claim of chronic pain.
37We have also considered the CNRs of the applicant’s family doctor, Dr. Yelenbaugen. The applicant frequently visited his family doctor, for a wide variety of ailments, yet the first mention of any accident-related injuries in the CNRs of Dr. Yelenbaugen, was 45 days after the accident. The only reference in those CNRs to an objective injury was a reference to “minor bruising”.
38The respondent argues the evidence in the CNRs of Dr. Yelenbaugen rebuts the applicant’s claim of chronic pain during the treatment period. Dr. Yelenbaugen examined the applicant on August 21, 2023, eleven days after the accident, and noted the applicant was “well” with “grossly normal” musculoskeletal and neurological findings. In the CNR for a visit by the applicant 45 days after the accident, Dr. Yelenbaugen makes the same observations of normal musculoskeletal and neurological form and function.
39We were not directed by the applicant to any functionality concerns raised by Dr. Yelenbaugen, nor any references to chronic pain, functional impairment, pain medication requests or referrals to a pain specialist.
40The respondent relies on a section 44 Insurer’s Examination (“IE”) assessment performed by Dr. Charanjit Sandhu, internist, on September 19, 2025.
41We find that the results of Dr. Sandhu’s September 2025 IE are consistent with the bulk of the evidence. While Dr. Sandhu noted the appellant’s complaints of upper and middle back pain, the applicant reported that, with reduced pacing, he is independent with his activities of daily living. Dr. Sandhu‘s physical examination of the applicant produced results similar to those documented by Dr. Yelenbaugen, in that neurological function was normal and the musculoskeletal exam revealed a full range of motion throughout the applicant’s entire spine.
42In assessing whether the appellant suffered from chronic pain syndrome, Dr. Sandhu concluded that applicant met just two of the six criteria under the 6th Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (the “Guides”). We agree that this is insufficient to confirm a diagnosis of chronic pain syndrome because the applicant must meet at least three criteria to qualify for a diagnosis under this framework.
43The applicant provided no evidence to contradict Dr. Sandhu’s evaluation under the Guides. While the applicant is not required to address the Guides, we find he fell short of meeting their evaluation criteria.
44Taken in totality, we find the available evidence does not support that the applicant has chronic pain with a functional impairment. While we accept the applicant experiences back pain, we find that it is most likely accident-related sequalae and therefore captured in the definition of a minor injury.
45We therefore conclude on a balance of probabilities the applicant has not met his onus and remains in the MIG.
Is the applicant entitled to the treatment plans in dispute?
46The applicant remains in the MIG. We therefore find it unnecessary to determine whether the disputed OCF-18s are reasonable and necessary because the parties submitted that the MIG limits have been exhausted.
Is the applicant entitled to an NEB?
47We find that the applicant has not shown entitlement to an NEB for the period in dispute.
48Section 12(1) provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident, if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391 “(Heath”), which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities.
49With respect to the pre-accident activities, we find that the applicant was employed as a window and door installer and was independent in his activities of daily living. We accept the applicant’s testimony on this point.
50Based on the medical evidence and reasoning outlined above, we find that the applicant’s accident-related impairments are soft tissue injuries to his back.
51Turning to the question of whether the applicant’ accident-related impairments continuously prevent the applicant form engaging in substantially all his pre-accident activities, we find that they do not.
52First, we find that the applicant can carry out normal activities of daily living. We note that Dr. Bare indicated on the OCF-3 that the applicant’s inability to carry on a normal life should resolve within 12 weeks. This is persuasive, given that when the applicant was asked during cross-examination whether he continued to be capable of handling his self-care, housekeeping, shopping and other normal activities of daily living, his response was “I’m not disabled, I’m just in pain. I can do all those things.”
53The applicant’s testimony is also corroborated by the absence of any limitations or restrictions documented in Dr. Yelenbaugen’s records. Further, in the IEs conducted by Dr. Sandhu on September 19, 2025, and Harish Sharma (occupational therapist) on December 23, 2025, we find Dr. Sandu and Mr. Sharma both agreed the applicant did not have a disability that would preclude the applicant from carrying on a normal life. Both assessors noted that the applicant could continue to do the same activities of daily living he performed pre-accident, albeit with reduced pacing and more frequent breaks. Mr. Sharma’s report also mentions that the applicant is able to socialize with friends and operate an electric bike in his community. In our view, this evidence is at odds with a complete inability to carry on a normal life and weighs against the applicant’s claim.
54Second, while it may be the case that the applicant cannot perform the same work duties he engaged with pre-accident, we find this, in and of itself, is not sufficient to meet the test of an inability to engaging is substantially all his pre-accident activities. To the extent that employment forms a part of the applicant’s pre-accident activities, and the applicant speculated that “nobody would want to hire him” post-accident, he did not go further to provide insight into what other work he considered, was capable of performing, or may have attempted. In other words, he has not established on a balance of probabilities that it is his accident-related impairments that are preventing him from doing his pre-accident work.
55Taken together, on a balance of probabilities, we find the applicant has not established NEB entitlement under the Schedule.
The respondent’s arguments about s. 44 IEs
56At the outset of the hearing, the respondent pointed to an argument it had raised in its response to the applicant’s appeal. The thrust of the respondent’s position was that the applicant was statutorily barred from applying for an NEB and the psychological OCF-18s in dispute because he had failed to attend section 44 psychological IEs to assess his eligibility for these benefits. Submissions were heard from the parties on this issue and we reserved our decision.
57Given our analysis that the applicant has not established his substantive entitlement to any of these medical benefits, we find it unnecessary to make a decision on the applicant’s compliance with the respondent’s section 44 IEs.
AWARD
49We find the respondent is not responsible for paying an award.
50The applicant seeks an award under section 10 of Regulation 664. Under section 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. The Tribunal has determined that an award is justified where the delay or withholding of benefits by the insurer is unreasonable conduct, meaning behaviour which is excessive, imprudent, stubborn, inflexible, unyielding or immoderate. The onus is on the applicant to prove, on a balance of probabilities, that the respondent’s conduct meets this threshold.
51The applicant did not lead submissions or evidence to support his award claim, and it therefore follows this claim must fail.
INTEREST
52Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. As no benefits are overdue in this case, the applicant is not entitled to interest.
ORDER
53The Tribunal orders:
i. The applicant’s injuries are predominantly minor and he is held within the MIG.
ii. As the applicant is held within the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
iii. The applicant is not entitled to an NEB.
iv. The applicant is not entitled to an award.
v. The applicant is not entitled to interest as there are no payments overdue for the benefits claimed.
Released: April 14, 2026
__________________________
Steve Gilchrist
Adjudicator
__________________________
Michael Beauchesne
Adjudicator