Licence Appeal Tribunal File Number: 24-011917/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:
Amit Parikh
Applicant
and
Unifund Assurance Company
Respondent
DECISION
ADJUDICATOR: Jeff Chatterton
APPEARANCES:
For the Applicant: Zehra Rizvi, Paralegal
For the Respondent: Peter Pietraszek, Counsel
HEARD: In Writing
OVERVIEW
1Amit Parikh, the applicant, was involved in an automobile accident on April 8, 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:
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 limit (“MIG”)?
ii. Is the applicant entitled to $1,751.24 for physiotherapy services, proposed by HealthPlus Rehab Centre in a treatment plan/OCF-18 (“plan”) dated October 6, 2022?
iii. Is the applicant entitled to $2,200.00 for psychological services, proposed by 00269236 Ontario Corp. in a plan dated October 27, 2022?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not met his onus to demonstrate he should be removed from the MIG, and is therefore still subject to the MIG and the $3,500 treatment limit.
4As the applicant is held to the MIG, it is not necessary to review the treatment plans to determine if they are reasonable and necessary.
5Neither interest nor an award are payable.
PROCEDURAL ISSUE
6The respondent argues that the applicant’s submissions were not sent to the Tribunal in time and therefore the entire application should be dismissed.
7I decline to dismiss the application on this basis. The applicant filed submissions on August 12, 2025, on time with the deadline of August 12, 2025 as set in the Case Conference Report and Order. There is no basis for the respondent’s position that the application should be dismissed on this basis.
ANALYSIS
Should the applicant be removed from the MIG on the basis of a psychological condition?
8The applicant has not demonstrated he should be removed from the MIG on the basis of a psychological condition.
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 or subluxation and includes any clinically associated sequelae to such an injury.”
10An 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.
11The applicant argues he has sustained a psychological condition and should - therefore be removed from the MIG. To support his claim, he relies upon the Clinical Notes and Records (CNRs) from his family physicians at the Bristol Family Medical Clinic. Although it is unclear from the CNRs presented, it appears both Dr. Raj Sidhu and Dr. Muhammad Akhtar have examined the applicant.
12The applicant further relies on the OCF-18 for a Psychological Assessment, arguing that he has attended a psychological pre-screen and that he has satisfied his burden to prove he should be removed from the MIG.
13I have carefully reviewed the applicant’s evidence and find the Clinical Notes and Records from his primary care physician do not support a finding that the applicant has suffered an accident-related psychological condition. On several occasions, the doctor notes that the applicant is suffering from stress, but points to concerns regarding the applicant’s business, as opposed to an accident-related condition. The onus remains with the applicant and I have not been led to evidence to suggest an accident-related psychological condition has been sustained.
14In the absence of supportive or corroborating medical evidence, I find the applicant has not, on the balance of probabilities, met his onus to demonstrate he should be removed from the MIG on the basis of a psychological condition.
Should the applicant be removed from the MIG on the basis of pre-existing condition?
15The applicant is not removed from the MIG on the basis of a pre-existing condition.
16The applicant argues he has submitted evidence of a pre-existing condition, specifically chronic upper and lower back pain, dating to prior to the accident. He argues this should be sufficient to establish he is eligible to be removed from the MIG on the basis of a pre-existing condition.
17Although I am alive to the fact that the applicant has a pre-existing condition, the existence of a pre-existing condition alone does not warrant removal from the MIG. The legal test under s. 18(2) specifies that an applicant may be removed from the MIG if they have a pre-existing condition combined with compelling medical evidence stating that the condition precludes recovery if they are kept within the confines of the MIG.
18The applicant has not provided compelling medical evidence that his pre-existing condition precludes recovery if kept in the MIG. Specifically, I have not been led to medical evidence stating that his pre-existing condition precludes recovery if he were to be held to the MIG.
19Therefore, I find on a balance of probabilities that the applicant has not met his onus to determine he should be removed from the MIG due to a pre-existing condition.
20As the applicant is being held to the MIG, it is not necessary to review the treatment plans to determine if they are reasonable and necessary.
Interest
21Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
Award
22The applicant sought an award under s. 10 of Reg. 664. Under s. 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 applicant has not made a substantial argument for an award, merely stating that the insurer has not considered all evidence.
23As I have ruled that no benefits are being unreasonably withheld or delayed, I find no award is payable.
ORDER
24The application is dismissed.
i. The applicant is being held to the MIG and the $3,500 treatment limit.
ii. As the applicant is being held to the MIG, it is not necessary to review the treatment plans in dispute.
iii. Neither award nor interest are payable.
Released: April 13, 2026
Jeff Chatterton
Adjudicator