Citation: Coriglione v. Definity Insurance Company, 2026 ONLAT 25-006471/AABS

Licence Appeal Tribunal File Number: 25-006471/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:

Leonardo Anthony Riccardo Coriglione

Applicant

and

Definity Insurance Company

Respondent

DECISION

ADJUDICATOR:

Steve Gilchrist

APPEARANCES:

For the Applicant:

Darya Katkouskaya, Counsel

For the Respondent:

Jonathan Charland, Counsel

HEARD: by Videoconference:

January 27 and January 28, 2026

OVERVIEW

1Leonardo Anthony Riccardo Coriglione, the applicant, was involved in an automobile accident on May 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, Definity Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUE

2The preliminary issue to be decided is:

i. Is the applicant barred from proceeding to a hearing for Issue (iii) below because the applicant failed to dispute the denial within the 2-year limitation period?

SUBSTANTIVE ISSUES

3The issues to be decided in the hearing 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 a non-earner benefit (“NEB”) of $185.00 per week from June 21, 2023 to May 24, 2025?

iii. Is the applicant entitled to $3,954.92 for physiotherapy services, proposed by Well Care Medical Rehab in a plan dated June 20, 2023?

iv. Is the applicant entitled to $3,790.70 for psychological services, proposed by 101 Assessment Centre in a treatment plan/OCF-18 (“plan”) dated January 8, 2024?

v. Is the applicant entitled to $2,460.00 for a psychological assessment, proposed by 101 Assessment Centre in a plan dated October 18, 2023?

vi. Is the applicant entitled to $2,460.00 for a chronic pain assessment, proposed by 101 Assessment Centre in a plan dated March 25, 2024?

vii. Is the applicant entitled to $2,460.00 for a neurological assessment, proposed by 101 Assessment Centre in a plan dated March 25, 2024?

viii. Is the applicant entitled to $616.07 ($1,300.00 less $683.93 approved) for physiotherapy services, proposed by Well Care Medical Rehab in a plan dated January 8, 2024?

ix. Is the applicant entitled to $2,805.40 for physiotherapy services, proposed by Well Care Medical Rehab in a plan dated March 15, 2024?

x. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

RESULT

4For the reasons that follow, I find that:

i. The applicant is barred from proceeding to a hearing on the treatment plan listed as Issue 3(iii).

ii. The applicant’s injuries are predominantly minor and he is held within the MIG.

iii. As the applicant is held within the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.

iv. The applicant is not entitled to an NEB.

v. The applicant is not entitled to an award.

vi. The applicant is not entitled to interest as there are no payments overdue for the benefits claimed.

PRELIMINARY ISSUE

5For the reasons that follow, I find that the applicant did not dispute the denial of the treatment plan dated June 20, 2023 within the 2-year limitation period and is therefore barred from proceeding to a hearing on that benefit.

6Section 56 of the Schedule provides that an application to the Tribunal in respect of a benefit shall be commenced within two years after the respondent’s refusal to pay the amount claimed. However, pursuant to section 7 of the Licence Appeal Tribunal Act, 1999, S.O. 1999, c. 12, Sched. G (the “LAT Act “), the Tribunal has the authority to extend the limitation period beyond the 2-year mark outlined by section 56 of the Schedule.

7The applicant submitted an OCF-18, dated June 20, 2023, in the amount of $3,954.82 which was denied by the respondent on the basis that the applicant was to be held within the MIG. The respondent submits that the OCF-18 was actually filed and received on June 29, 2023. As evidence, the respondent submitted the OCF-18 showing the HCAI number and receipt date and time as June 29, 2023 at 2:47 pm. The applicant did not contest that correction. The respondent denied the OCF-18 on July 14, 2023.

8The applicant does not dispute that the application was filed on August 6, 2025, which is outside the two-year limitation period to dispute a denial. However, the applicant submits that the respondent is precluded from denying this treatment plan because the respondent failed to provide a proper response in writing within the 10-business day deadline established within s. 38(8) of Schedule and submits that the treatment plan is therefore automatically approved in accordance with s. 38(11) of the Schedule.

9The respondent notes that it issued a denial letter which was delivered by email, on July 14, 2023. This letter is found at Tab 25 of the Respondent’s Brief. The respondent noted that, since Canada Day fell on a weekend, the following Monday was considered a statutory holiday. Accordingly, July 14 was the tenth business day following receipt of the OCF-18, which means it fell within the statutory requirements under s. 38(8).

The denial triggered the limitation period

10In order for the denial to trigger section 56, it must comply with the principles set out in Smith v. Co-operators General Insurance Co., 2002 SCC 30 (“Smith”). According to Smith, the information in a denial notice must be provided in straightforward and clear language, directed towards an unsophisticated person. The information should also include a description of the most important points of the dispute resolution process, and the relevant time limits that govern the process.

11The sole issue raised by the applicant is the failure of the respondent to deny the treatment plan within the 10-business day period provided in s. 38(8).

12In the denial letter, the respondent advised the applicant that his injuries fell within the designation of the MIG. The denial letter provided the definition of MIG and advised that this designation carries a maximum medical and rehabilitation benefit limit of $3,500.00. The denial letter identified the individual treatment plan submitted and the amount for which it is denied in full.

13In my opinion, the denial letter clearly and unequivocally explains the denial in a way that an unsophisticated person would understand, and it is clear that the respondent would not be paying the amount claimed. As noted above, whether reference to the MIG satisfies the requirement of “medical reasons and all of the other reasons” stipulated at section 38(8) is not a consideration here.

14The letter also includes “right to dispute” information setting out the process to dispute the denials. Regarding the two-year limitation period, I note that the letter includes the following:

WARNING: TWO YEAR TIME LIMIT

You have TWO YEARS from the date of your insurance company's refusal to pay,

or reduction of a benefit, to file an application with the Licence Appeal Tribunal –

Automobile Accident Benefits Service. If you do not apply within two years, you

will lose the right to dispute the determination.

15I find that the denial letter satisfies the requirements as set out in Smith. As such, the 2-year limitation period was triggered as of July 14, 2023.

An extension of the 2-year limitation period is denied

16Section 7 of the LAT Act allows the Tribunal to extend a limitation period for filing an appeal. In considering whether to exercise its discretion to extend the limitation period, the Tribunal must consider the following four factors set out in Manuel v. Registrar, 2012 ONSC 1492 (“Manuel”):

i. The existence of a bona fide intention to appeal within the limitation period;

ii. The length of delay;

iii. The prejudice to the other party; and,

iv. The merits of the appeal.

17The onus is on the applicant to establish reasonable grounds for an extension under s. 7 of the LAT Act. The applicant made no submissions regarding an extension or make substantive submissions as to whether one is warranted.

18Accordingly, I decline to use the discretion provided to me under section 7 of the LAT Act to extend the limitation period.

19For the reasons provided above, I find that the denial met the provisions of the Schedule and, accordingly, the applicant is barred pursuant to s. 56 from proceeding to a hearing on Issue 3(iii).

PROCEDURAL ISSUE

20At the outset of the hearing, the respondent objected to the late filing of a revised prescription summary by the applicant. The summary was delivered to the Tribunal on January 24, 2026, two business days before the commencement of this hearing. The respondent argued that this late filing was in contravention of the timelines for filings included in the Case Conference Report and Order of September 2, 2025. It further argued there was no reason for the late filing and that, if it were accepted, it would cause prejudice to the respondent due to its inability to prepare a rebuttal.

21The applicant provided no explanation for the late filing but did note that the only material changes between this summary and the one already included in his earlier filing was the listing of additional prescriptions of Lyrica, a pain killer. The applicant did not provide any arguments on whether the factors in Rule 9.3 with respect to admitting late-filed evidence, were applicable.

22Given that the prescribing of Lyrica was already admitted as evidence at this hearing and the lack of any reason for the non-compliance, I saw no compelling argument in favour of allowing this late filing and, on the contrary, I accepted the argument of the respondent that allowing it would cause it prejudice.

23The respondent’s request to exclude the late-filed prescription summary is granted.

SUBSTANTIVE ISSUES

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 MIG limit?

24On the balance of probabilities, I find that the applicant’s injuries are predominantly minor, and his treatment should be held within the MIG.

ANALYSIS

25Section 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”.

26An 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.

27The applicant submits that he suffers from psychological injuries and chronic pain and should be excluded from the MIG. The respondent disagrees.

Chronic Pain with Functional Impairment

28The applicant has not established that he suffers chronic pain with functional impairment which would warrant his removal from the MIG.

29The applicant testified that he suffers from chronic pain in his neck, shoulders, upper and lower back and his left leg and he began suffering from headaches and fitful sleep as a result of injuries incurred in the accident. The applicant testified that he had no health issues prior to the accident and no sleep issues.

30The applicant testified that, as a result of injuries he sustained in the accident, he commenced physiotherapy, chiropractic and massage treatments. He found the treatments therapeutic, though the benefits were short-lived. He continued the treatments until the insurance benefits were exhausted.

31The applicant has directed me to limited medical evidence to corroborate his injury claims. The applicant testified that he only saw his family doctor once or twice for accident-related injuries, since the accident, because he claims to have an aversion to visiting doctors noting he believes “doctors only want to prescribe pills”. The applicant stated he doesn’t want to take pain killers due to past addiction to opioids.

32The respondent noted that the applicant has visited his family doctor in person only once, on May 2, 2025, almost two years after the accident, at which time he was assessed with left shoulder and neck strain. These injuries are, by definition in the Schedule, considered minor. At that visit, the applicant requested medical imaging but didn’t ask for any referrals or medication to help deal with pain.

33The applicant also provided X-ray and ultrasound records from Finchview X-Ray and Ultrasound Clinic taken on May 8, 2025 to support his argument that his chronic pain arose from injuries to his back. The results of that imaging were as follows:

i. “Left shoulder X-ray and U/S: Mild to moderate degenerative changes in the left shoulder as described. Ultrasound demonstrates a partial thickness intrasubstance supraspinatus tear, subscapularis tendinosis, subacromial/subdeltoid bursitis, and bicipital calcific tendinitis

34The applicant provided no additional medical evidence or interpretation of the X-ray and ultrasound report.

35The respondent’s musculoskeletal examiner, Dr. Seung-Jun Lee, testified that, in the absence of any imagery pre-accident, it is difficult to prove there is any connection between the current condition of the applicant and the subject accident. Dr. Lee noted that the “partial thickness intrasubstance supraspinatus tear” is specifically considered a minor injury and that only a full thickness tear would fall outside the MIG. Dr. Lee noted that, particularly for someone engaged in the sort of repetitive activities in which the applicant would have engaged in his construction work, it is very typical to find a partial tear. Dr. Lee testified he found no limitation in the applicant’s range of motion.

36Dr. Lee concluded that the X-ray and ultrasound imaging of the applicant revealed conditions which are specifically defined in the Schedule as “minor injuries” and degenerative changes unrelated to the accident, which do not warrant removal from the MIG.

37To support his claims, the applicant is also relying on the chronic pain assessment by Dr. Grigory Karmy, chronic pain specialist, on June 17, 2025.

38In his report, Dr. Karmy diagnosed the applicant as suffering from chronic mechanical neck, left shoulder, left wrist, left hand and upper back pain, as well as myofascial pain syndrome, chronic pain syndrome and sleep disorders and he attributed those injuries to the subject accident.

39Dr. Karmy notes that his diagnosis was based on a review of the applicant’s medical history, a physical examination and a review of the clinical notes and records (“CNRs”) of the methadone clinic attended by the applicant.

40The respondent raised the issue of the failure of the applicant to call Dr. Karmy as a witness despite Dr. Karmy being listed by the applicant as a witness in the Case Conference Report and Order. The respondent argued that the Tribunal should give no weight to Dr. Karmy’s report given the procedural unfairness of the respondent not being able to cross-examine Dr. Karmy on his evidence.

41The applicant made no submissions on the issue.

42In my deliberations, I gave greater weight to the evidence of the witnesses who did testify and who, therefore, could be cross-examined on their evidence.

43I note that Dr. Karmy’s report offered two observations which significantly contradicted the current testimony of the applicant. In his report, Dr. Karmy noted about the applicant: “His pre-existing upper back pain was aggravated by the subject accident”. This directly contradicts the applicant’s claim that he had no chronic pain prior to the accident. Similarly, Dr. Karmy noted: “The claimant has developed worsening of his sleep disturbances since the subject accident. Again, this directly contradicts the applicant’s testimony that he had no sleep issues prior to the subject accident.

44There were significant inconsistencies in the applicant’s self-reporting to various assessors. Dr. Karmy’s report mentioned “pre-existing upper back pain that was aggravated by the subject accident”. Dr. Papazoglou’s report placed considerable weight on the applicant’s claim of severe headaches while Dr. Karmy’s reference to headaches noted “they have resolved at the current time”. When listing the prescriptions the applicant was taking at the time of the report, Dr. Karmy makes no reference to Lyrica in contrast with the prescription record in the evidence. These are all significant discrepancies which highlight contradictions in the self-reporting of the applicant during different examinations.

45Despite the diagnosis in the report by Dr. Karmy that the applicant suffers from driving anxiety, the applicant testified that he never made such a claim during his s. 25 assessment. In his testimony and in the surveillance video, there is clear evidence that the applicant drives long distances for work and to socialize with his girlfriend. Contrary to the claims in the report by Dr. Karmy, the applicant testified that he uses 400-series highways for the bulk of his long-distance travel.

46The applicant also provided the CNRs of True North Medical Centre (“True North”), the facility which was providing the methadone treatment for the applicant from May 24, 2020 to March 29, 2025. Those records show that the applicant attended, weekly, over the previous five years, except for two intervals where he was travelling in Europe. Despite the frequency of the visits, there is only one reference in those CNRs, on March 11, 2024, to pain arising from the motor vehicle accident. These CNRs do not assist the applicant in establishing that he has an ongoing accident-related pain, or that that pain results in a functional limitation.

47The applicant testified during cross-examination that he has an extreme aversion to going to doctors because “they only push pills”, yet I note that he sought, and obtained, prescriptions from the doctors at the methadone clinic for 10 different medications representing a total of 19 different prescriptions.

48Similarly, the applicant testified he had no sleep issues prior to the accident but the prescription for trazodone, a medication used to treat sleep disorders, was first prescribed on June 4, 2020, three years prior to the subject accident. On March 25, 2023, two months prior to the accident, the CNRs of True North show that the applicant again requested trazodone and it included the notation “it had worked well in the past”. During his cross-examination, the applicant claims he never made such a statement to the doctor because “they don’t work” yet his most recent prescription was on May 24, 2025. When asked by the respondent to explain this apparent contradiction and why he filled these prescriptions, the applicant testified he “takes them to make the pharmacist money”.

49An insurer’s neurology examination was performed by Dr. Barbara Connolly on May 21, 2024. Dr. Connolly found the applicant should be held within the MIG. Dr. Connolly diagnosed the applicant’s only neurological impairment as being consistent with carpal tunnel syndrome which she noted was unlikely to be related to the subject accident.

50Dr. Sun Jeung Lee testified regarding his in-person s. 44 musculoskeletal assessment of the applicant performed on May 1, 2024. Dr. Lee testified he is qualified to provide an opinion on permanent impairment using the 6^th Edition of the AMA Guides to the Evaluation of Permanent Impairment (“AMA Guide”).

51Dr. Lee noted the applicant claimed to have had a 65-70% improvement in his physical condition since the subject accident and that he was fully independent with all self-care before and after the accident.

52Dr. Lee found the applicant’s prognosis to be good and his conclusions were that the applicant’s musculoskeletal injuries as a result of the May 24, 2023 motor vehicle accident are predominantly minor injuries as defined in the Schedule. He noted that the AMA Guide requires a patient to meet 3 of 6 possible criteria to be diagnosed with chronic pain syndrome and he found the applicant met none of the criteria.

53I was shown no evidence citing the AMA Guide by the applicant. Of the expert testimony before me, that of Dr. Lee is clearly the more detailed and credible, given the in-person and objective nature of his assessment, versus the applicant’s self-reporting that formed the basis of Dr. Karmy’s report.

54Dr. Lee’s characterization of the physical injuries as “minor” under the AMA Guide and the Schedule was not contested by the applicant.

55I find that the applicant’s testimony that he did not seek treatment for his pain because he had an aversion to seeing doctors because they “push pills” was not supported by the CNRs of his medical practitioners, particularly True North. I further find that the applicant’s testimony that he only discussed methadone treatment issues when he attended True North was contradicted by their CNRs. The CNRs of True North reveal that the applicant consistently discussed a number of health-related issues outside of his methadone treatment but that the applicant only once raised the issue of accident-related pain in the years since the accident. Further, the CNRs demonstrate that the applicant has been prescribed a wide variety of medications pre-accident, including medication for anxiety and sleep issues, which contradicted his testimony that he did not suffer from sleep issues or psychological symptoms pre-accident.

56I am not persuaded by the applicant’s testimony that he was suffering from chronic pain. The applicant testified that he has been offered several strategies to address the pain he claims to be suffering from. However, he declined to take the pain relief medication prescribed by Dr. Fong after the accident. He testified he makes monthly visits to his addiction specialist, but his testimony was that only once, 16 months after the accident, did he raise the issue of any post-accident ailments with that doctor. Finally, I note that although the applicant indicates that his pain is chronic, he waited over eight months after the motor vehicle accident, before he first mentioned the accident to his family doctor and almost two years after the accident before undergoing X-rays and an MRI.

57I find the failure of the applicant to seek timely medical assistance is inconsistent with his claims of serious and chronic pain and constant driving anxiety.

58I find that the medical evidence does not support a conclusion that the applicant suffers from chronic pain with functional impairment as a result of the accident. I further find that the applicant’s physical injuries fall under the definition of a minor injury.

Psychological Injuries

59The applicant has not established that he suffers from psychological injuries which would warrant his removal from the MIG.

60The applicant claims to suffer from sleep disorders, driving anxiety and depression.

61The applicant is relying on the report prepared by Dr. Konstantinos Papazoglou after a psychological assessment on November 6, 2023. The virtual assessment involved seven questionnaires and validity tests but did not involve review of any medical records.

62Dr. Papazoglou diagnosed the applicant as having developed emotional/ psychological problems which are consistent with diagnoses of Adjustment Disorder (mixed anxiety and depressed mood) and a Specific (Isolated) Phobia (Driving/Passenger). He recommended 12 1.5-hour psychological counselling sessions to help the applicant cope with his pain and anxiety.

63Dr. Papazoglou further noted that the applicant reported he does drive “however only for essential purposes and only in the local area” and “he avoids passing by the place of the index accident” (i.e. Hwys 400 and 401). He recommended the applicant undergo a driving evaluation assessment.

64I find the psychological assessment report by Dr. Papazoglou was of limited persuasive value. Dr. Papazoglou conceded, under cross-examination, that virtually all the tests he performed relied exclusively on the applicant’s self-reporting and not on any objective external evaluations. Dr. Papazoglou further admitted that he was not provided any medical documentation to review, as part of his assessment. Faced with specific references to aspects of the applicant’s medical history, such as past prescriptions for psychotropic medications, Dr. Papazoglou conceded that the applicant’s self-reporting, in terms of medication, was not accurate and, similarly, that the applicant’s self-reporting was inconsistent with his actual cognitive state.

65Dr. Papazoglou’s report is also inconsistent with the CNRs of the family doctor and the methadone clinic. There are no accident-related psychological issues mentioned in either of those CNRs. On the contrary, the methadone clinic added a notation to 13 of the applicant’s monthly assessments between the first assessment after the subject accident, on June 24, 2023, and the last CNR, on March 1, 2025, that the applicant had experienced “no mood changes” since the previous appointment. One two occasions, a more extensive assessment was done and the clinic noted: “Anthony’s mental health status currently appears stable.”

66The respondent raised the issue of the applicant’s failure to attend a s. 44 psychological assessment, despite several attempts by the respondent to find a convenient time for the applicant to attend. The applicant suggested he didn’t attend because he felt he should have been consulted before any date was proposed. However, the applicant had previously testified that his workday concluded at 12:30, every day, which would suggest there was adequate time, any day, for an assessment.

67The applicant also raised the issue of the timing of the request for the assessment, which occurred after the case conference, however, when asked to provide a reference in the SABS which would address the issue of timing, the applicant was unable to provide one.

68I find that the applicant’s explanation for his failure to attend is not reasonable. I further find that the respondent was prejudiced by being denied the opportunity to obtain their own psychological assessment as provided by the SABS.

69During the applicant’s only visit to his family doctor, post-accident, on May 2, 2025, Dr. Fong records no psychological injuries or impairment, and, on the contrary, he notes the applicant reported no mood changes after the accident.

70During his cross-examination, the applicant was asked about the reference in Dr. Papazoglou’s report that he suffered from psychological impairments. The applicant rejected the premise that he had said he was suffering from such impairments. When pressed further and asked whether he had ever sought psychological assistance, he replied “I don’t have psychological issues or I couldn’t manage a $20 million work site”.

71I find the applicant has not met his onus of providing medical evidence to support his claim of a psychological injury. Moreover, I find the applicant’s fervent rejection of the conclusions in Dr. Papazoglou’s report to be compelling evidence that, from the applicant’s own perspective, he did not sustain accident-related psychological injuries which would warrant removal from the MIG.

72After considering all the evidence of the parties and on the balance of probabilities, I find the applicant’s injuries are minor and his treatment should be held within the MIG.

Is the applicant entitled to the treatment plans in dispute?

73As I have found that the applicant continues to be held within the MIG, it is not necessary for me to determine whether the treatment plans in dispute are reasonable and necessary.

Is the applicant entitled to a non-earner benefit (“NEB”)?

74The applicant is not entitled to the non-earner benefit.

75Section 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, which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities.

76The applicant testified that he is entitled to an NEB as he struggled to maintain his activities of daily living and his employment during the qualifying period. The applicant submits that the OCF-3 prepared by Well Care Medical Rehab (“Well Care”) on June 29, 2023 medically qualified him for this benefit. The applicant further submits that the respondent has unfairly denied this benefit and provided no reason for the denial. The applicant also maintains that six months after the accident, he took 13 months off work, during the qualifying period, to cope with accident-related injuries.

77The applicant testified that he continued to work, full-time, after the accident at what he testified was arduous manual labour. The applicant provided no evidence of the exact nature of the work he was performing at the time of the accident and the extent to which it involved manual labour.

78Six months after the accident, the applicant testified he stopped working to “see if my body gets better”. He testified that he was off work from November 2023 to December 2024. The applicant filed no evidence to substantiate the reason for leaving his job in November 2023.

79I am aware of the claim by the applicant that he discontinued his full-time employment for a period of thirteen months, all of which fell within the 104-week period. There is sufficient evidence that, on at least five occasions, he informed the doctor at his methadone clinic that he was engaged in work during this claimed break period. The evidence also shows that the applicant did construction work for a friend spanning at least four weeks beginning in May 2024.

80When the applicant returned to work, it was as a site supervisor. The applicant testified that he is currently maintaining a 37.5-hour work week in a position with considerable authority.

81As a result of his injuries, the applicant testified he has been forced to make accommodations at his work, including discontinuing physical labour and shifting to more of a supervisory role. He further testified that since April 2025, he has utilized a handicapped parking tag to access parking spaces which require a shorter walk to his destination.

82Although the applicant points to the fact that when he returned to work it was with accommodations, being able to work with accommodations does not support a complete inability to carry on a normal life, as required by s. 12 of the Schedule.

83Even the CNR of Well Care on June 20, 2023, one of the earliest visits by the applicant after the accident, includes a notation that the applicant was experiencing “no limitations” in activities of daily living.

84The report of Dr. Lee notes the applicant claimed to be fully independent in terms of self-care and had experienced a 65-70% improvement in his functioning since the accident. When asked about the extent of the impact of the accident on his activities of daily living, the applicant testified he had some difficulty showering and putting on a jacket. His only other claims were that his sister and girlfriend have assumed “some” of the activities which would otherwise involve heavy lifting, such as carrying groceries or shoveling snow.

85The applicant has not provided any evidence with respect to the principles set out in Heath or on how he meets the test for entitlement. The applicant has not testified or directed me to evidence detailing his pre-accident activities or the extent to which he has been prevented from engaging in in his pre-accident activities post-accident. The applicant has made no claims that he has a complete inability to perform his pre-accident activities of daily living.

86I find that the applicant is not entitled to a non-earner benefit.

Award

87I find the respondent is not responsible for paying an award.

88The 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.” [See, for example: 17-006757 v. Aviva Insurance Canada, 2018 CanLII 81949 (ON LAT); and S.M. v. Unica Insurance Inc., 2020 CanLII 61460 (ON LAT Reconsideration]. The onus is on the applicant to prove, on a balance of probabilities, that the respondent’s conduct meets this threshold.

89As I find that no benefits are payable and that no payments have been unreasonably withheld, the applicant is not entitled to a special award.

Interest

90Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, the applicant is not entitled to interest.

ORDER

91The Tribunal orders:

i. The applicant is barred from proceeding to a hearing on the treatment plan listed as Issue 3(iii).

ii. The applicant’s injuries are predominantly minor and his treatment should be held within the MIG.

iii. The applicant is not entitled to the treatment plans in dispute, or interest.

iv. The applicant is not entitled to a non-earner benefit.

v. The applicant is not entitled to an award.