Licence Appeal Tribunal File Number: 24-008369/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:
Vadim Vovneko
Applicant
And
TD General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Matthew Frontini
APPEARANCES:
For the Applicant:
Anna Korolkova, Paralegal
For the Respondent:
Kateryna Borodenko, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Vadim Vovneko, the applicant, was involved in an automobile accident on October 20, 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, TD General 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 $2,204.69 for Physiotherapy Services, proposed by 101 Physio, in a treatment plan/OCF-18 (“treatment plan”) dated May 24, 2023?
iii. Is the applicant entitled to $4,688.39 for Physiotherapy Services, proposed by 101 Assessments, in a treatment plan dated December 23, 2022?
iv. Is the applicant entitled to the assessments proposed by 101 Assessments, as follows:
$2,460.00 for a Psychological Assessment, in a treatment plan dated November 28, 2022;
$2,460.00 for an Orthopaedic Assessment, in a treatment plan dated December 23, 2022;
$2,460.00 for a Neurological Assessment, in a treatment plan dated February 28, 2023;
$2,460.00 for a Cognitive Assessment, in a treatment plan dated February 28, 2023;
$2,460.00 for a Functional Abilities Assessment, in a treatment plan dated May 2, 2023; and
$2,460.00 for a Chronic Pain Assessment, in a treatment plan dated May 2, 2023?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
i. The applicant’s injuries are predominantly minor and therefore are subject to treatment within the $3,500.00 limit of the MIG;
ii. As the applicant is in the MIG, it is not necessary to consider if the disputed treatment plans are reasonable and necessary;
iii. The applicant is not entitled to interest pursuant to s. 51 of the Schedule; and
iv. The application is dismissed.
ANALYSIS
The applicant is not removed from the MIG
4The applicant is not removed from the MIG. He has not established on a balance of probabilities that he has suffered more than a minor injury because of the accident.
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 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 claims that he is entitled be removed from the MIG because he suffers two diagnosed psychological impairments as a result of the accident, Generalized Anxiety Disorder and Adjust Disorder.
The applicant has not established that he suffers a psychological injury as result of the accident
8The applicant has not established on a balance of probabilities that he suffers a psychological injury as a result of the accident warranting removal from the MIG.
9The applicant’s submissions note that he struggled with anxious and depressive symptoms in his youth, and later, when immigrating to Canada in 2017, he experienced what is described as “anxious and depressive symptomology”. The applicant’s submissions state that this symptomology improved after the applicant obtained his permanent residence in Canada, although neither this date of this event nor any records of the applicant’s pre-accident health are in the evidence before me.
10The applicant’s submissions describe the immediate aftermath of the accident, stating that he attended a hospital and was discharged the same day. The applicant’s submissions go on to state that he developed “stress, it increased again (noting “stressors prior to the [accident]” (emphasis added) and he attended a walk-in clinic where he was seen by Dr. Gasparro, physician. The applicant further submits that he had been feeling added stress since coming to Canada in 2017 and reflected on bullying and mental health issues from his childhood.
11The applicant relies on several different sources of evidence to support his submission that he has suffer psychological injuries, specifically Generalized Anxiety Disorder and Adjustment Disorder, as a result of the accident. A key point in the applicant’s submissions is that he did not have a history of mental health symptomology prior to the accident, a claim that is contradicted in other parts of his submissions.
12The applicant relies on a pre-screening report was that prepared in connection with a treatment plan for a psychological assessment, dated November 28, 2022. The pre-screen report made a provisional diagnosis of Adjustment Disorder (with mixed anxiety and depressed mood) based on a clinical interview with the applicant. During the interview, the applicant denied a history of mental health impairments and reported that his anxious and depressive symptomology only developed after the accident.
13The applicant also relies on the psychological assessment report, dated December 22, 2022, of Lila Grinberg, psychological associate. Ms. Grinberg’s assessment comprised a clinical interview and the administration of four psychometric tests. Ms. Grinberg diagnosed the applicant with Adjustment Disorder: Unspecified, as a result of the accident. This diagnosis was based, in part, on Ms. Grinberg’s finding that the applicant’s account of his past and present mental health was credible. During the clinical interview, the applicant denied any history of mental health issues and reported that his anxious and depressive symptomology only developed after the accident.
14The applicant also relies on a diagnosis of Generalized Anxiety, which he submits was a result of the accident. It is unclear who made this diagnosis and when it was made. The applicant relies on two letters describing appointments with Dr. Vaithianathan, psychiatrist, on November 9, 2023 and December 14, 2023. Based on the letters, the applicant was referred to Dr. Vaithianathan for anxiety by Dr. Gasparro. Dr. Gasparro’s referral, dated May 28, 2023, does not mention the accident and states that the applicant has “anxiety type depression”. Dr. Gasparro’s clinical notes and records in evidence before me, which comprise four appointments during the period of October 26, 2022 to December 9, 2022, do not reference any mental health concerns, instead describing medical imaging and reports of pain in the applicant’s left shoulder.
15According to Dr. Vaithianathan’s first letter to Dr. Gasparro, dated November 9, 2023, the applicant denied any past history of seeing a psychiatrist or partaking in therapy. The applicant also reported that his anxiety got worse after the accident. The applicant also reported an improvement of his mood using Trintellix, a prescription medication. However, due to the side effects reported by the applicant, Dr. Vaithianathan changed his prescription and scheduled a reassessment for a month later.
16Dr. Vaithianathan’s second letter, dated December 14, 2023, describes the reassessment of the applicant. The letter states that the applicant is a 34-year-old with generalized anxiety. The letter does not mention the motor vehicle accident, who made the diagnosis of generalized anxiety, and concludes by noting the applicant’s reported improvement leading to his discharge from Dr. Vaithianathan’s care.
17I find that a review of the evidence, and the applicant’s own submissions, does not establish on balance of probabilities that he suffered psychological injuries as a result of the accident. The healthcare practitioners that state that the applicant’s psychological injuries, specifically Adjustment Disorder, was a result a of the accident did so in the context of submitting a treatment plan and s. 25 reports. In both cases, these healthcare practitioners relied on the applicant’s reporting that he did not experience anxious and depressive symptomology prior to the accident. Yet, the applicant’s own submissions contradict this key point by referring to a history of anxious and depressive symptomology, that worsened after the accident.
18As such, I am not persuaded by the either the pre-screening report or the psychological assessment of Ms. Grinberg. Specifically, I am not persuaded that the opinions in these documents would have concluded that the diagnoses that were made were a result of the accident if the applicant has accurately reported his pre-accident history of anxious and depressive symptomology to these practitioners.
19With respect to the diagnosis of Generalized Anxiety, the applicant has not identified medical evidence that his reported anxiety was a result of the accident. While there is a reference to the accident in one letter, there no evidence from either Dr. Vaithianathan, psychiatrist, or the applicant’s referring physician, Dr. Gasparro, that accident caused the applicant’s anxious and depressive symptomology.
20In sum, given that the applicant’s own submissions refer to experiencing mental health symptomology just prior to the accident, I find that this undercuts the applicant’s submission that he suffers mental health injuries, specifically the generalized anxiety and depression, as a result of the accident. Further, I find that the medical evidence does not support a finding that he has a psychological condition as a result of the accident that warrants removal from the MIG.
21Based on the evidence and submissions before me, I find that the applicant has not established on a balance of probabilities that he suffers a psychological injury as a result of the accident warranting removal from the MIG.
The Treatment Plans in Dispute
22As the applicant is in the MIG, it is not necessary for me to consider if the treatment plans in dispute are reasonable and necessary.
Interest
23Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As the applicant is not entitled to the disputed treatment plans, no payments are overdue, and interest does not apply.
ORDER
24I find that:
i. The applicant’s injuries are predominantly minor and therefore are subject to treatment within the $3,500.00 limit of the MIG;
ii. As the applicant is in the MIG, it is not necessary to consider if the disputed treatment plans are reasonable and necessary;
iii. The applicant is not entitled to interest pursuant to s. 51 of the Schedule; and
iv. The application is dismissed.
Released: April 10, 2026
__________________________
Matthew Frontini
Adjudicator