Citation and File Number
Licence Appeal Tribunal File Number: 24-011421/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.
Parties
Between:
Kirandeep Kaur
Applicant
and
Definity Insurance Company
Respondent
Decision
ADJUDICATOR:
Jeff Chatterton
APPEARANCES:
For the Applicant:
Bianca Marinescu, Counsel
For the Respondent:
Owen Cromb, Counsel
HEARD: In Writing
OVERVIEW
1Kirandeep Kaur, the applicant, was involved in an automobile accident on July 2, 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.
ISSUES
2The issues in dispute are:
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?
Is the applicant entitled to $1,920.52 for a psychological assessment, proposed by Inline Rehabilitation Centre in a treatment plan/OCF-18 (“treatment plan”) dated October 31, 2023?
Is the applicant entitled to $4,356.31 for a chiropractic service, proposed by Inline Rehabilitation Centre in a treatment plan dated December 6, 2023?
Is the applicant entitled to $3,316.68 for a psychological assessment, proposed by Inline Rehabilitation Centre in a treatment plan dated May 28, 2024?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is held to the MIG and the $3,500.00 treatment limit.
4As the applicant is being held to the MIG, it is not necessary to review the treatment plans in dispute.
5No interest is payable.
6The application is dismissed.
ANALYSIS
Is the applicant removed from the Minor Injury Guideline due to a psychological condition?
7The applicant has not met her onus to demonstrate she should be removed from the MIG due to psychological condition.
8Section 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.”
9An 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.
10The applicant argues she should be removed from the MIG on the basis of a psychological condition. To support her claim, she is relying upon the Psychological Assessment conducted by Psychological Associate Sabrina Simmons, while under the supervision of Psychologist Dr. Valery Kleiman, dated March 21, 2024. She also relies upon the Clinical Notes and Records of her Family Physician, Dr. Aakash Modi.
11The respondent submits that the applicant has not met her onus to prove she has suffered a psychological injury. To support its claim, they rely upon a s. 44 Psychological Assessment conducted by Psychologist Dr. Janet Clewes, dated January 21, 2024, which claims the applicant is not suffering from a psychological condition.
12While carefully considering the competing opinions given in the Psychological Assessment Reports, I give more weight to the respondent’s evidence. I make this finding for several reasons.
i. Dr. Clewes’ report was conducted in person, while Ms. Simmon’s report was conducted via video call. I prefer the evidence collected in person because it provides a more thorough picture of the patient’s condition to the medical professional via the use of body language and direct observation in a controlled setting.
ii. While I am alive to the applicant’s argument that Ms. Simmons conducted more tests than Dr. Clewes, I find the majority of the tests were subjective and self-administered (the Depression Anxiety Stress Scale, or DASS-42, and the Accident Fear Questionnaire, or AFQ-PA.) The tests conducted by Dr. Clewes (the Pain Patient Profile, or P-3, and the Trauma Symptom Inventory, or TSI-2, contained internal validity scores to determine the validity of the responses.
iii. While I note that Dr. Kleiman is the supervising Psychologist, the applicant was tested and assessed by Ms. Simmons, who is a Psychological Associate. It was unclear what role Dr. Kleiman’s supervision in this process was, if any. I prefer the respondent’s assessment report because the testing and assessment was conducted directly by Dr. Clewes, who is a Psychologist.
13While I have reviewed the Clinical Notes and Records from Dr. Modi, I give them little weight for the purpose of assessing a psychological condition. I make this finding because:
i. The applicant provided the Clinical Notes and Records from only one visit, where Dr. Modi reported that the applicant was “feeling depressed and anxious.” While I find this is evidence of a psychological complaint, I was not led to evidence that Dr. Modi offered a diagnosis, or otherwise felt it relevant to take action upon this complaint with a referral. Such reporting helps establish a history of ongoing psychological complaints but a single reference is not sufficient, in and on its own, to merit removal from the MIG.
ii. I have not been led to further evidence of ongoing psychological complaints or other psychological related concerns which were presented to Dr. Modi.
14In summary, I give more weight to the respondent’s evidence for the reasons listed above, while I do not lend significant weight to Dr. Modi’s corroborating evidence that the applicant has suffered a psychological condition.
15For these reasons, I find the applicant has not, on the balance of probabilities, met her onus to establish that she has suffered a psychological condition and should be removed from the MIG.
16As I have ruled that the applicant is being held to the MIG, it is not necessary for me to review the treatment plans in dispute to determine if they are reasonable and necessary.
Interest
17Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
ORDER
18The application is dismissed.
i. The applicant is being held to the MIG, and the $3,500.00 treatment limit.
ii. As the applicant is being held to the MIG, it was not necessary for me to review the treatment plans in dispute.
iii. No interest is payable.
Released: April 13, 2026
__________________________
Jeff Chatterton
Adjudicator