Citation: Alakbarova v. Allstate Insurance Company of Canada, 2026 ONLAT 24-013101/AABS

Licence Appeal Tribunal File Number: 24-013101/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:

Ilaha Alakbarova

Applicant

and

Allstate Insurance Company of Canada

Respondent

DECISION

ADJUDICATOR:

John Mazzilli

APPEARANCES:

For the Applicant:

IIia Estrah, Counsel

For the Respondent:

Duha Sikander, Counsel

HEARD:

By way of written submission

OVERVIEW

1Ilaha Alakbarova, ("the applicant"), was involved in an automobile accident on May 14, 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 Allstate Insurance Company of Canada ("the respondent") and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.

ISSUES

2The 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? Note: The parties agree the MIG limits have been exhausted.

2 Is the applicant entitled to $5,128.11 for physiotherapy, proposed by HM Medical Network, in a treatment plan/OCF-18 ("plan") dated May 25, 2023?

3Is the applicant entitled to $4,713.11 for physiotherapy, proposed by HM Medical Network, in a plan dated February 13, 2024?

4Is the applicant entitled to the medical services proposed by Healthspot Assessments Inc, as follows:

i. $2,460.00 for a psychological assessment, in a plan dated September 26, 2023;

ii. $2,200.00 for a chronic pain assessment, in a plan dated May 15, 2024;

iii. $4,688.39 for psychological services, in a plan dated May 15, 2024; and,

iv. $2,573.00 for physiotherapy, in a plan dated July 22, 2024?

5Is the applicant entitled to interest on any overdue payment of benefits?

3In her reply to submissions the applicant withdrew Issue 4 ii. as listed in the Case Conference Report and Order dated February 24, 2025, namely a chronic pain assessment in the amount of $2,200.00 dated May 15, 2024.

RESULT

4The applicant remains in the MIG; therefore, it is not necessary to consider whether the disputed plans are reasonable and necessary.

5As no benefits are owing, interest is not owing.

6The application is dismissed.

ANALYSIS

Minor Injury guideline

7Section 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."

8An 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 a functional impairment or a psychological condition may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant. In this case the applicant argues that she should be removed from the MIG because she suffers from an accident-related psychological injury.

Psychological

9I find on a balance of probabilities that the applicant has failed to establish that she suffers from an accident-related psychological injury that warrants removal from the MIG.

10The applicant submits that she has experienced both emotional and psychological adjustment difficulties because of the accident which are exacerbated by symptoms of pain in her back, right shoulder, right knee, right arm as well as headaches, migraines, dizziness, light-headedness. She submits that she frequently has trouble sleeping due to pain, discomfort, anxiety, and accident-related nightmares. The applicant relies on the psychological report of Ms. Tolmatshov, psychotherapist and Dr. Gosselin, psychologist, dated March 7, 2024, which concludes that the applicant meets a diagnosis of major depressive disorder, moderate single episode and specific phobia related to vehicular travel.

11The applicant submits that the results of her psychometric testing are consistent with her self-reported symptomology. The applicant also relies on an OHIP Summary which shows that she consulted with Dr. Prigozhikh, neurologist, however I note that the CNRs of Dr. Prigozhikh were not provided to the Tribunal or the respondent.

12The respondent argues that the applicant attended Mackenzie Hospital following the accident where she underwent a CT of the head which revealed no abnormalities, and she was diagnosed with back strain and discharged the same day. It argues that the applicant attended an appointment with her family physician Dr. Bondarev three days after the accident and no accident-related injuries were discussed at this examination and that Dr. Bondarev's assessment of the applicant was unremarkable.

13The respondent further argues that the applicant returned to her pre-accident employment one week following the accident and she is currently enrolled at Seneca College completing a computer system technology program. The respondent argues that there is no objective evidence that she sustained a psychological impairment as a result of the accident and that it is not clear if Dr. Gosselin was involved in the assessment process. The respondent relies on the CNRs of Dr. Bondarev, the applicant's family physician, and the CNRs of Mackenzie Hospital.

14I find on a balance of probabilities that the applicant has failed to establish that she suffers from a psychological injury as a result of the accident that warrants removal from the MIG because the contemporaneous corroborating evidence does not support a finding of a psychological injury that warrants funding beyond the limits of the MIG.

15For example, the CNRs of Dr. Bondarev do not show any accident related psychological complains from the applicant. In addition, I place little weight the report of Dr. Gosselin because I am unable to determine if Dr. Gosselin participated in the applicant's assessment because the assessor listed in her report is Viktoria Tolmatshov (psychotherapist under supervised practice). The report states that "The opinions and recommendations provided in this report are based upon the history obtained, the mental status examination performed on the client, and a review of the medical documentation on file. The assessment included a diagnostic clinical interview and a feedback interview in addition to several psychometric tests, which has been reviewed and endorsed by Dr. Julie Gosselin, C. Psych" This statement on balance is not persuasive and leaves doubt in my mind as to Dr. Gosselin's participation in the online clinical interview, feedback interview and the psychometric testing, for this reason I placed little weight on the report of Dr. Gosselin.

16In addition, Dr. Gosselin's report is based on the applicant's subjective descriptions and subjective psychometric testing that does not offer any validity testing to confirm the accuracy or the proportionality of the applicant's self report because Dr. Gosselin's report, does not contain objective psychometric testing for this reason I placed little weight to the report of Dr. Gosselin.

17Finally, in her report Dr. Gosselin informs that the applicant returned to her pre-accident employment a week after the accident, however Dr. Gosselin also provides a contradictory opinion, namely that the applicant suffers a substantial inability to carry on the essential tasks of her pre-accident employment. This inconsistency is an additional reason as to why I placed little weight to the report of Dr. Gosselin.

18Accordingly, I find on a balance of probabilities that the applicant has not met her onus to prove she should be removed from the MIG due to an accident-related psychological injury.

The disputed treatment and assessment plans

19The applicant has failed in her onus to prove that she suffers from an accident-related psychological injury that warrants removal from the MIG. Therefore, it is not necessary to consider whether the disputed plans are reasonable and necessary.

Interest

20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, interest is not owing.

ORDER

21It is ordered that:

i. The applicant remains in the confines of the MIG

ii. As the applicant remains in the MIG, it is not necessary to consider whether the disputed plans are reasonable and necessary.

iii. As no benefits are owing, interest is not owing.

iv. The application is dismissed.