Licence Appeal Tribunal File Number: 24-015339/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:
Davinder Kumar
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Maka Metreveli, Paralegal
For the Respondent:
Marcin Panasewicz, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Davinder Kumar, the applicant, was involved in an automobile accident on July 29, 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, Aviva Insurance Company of Canada, 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 $2,152.71 for chiropractic services, proposed by 101 Physio in a treatment plan/OCF-18 submitted February 21, 2023?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant’s injuries are predominantly minor and therefore he is subject to the MIG.
4Since the applicant is subject to the MIG, an analysis of whether the treatment plan in dispute is reasonable and necessary is not warranted.
5The applicant is not entitled to interest.
ANALYSIS
MIG
6I find that the applicant’s injuries are predominantly minor.
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 functional impairment or a psychological condition may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
9The applicant argues that a recent MRI finding and a referral for spine surgery warrants removal from the MIG. As of June 29, 2025, the applicant was waiting for the surgical referral to materialize.
10The applicant acknowledges that there is scant medical evidence prior to July 2024 and argues there is a reasonable explanation for this. The applicant submits that, as an international student, he did not have access to OHIP coverage, and this financial burden hindered his access to medical care that would establish medical evidence for this hearing. Once the applicant obtained access to OHIP coverage in July 2024, the applicant submits that the frequency and severity of his complaints clearly indicate the significance of his accident-related injuries. In summary, between August 2024 and June 2025, the applicant submits that his complaints included lower and upper back pain, a need for daily pain killers, lumbar spine stiffness, muscular low back pain, and renewal of a Naproxen and Baclofen prescription. Further, an L5-S1 pars defect was revealed on x-ray and a subsequent MRI revealed a broad-based disc bulge, more prominent left laterally, causing mild narrowing of the left neural foramen. The applicant was given a referral for spinal surgery.
11The respondent’s position is all of the applicant’s diagnosed injuries are within the definition of a minor injury under the Schedule. Further, that the evidence of the recently revealed disc bulge is not outside the definition of a minor injury. The respondent argues that has not addressed whether the disc bulge was caused by the accident, a required element under the Schedule. The respondent refers to case law in support of its position that can be summarized as holding that imaging of a disc bulge, without more, does not warrant removal from the MIG.
12I am persuaded by the respondent that the Tribunal has consistently held, that the disc bulge cannot be linked to the accident where the applicant has not addressed causation. While the respondent’s references to prior Tribunal decisions are not binding on me, the Tribunal consistently holds that the applicant bears the onus to establish causation, and in this case, he has not done so. Accordingly, the applicant has not established that the disc bulge is accident related. Further, the applicant has not led evidence of any accident-related injury that is not predominantly a minor injury under the Schedule. I note that the results of the applicant’s spinal surgery referral were not in evidence, so are not part of the evidentiary record before me. Based on the submissions and available evidence, the applicant’s accident-related injuries are minor.
13For the reasons above, on a balance of probabilities, I find that the applicant has not established his accident-related injuries are not predominantly minor.
14Since the applicant is subject to the MIG, an analysis of whether the treatment plan in dispute is reasonable and necessary is not warranted.
Interest
15Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. The applicant is not entitled to interest because there are no overdue benefits.
ORDER
16For the reasons above, I make the following orders:
i. The applicant’s injuries are predominantly minor and he is subject to the MIG.
ii. Since the applicant is subject to the MIG, an analysis of whether the treatment plan in dispute is reasonable and necessary is not warranted.
iii. The applicant is not entitled to interest.
Released: April 23, 2026
__________________________
Amar Mohammed
Adjudicator