Citation: Anibuali v. Aviva General Insurance, 2026 ONLAT 23-011620/AABS

Licence Appeal Tribunal File Number: 23-011620/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:

Abiola Anibuali

Applicant

and

Aviva General Insurance

Respondent

DECISION

VICE-CHAIR: Amanda Marshall

APPEARANCES:

For the Applicant: Naman Nanda, Counsel

For the Respondent: Ibrahim Farag, Counsel

HEARD: In Writing

OVERVIEW

1Abiola Anibuali, the applicant, was involved in an automobile accident on December 3, 2021, 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, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2A decision was issued on December 5, 2025. The applicant requested a reconsideration on December 24, 2025. In a reconsideration decision dated March 30, 2026, it was found that the applicant established grounds for reconsideration regarding the physiotherapy treatment plans, but not the psychological treatment plan. Accordingly, the decision relating to the physiotherapy treatment plans, associated interest, and the award was cancelled, and a rehearing before a different adjudicator was ordered to determine entitlement to the two physiotherapy treatment plans.

ISSUES

3The issues in dispute are:

i. Is the applicant entitled to $1,274.95 for physiotherapy services, proposed by Mackenzie Medical Rehabilitation in a treatment plan/OCF-18 (“plan”) dated August 10, 2022?

ii. Is the applicant entitled to $1,198.04 for physiotherapy services, proposed by Mackenzie Medical Rehabilitation in a plan dated October 13, 2023?

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

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

RESULT

4I find the applicant is not entitled to the physiotherapy treatment plans, interest or an award.

ANALYSIS

5To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.

6The applicant submits that the two treatment plans in dispute are reasonable and necessary and relies on the clinical notes and records (“CNRs”) of her treating practitioners at the walk-in clinic, Urgent Care Clinic, Mackenzie Medical Rehabilitation Centre, and the treatment plans in dispute.

7The respondent contends that the applicant has not satisfied her onus of demonstrating how the treatment plans would support the goals of the treatment plan, nor demonstrate that any potential benefits are proportional to their costs. The respondent also relies on the Insurer Examination (“IE”) report of general practitioner, Dr. Neetan Alikhan pertaining to the October 13, 2023 treatment plan.

Is the applicant entitled to the physiotherapy treatment in the amount of $1,274.95 dated October 10, 2022?

8On the balance of probabilities, I find the applicant is not entitled to this treatment plan for assistive devices as she has not demonstrated it to be reasonable and necessary.

9The treatment plan was completed by chiropractor, Dr. Ayden Banibashar, at Mackenzie Medical Rehabilitation Centre and recommends the following assistive devices:

i. Thumper (massage device) $425.00

ii. Cryoderm heat gel 4 ozs $39.00

iii. Cryoderm gel 4 ozs $39.00

iv. Tempurpedic pillow $299.99

v. Obus Forme backrest $169.99

vi. Electric heating pad $150.00

vii. Exercise ball $149.99

10The goals of the treatment plan are to reduce pain, increase strength and increase range of motion to allow the applicant to return to activities of normal living and return to pre-accident work activities.

11It is well established that an OCF‑18 alone does not entitle an applicant to the treatment proposed. In assessing entitlement, an adjudicator looks for contemporaneous corroborating medical evidence to support the need for the treatment, in this case, the recommended assistive devices.

12The Urgent Care Clinic records indicate that the applicant first attended on December 20, 2021, reporting involvement in a motor vehicle accident. The physician recommended Aleve and/or physiotherapy. On June 9, 2022, the applicant returned with complaints of back pain. Dr. Colin Lee assessed a muscular strain and recommended non‑steroidal anti‑inflammatory drugs and physiotherapy. On September 7, 2022, while attending a scheduled appointment for an unrelated condition, the applicant mentioned having occasional headaches, and muscle aches since the accident. Dr. Lee noted that the applicant attends physiotherapy and massage therapy, works as a personal support worker, and may have re‑injured herself. Naproxen was specifically suggested for the headaches; however, no recommendations were provided for the applicant’s muscle pain.

13Although the applicant relies on the CNRs from the Urgent Care Clinic recommending physiotherapy, the contemporaneous records do not reference or support the need for the assistive devices claimed in the treatment plan.

14On the evidence before me, the applicant has not provided sufficient medical evidence to establish that the assistive devices listed in the disputed treatment plan are reasonable and necessary. Accordingly, the applicant is not entitled to payment for the treatment plan.

Is the applicant entitled to the physiotherapy treatment in the amount of $1,198.04 dated October 13, 2023?

15I find on a balance of probabilities, that the proposed physiotherapy treatment plan is not reasonable or necessary.

16The treatment plan was submitted by Ms. Anjali Patil, physiotherapist, and recommends six sessions of massage therapy and six sessions of physiotherapy. The stated goals are to reduce pain, increase strength and range of motion, and improve the applicant’s quality of life, including a return to activities of daily living, pre‑accident work, social participation, and an active lifestyle.

17I note that the applicant was in subsequent accident on December 5, 2023, and from the information provided by the respondent, the accident appears to have been more severe than the subject accident. As such, I have reviewed the CNRs up to the second accident date to assist in determining the disputed treatment plan.

18The Urgent Care Clinic records reflect several visits by the applicant between August and November 2023, during which she consistently reported pain symptoms. Across these visits, different physicians recommended conservative treatment only, including non‑steroidal anti‑inflammatory medication, acupuncture and physiotherapy.

19While various walk‑in physicians recommended physiotherapy, I find that those recommendations were based primarily on the applicant’s subjective pain complaints and were not supported by diagnostic testing or an assessment of treatment effectiveness. Although the applicant submits that she should be entitled to the proposed treatment plan, she has already undergone extensive physiotherapy with minimal benefit. Records from Mackenzie Medical Rehabilitation Centre indicate that by October 2023 the applicant had attended the clinic for 94 weeks while continually reporting the same or similar complaints. Further, the progress reports show that between May 2023 and mid-October 2023, the applicant’s cervical and lumbar range of motion decreased rather than improved.

20I am persuaded by Dr. Alikhan’s December 7, 2023 report, which concluded that additional facility‑based therapy was not warranted because the applicant had reached a therapeutic plateau and maximum medical recovery. Dr. Alikhan met with the applicant on November 27, 2023 for over one hour and conducted a clinical interview and physical examination whereby he administered several tests. He also reviewed 18 previous approved treatment plans and four IE reports. He opined that the examination revealed no objective evidence of an ongoing, accident‑related musculoskeletal functional impairment, range‑of‑motion deficit, or neurological sensory or motor deficit. He concluded the applicant sustained various uncomplicated soft tissue and myofascial sprain/strain injuries that the applicant’s clinical presentation was attributable to non‑organic, pain‑focused behaviour.

21Given the prolonged history of physiotherapy, the lack of functional improvement, and the absence of objective findings, I find, on the balance of probabilities, that the physiotherapy treatment plan is not reasonable nor necessary.

22The physiotherapy treatment plan is, therefore, not payable.

Interest

23Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since there are no overdue payments, no interest is payable.

Award

24Section 10 of Regulation 664 provides that an award may be granted if the respondent unreasonably withheld or delayed payments. Here I find there was no payment unreasonably withheld or delayed and as a result no award is payable.

ORDER

25For the above reasons, I find:

i. The treatment plans are not payable.

ii. The applicant is not entitled to interest or an award.