Licence Appeal Tribunal File Number: 23-014776/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:
Arshpreet Mann
Applicant
and
Wawanesa Insurance
Respondent
DECISION
ADJUDICATOR:
Nikisha Evans
APPEARANCES:
For the Applicant:
Zehra Rizvi, Paralegal
For the Respondent:
Elizabeth Scott, Counsel
HEARD:
In Writing
OVERVIEW
1Arshpreet Mann (the “applicant”) was involved in an automobile accident on July 6, 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 Wawanesa Insurance (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
PROCEDURAL ISSUES
2The respondent further submits the applicant failed to provide the following documents as required by the Case Conference Report and Order dated April 29, 2024:
a. All hospital records, if they exist, including records of the Applicant’s attendance at hospitals in India.
b. The decoded OHIP summary of the Applicant, from one year pre-accident to the date of the case conference.
c. The clinical notes and records of all treating physicians, from one year pre-accident to the date of the case conference.
d. The applicant’s complete prescription summary from one year pre-accident to the date of the case conference.
e. The Applicant’s complete employment file from one year pre-accident to the date of the case conference.
f. The Applicant’s flight itinerary regarding his post-accident trip to India.
3Rule 9 of the Licence Appeal Tribunal Rules states that the parties are required to exchange all documents, witness lists and anything else they intend to rely on as evidence at the hearing. The requirement for document exchange begins as soon as the application is filed.
4The applicant did not submit a reply in response to the respondent’s submissions. I have considered the respondent’s position, and I am satisfied the applicant has failed to produce the reports in paragraph 2 in accordance with Rule 9. I will address the documents in question in accordance with LAT Rule 9 and I will speak to the weight in my decision.
5Further, the applicant attempts to include his claim for a psychotherapy assessment (submitted October 21, 2021, and denied November 4, 2021) as an issue in dispute for this hearing. I note that in the same Case Conference Report and Order, Vice Chair Todd heard submissions from both parties and ordered that the psychotherapy assessment was not to be added pursuant to s.56 of the Schedule. I have not considered this issue as it is not before me as an issue in dispute.
ISSUES
6The 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 (the “MIG”) limit?
ii. Is the applicant entitled to $987.00 for physiotherapy services, proposed by Ontario Rehab Centre in a treatment plan/OCF-18 dated October 10, 2021?
iii. Is the applicant entitled to $1,592.00 for physiotherapy services, proposed by Ontario Rehab Centre in a treatment plan/OCF-18 dated August 4, 2022?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
7The applicant has not established on a balance of probabilities that his impairments arising from the accident fall outside of the MIG.
8As the MIG limit has been exhausted, it is not necessary to determine if any of the treatment plans are reasonable and necessary. The applicant is not entitled to payment of the treatment plans or the interest in dispute.
9The respondent is not liable to pay an award.
ANALYSIS
The applicant has not demonstrated that he suffers from accident-related injuries that warrant removal from the MIG
10Section 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.”
11An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, under section 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 lies with the applicant.
12The applicant submits that the clinical notes and records dated July 23, 2021, and July 28, 2021, from Ontario Rehab Centre and the OCF-18 dated November 10, 2022, and OCF-18 dated July 24, 2023, support his removal from the MIG. The applicant submits that he suffers pain in his left side of his neck, left shoulder, left shoulder blade, upper back, middle back, and lower back that has prevented him from working. Further, the applicant submits he developed psychological impairments as a result of the accident that also warrant his removal from the MIG. The applicant submits Dr. Jacqueline Brunshaw’s pre-assessment psychological report supports the applicant’s removal from the MIG. The applicant further relies upon Janaratharajan v. Aviva Insurance Canada, 2021 CanLII 76646 (ONLAT), Catherine Horvath v. Allstate Insurance Company of Canada, 2003 ONFSCDRS 92 and Carol McIntosh-Smith v. Belair Insurance Company Inc., 2004 ONFSCDRS 110, to substantiate his removal from the MIG.
13The respondent submits that the applicant’s injuries fall within the MIG. The respondent further submits the OCF-3 completed by physiotherapist, Bhavita Gajjar, dated July 30, 2021, provided by Ontario Rehab Center submits the applicant is not substantially unable to perform the tasks of his employment. The respondent submits the applicant relies upon a pre-screening and report by Dr. Brunshaw. The respondent submits the Tribunal should exclude the reports of Dr. Brunshaw because the issues in dispute are physical and not psychological. Further, the respondent submits the applicant failed to provide requested documents as per the Case Conference Report and Order dated, April 29, 202 to know what factors may contribute or cause any of the applicant disputed issues. The respondent relies upon Sabadash v State Farm et al., 2019 ONSC 1121, Caselle v Aviva Insurance Company, 2023 CanLII 119834 (ON LAT) and S.S. v RBC Insurance, 2017 CanLII 59500 (ON LAT).
14The applicant does not point me to any medical evidence indicating physical impairments that would warrant his removal from the MIG. Instead, the applicant’s submissions focus on the alleged psychological matters and relies on Dr. Brunshaw’s report recommending a psychological assessment. As I indicated earlier, a psychological assessment is not before me. Given that Dr. Brunshaw’s psychological recommendation does not include any notes about physical impairments, I give Dr. Brunshaw’s report no weight.
15The balance of the evidence before me as it relates to the applicant’s physical impairments lead me to find that he sustained only minor injuries as defined in the Schedule. As a result, I find that the applicant is not removed from the MIG on the basis of a non-minor physical injury.
16Given that I have found that the applicant’s accident-related impairments do not warrant removal from the MIG, it is not necessary for me to consider the reasonableness and necessity of the treatment plans in dispute.
The applicant is not entitled to interest and an award
17Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
18Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
19Since there are no benefits owing or unreasonably withheld or delayed, there is no interest or an award payable to the applicant.
ORDER
20The application is dismissed, and I find that:
i. The applicant has not demonstrated that his accident-related impairments warrant removal from the MIG.
ii. The applicant is not entitled to the treatment plans at issue.
iii. The respondent is not liable to pay an award.
iv. Interest is not payable.
Released: January 16, 2026
Nikisha Evans
Adjudicator