Licence Appeal Tribunal File Number: 24-012713/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:
Vladimir Chtchourko
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Jim Zotalis
APPEARANCES:
For the Applicant:
Kameliya Stancheva, Paralegal
For the Respondent:
Marilyn Maxwell-Smith, Counsel
HEARD:
In Writing
OVERVIEW
1Vladimir Chtchourko, the applicant, was involved in an automobile accident on August 13, 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, Intact 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:
i. Are the applicant’s injuries predominantly minor as defined is 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 not been exhausted and there was $318.03 remaining as of the date of the case conference.
ii. Is the applicant entitled to $87.19 ($1,356.35 less $1,269.16 approved) for chiropractic services proposed by Toronto Medical Centre in a treatment plan/OCF-18 (“plan”) submitted November 10, 2023, and partially denied November 17, 2023?
iii. Is the applicant entitled to $1,581.98 for chiropractic services proposed by Toronto Medical Centre in a plan submitted November 27, 2023, and denied November 28, 2023?
iv. Is the applicant entitled to $1,748.05 for a biopsychosocial assessment proposed by Toronto Medical Centre in a plan submitted September 27, 2023, and denied October 4, 2023?
v. Is the applicant entitled to $1,995.32 for a psychological assessment proposed by Dr. Svetlana Gabidulina and Courtney Dowling in a plan submitted February 14, 2024, and denied February 25, 2024?
vi. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has sustained predominantly minor injuries as defined in s. 3 of the Schedule and therefore is subject to treatment within the limits of the MIG.
4As I have found the applicant to have sustained minor injuries and subject to the MIG funding limits, it is not necessary for me to consider the proposed treatment plans or remaining balances.
5The respondent is not liable to pay an award under s. 10 of Reg. 664 as no payments were due to the applicant.
6As there are no payments overdue to the applicant, no interest is due.
7The application is dismissed.
ANALYSIS
Do the applicant’s impairments fit within the MIG framework?
8The MIG establishes a framework for the treatment of minor injuries. The term “minor injury” is defined in s. 3(1) of the Schedule 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.” The terms “strain”, “sprain”, “subluxation”, and “whiplash associated disorder” are also defined in s. 3(1). Section 18(1) limits recovery for medical and rehabilitation benefits for such injuries to $3,500.
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 submits he should be removed from the funding limits of the MIG on the basis of chronic pain and psychological impairment.
Do the applicant’s injuries fall outside of the MIG?
11The applicant has sustained predominantly minor injuries as a result of the accident and is confined to the funding limits of the MIG.
12The applicant submits that his injuries do not fall within the definition of a minor injury as set out in s. 3(1) of the Schedule and should therefore not be subject to the $3,500 funding limits of the MIG. The applicant further submits that his injuries extend beyond those identified in s. 3(1) as he has lumbar, sacroiliac, shoulder and knee injuries, chronic headaches, and significant psychological impairments, including PTSD and fatigue.
13The applicant relies on the following medical evidence to support his position that he should be removed from the MIG:
i. OCF-3 disability certificate, prepared by Dr. Shadi Jahandideh, chiropractor, dated August 21, 2023;
ii. CNRs from Dr. Michael Hanna, family physician, August 13, 2020, to April 9, 2024;
iii. CNRs from Dr. Lioudmila Kaminiar, family physician, August 14, 2020, to April 24, 2024;
iv. Mackenzie Health Hospital Records, August 14, 2020, to February 4, 2025; and
v. Decoded OHIP summaries.
14The respondent submits that there is no evidence of a pre-existing medical condition or injury, chronic pain with functional impairment or disability or a psychological impairment that warrants removal from the MIG. The respondent further submits that the CNRs of Dr. Hanna do not establish any basis upon which the applicant’s claim would fall outside of the MIG. The respondent also contends that the applicant’s own submissions point to no evidence from the applicant’s treating physicians or service providers of any non-MIG condition and rely entirely on unsubstantiated evidence from a disability certificate and injury list and thus without supporting evidence, the applicant is unable to meet his burden of proof. The respondent advises it has paid the applicant $3,181.97 in medical and rehabilitation benefits.
15The respondent relies on the following medical evidence to support its position that the applicant should not be removed from the MIG.
i. S.44 IE report of Dr. Alisa Naiman, family physician, dated January 10, 2024; and
ii. S.44 IE report of Dr. Marc Mandel, psychologist, dated January 26, 2024.
16I find the applicant has sustained predominantly minor injuries as a result of the accident and should be held to the MIG funding limits. I also find that the applicant does not suffer from chronic pain with functional impairment or from a psychological impairment as a result of the accident.
17I make these findings for the following reasons.
18The medical evidence from Dr. Michael Hanna does not support that the applicant suffers from chronic pain with functional impairment nor of any psychological impairment. The applicant attended at his family doctor some three months after the accident and complained of pain in his shoulders, knees and low back and denied having sustained a head injury, vomiting or headache. The applicant was encouraged to continue with rehabilitation and seek a follow-up visit. The applicant next visited with his family doctor with respect to accident-related impairments on March 12, 2025, and reported left sided back pain which increased with movement, and tingling and numbness in both feet. The CNRs indicate back pain/muscle spasm and the recommendation was for heat packs, Voltaren gel and Tylenol Arthritis Tecta.
19I agree with the respondent that the applicant’s family doctor’s CNRs do not establish any basis upon which the claim would fall outside of the MIG. Although the OCF-3 confirms substantial limitations in performing essential tasks of employment and daily living, under duration of disability test the author of the certificate indicates between 9 – 12 weeks. I place little weight on the disability certificate prepared by Dr. Shadi Jahandideh, dated August 21, 2023, as I have not been directed to medical evidence to corroborate the OCF-3 in terms of the injuries listed.
20I find the records provided by the applicant including CNRs from Dr. Lioudmila Kaminiar and the Mackenzie Health Hospital records speak to health issues that are non-accident related such as visits for a colonoscopy, cardiac assessment and covid-19 assessment which do not support the applicant’s claim for removal from the funding limits of the MIG on the basis of an accident related impairment.
21In order for an applicant to be removed from the MIG due to chronic pain, the Tribunal has held that there must be functional limitation as a result of the pain. The respondent submits that the applicant’s claim of chronic pain should be assessed against six criteria described in the American Medical Association (“AMA”) Guides to the Evaluation of Permanent Impairment, which state that at least three of the six criteria must be met for a diagnosis.
22I find that the applicant has not led evidence to satisfy me on a balance of probabilities that he meets at least three of the six criteria for a diagnosis of chronic pain with functional impairment. I also find that the applicant has not demonstrated that he is limited in completing his pre-accident activities of daily living, work or other activities such that he has a functional impairment related to his pain. For example, to Dr. Alisa Naiman, family physician, during a s.44 assessment, the applicant endorsed being independent in his personal hygiene and self care as well as being able to clean, laundry and do groceries.
23For reasons similar to those above, I find the applicant has not met his burden to be removed from the MIG due to a psychological impairment as a result of the accident. Dr. Marc Mandel completed a s.44 in-person psychological assessment of the applicant and concluded that there is a lack of consistent objective information that would suggest the applicant has a psychological impairment or disability as a result of the accident. Although the applicant has made submissions that he has suffered from psychological distress, anxiety, sleep problems and reduced daily function, he has not persuaded me by directing me to the evidentiary record to demonstrate this case. Submissions alone are not a substitute for evidence. As such, I find the evidentiary record lacking to support the applicant’s proposition that he should be removed from the funding limits of the MIG.
24For the reasons stated above, I find on a balance of probabilities that the applicant has sustained predominantly minor injuries as a result of the accident and is subject to the MIG.
Is the applicant entitled to the treatment plans?
25As I have found the applicant to have sustained minor injuries and subject to the MIG funding limits, it is not necessary for me to consider the proposed treatment plans.
Interest
26Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
27There are no overdue payments and therefore no interest is payable.
Award
28The applicant sought an award under s. 10 of Reg. 664. Under 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.
29Having found that the respondent properly denied the applicant’s claim, I dismiss the applicant’s award request.
ORDER
30The Order of the Tribunal is as follows:
i. The applicant has sustained predominantly minor injuries as defined in s. 3 of the Schedule and therefore is subject to treatment within the limits of the MIG.
ii. As I have found the applicant to have sustained minor injuries and subject to the MIG funding limits, it is not necessary for me to consider the proposed treatment plans.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664 as no payments were due to the applicant.
iv. As there are no payments overdue to the applicant, no interest is due.
v. The application is dismissed.
Released: May 5, 2026
Jim Zotalis
Adjudicator