Licence Appeal Tribunal File Number: 25-006294/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:
Dwight Rance
Applicant
and
Intact Insurance Company
Respondent
DECISION
PANEL:
Tim Porter, Adjudicator Harouna Saley Sidibé, Adjudicator
APPEARANCES:
For the Applicant:
Lorne Climans, Counsel
For the Respondent:
Sin Ying (Olivia) Cheng, Counsel
Court reporter:
Prashanth Thambipillai
HEARD: by Videoconference:
March 10 and 11, 2026
OVERVIEW
1Dwight Rance, the applicant, was involved in an automobile accident on December 15, 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 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 that the MIG monetary limit has been exhausted.
ii. Is the applicant entitled to a non-earner benefit (“NEB”) of $185.00 per week from January 11, 2024, to ongoing?
iii. Is the applicant entitled to $349.09 ($3,800.00 less $3,450.91 approved) for chiropractic and massage therapy services, proposed by Finch Health Centre Inc., in a treatment plan/OCF-18 (“plan”) dated January 18, 2024?
iv. Is the applicant entitled to $2,200.00 for a chronic pain assessment, proposed by Finch Health Centre Inc., in a plan dated November 26, 2024?
v. Is the applicant entitled to $38.67 for prescription medication submitted on a claim form (OCF-6) dated June 6, 2024?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3For the reasons below, the Tribunal finds that:
The applicant’s injuries remain within the MIG; therefore, the MIG’s monetary limit applies.
The applicant has not met his onus to establish entitlement to NEB
Because the applicant remains within the MIG, we do not need to assess the reasonableness and necessity of the disputed treatment plans beyond the MIG limits.
The applicant is not entitled to interest.
ANALYSIS
Are the applicant’s injuries predominantly minor?
4The Tribunal finds that the applicant’s accident‑related impairments are predominantly minor and fall within the MIG monetary limit.
5Section 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.”
6An 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.
7The applicant submits that he should be removed from the MIG due to pre‑existing medical and psychological conditions allegedly worsened by the accident, as well as accident‑related chronic pain causing functional impairment.
Pre-existing Conditions
8The Tribunal finds that the applicant has not presented convincing medical evidence that he has any pre‑existing condition would prevent maximal recovery within the MIG.
9The applicant described a history of significant prior medical issues arising from a workplace incident in which a heavy door fell on his head, causing a traumatic neck and head injury with hospitalization and cognitive difficulties. He testified that he sustained a neck injury and a concussion in that workplace event.
10He further testified that the accident caused neck and back injuries, which aggravated his prior problems. He relies on the Canadian Pension Plan (“CPP”) and Workplace Safety and Insurance Board of Ontario (“WSIB”) medical records.
11The Tribunal accepts that the applicant has a material pre‑accident history, including a workplace injury and associated conditions. However, the relevant question under the Schedule is not whether pre‑existing conditions exist, but whether there is compelling medical evidence that such conditions would prevent maximal medical recovery if the applicant is treated within the MIG. WSIB records document a neck and head injury on March 20, 2001, with subsequent diagnoses including chronic pain disorder of mixed etiology, dysthymic disorder with anxiety symptoms, and mild cognitive impairment secondary to traumatic brain injury.
12Lakeridge Health Emergency records dated December 15, 2023, reflect that the applicant denied head injury at that visit and reported chronic neck pain that had worsened and low back pain.
13The applicant’s family doctor Dr. Tak Lo’s clinical notes and records (“CNRs”) dated January 22, 2024, and January 31, 2024, mainly document soft-tissue complaints of the neck and back, injuries that clearly fall under the Schedule’s definition of minor injury.
14The applicant’s historical diagnoses, such as chronic pain disorder, dysthymic disorder with anxiety symptoms, and mild cognitive impairment, are documented and date back many years before the accident, as does his CPP disability status. However, the current post-accident evidence, including the December 2023 Emergency records, describes the accident-related injuries as soft tissue in nature.
15In a sworn statutory declaration dated February 2024, the applicant stated that injuries sustained in a prior workplace accident had healed after about a year of WSIB-funded physiotherapy. His evidence shows that this recovery occurred before the accident. In our view, this testimony weakens the argument that his pre‑existing condition was ongoing or unresolved enough to, on its own, prevent recovery from the accident‑related injuries if treatment was limited to the MIG.
16The evidentiary record does not establish that these pre-existing conditions would prevent full recovery within the MIG for the soft-tissue injuries sustained in the accident. The Tribunal was neither directed to nor provided with medical opinions from treating health-care professionals that specifically address the requirements of s. 18(2) by explaining how and why any identified pre-existing condition would hinder the applicant from achieving maximum recovery if confined to treatment within the MIG.
17Accordingly, on a balance of probabilities, the Tribunal finds that the applicant has not met his onus to demonstrate that his pre-existing condition warrants removal from the MIG.
Chronic Pain
18The Tribunal finds that the applicant has not met his onus to establish that he suffers from accident‑related chronic pain with functional impairment sufficient to remove him from the MIG.
19The applicant relies on a s. 25 report from Dr. David Brooks, a general practitioner, dated November 26, 2024, in which he states that the applicant meets the AMA Guides criteria for chronic pain syndrome caused by the accident. However, the report does not clarify the applicant’s pre‑accident chronic pain diagnosis or whether, and how, s. 18 is satisfied in light of the pre‑existing condition.
20The applicant testified that he experiences significant pain, including difficulty sleeping due to back pain, that he avoids heavy lifting because of his neck, and that he is unable to work, although he was not working at the time of the accident. While this testimony reflects ongoing pain complaints, it does not demonstrate a material change in functional ability after the accident. The applicant also testified that he can perform his activities of daily living, and there was no evidence of a sustained loss of function beyond an initial post‑accident period typical of soft‑tissue injuries.
21Dr. Brooks concluded the applicant meets six AMA criteria for chronic pain and reports that the applicant has: (1) continued use of analgesics; (2) excessive dependence on health-care providers; (3) deconditioning and fear-avoidance; (4) social withdrawal; (5) failure to regain pre-injury function; and (6) psychosocial sequelae (e.g., anxiety, sleep disturbance). He referenced high scores on neck and low-back disability questionnaires and asserted that multimodal therapy would aid recovery.
22In his testimony, Dr. Brooks acknowledged that there is no dependable way to divide the impairment between the applicant’s pre‑existing condition and the accident. He also testified that the applicant reported being able to carry out his daily activities in a similar way both before and after the accident, despite consistently reporting high pain scores. In our opinion, this shows an internal inconsistency between the applicant’s reported pain levels and his described level of functional ability, rather than evidence of a significant change in function caused by the accident.
23On cross-examination, Dr. Brooks acknowledged that his AMA-based criteria findings primarily depended on the applicant’s self-report and lacked detail: (1) medication type, dosage, and duration were not specified; (2) the nature and length of therapy, as well as the identities of other providers, were not clarified; (3) ADLs were not itemised; (4) the extent of social withdrawal was unspecified; (5) the impact on family and recreation was not specified; and (6) psychosocial sequelae lacked support from a contemporaneous mental health assessment or diagnosis.
24The Tribunal assigns less weight to Dr. Brooks’s opinion for several reasons. His conclusions mainly rely on the applicant’s self-reported symptoms, with limited objective evidence to support them, and several of the AMA Guides criteria are either misstated or not well substantiated by the evidence. Dr. Brooks does not base his assessment on specific functional measurements obtained from objective assessment tools. For example, Dr. Brooks concludes that the applicant meets the first AMA criterion because he uses medication. However, the criterion requires evidence of medication abuse or dependence on prescribed drugs, and neither party pointed to evidence establishing such abuse or dependence. Similarly, Dr. Brooks identifies “excessive dependence” on health‑care providers without defining the term or citing clinical evidence to support that conclusion.
25Dr. Brooks also reports social withdrawal; however, this claim is inconsistent with the applicant’s testimony that he socialized frequently and saw his friends “all the time.” Dr. Brooks further assesses restrictions in activities of daily living, but these restrictions are not supported by the clinical notes and records reviewed, including the family physicians’ CNRs referenced by the parties, which document ongoing pain complaints but do not substantiate the functional limitations Dr. Brooks describes. Nor are such limitations reflected in the applicant’s own testimony regarding his ability to perform daily activities.
26Finally, Dr. Brooks acknowledged in both his report and testimony that he could not differentiate the effects of the applicant’s longstanding pre‑existing conditions from any additional impairment caused by the accident. He did not address the statutory test under s. 18 or explain how the applicant’s documented pre‑accident chronic pain condition would be impacted by the accident to support his conclusions. This inability to apportion causation, coupled with the lack of a s. 18 analysis, weakens the persuasiveness of his opinion on causation and chronic pain related to the accident.
27The applicant testified that he takes daily pain medication prescribed by his family physician. However, the evidentiary record does not include clinical information demonstrating ongoing medication dependence or documenting accident-related functional impairment that would support removal from the MIG. In particular, the Tribunal was not provided with longitudinal clinical notes or records showing escalating dosages, changes in prescribing patterns, or related functional observations to substantiate chronic impairment attributable to the accident.
28This record shows that the medical evidence indicates the applicant sustained soft-tissue injuries and tension-type headaches from the accident. The Tribunal accepts that chronic pain can result from such injuries and does not need evidence of serious structural damage. However, the evidence does not prove that the applicant experiences ongoing functional impairment from pain caused by the accident that is sufficient to be classified as chronic pain.
29The parties did not direct the Tribunal to the treating physicians’ CNRs documenting persistent or worsening functional limitations, escalating treatment, or clinical observations linking ongoing impairment to the accident. Although the CNRs reflect continued reports of pain, they do not substantiate accident-related restrictions in function consistent with a chronic pain condition. Nor were treating specialist opinions provided to connect the applicant’s reported limitations to accident-related chronic pain rather than to his pre-existing conditions.
30Taken together, the evidence indicates that the applicant experienced a temporary period of pain-related impairment following the accident but does not prove ongoing functional impairment caused by the subject accident. This evidentiary gap, when considered alongside the applicant’s testimony and medical records as a whole, weakens the claim that the applicant meets the criteria for chronic pain resulting from the accident.
31Accordingly, on a balance of probabilities, the Tribunal finds that the applicant has not established accident‑related chronic pain with functional impairment sufficient to remove him from the MIG.
32Therefore, the applicant has not satisfied the evidentiary threshold for removal from the MIG.
Is the applicant entitled to the disputed treatment plans?
33The parties have confirmed that the MIG limits have been exhausted. Because the applicant remains within the MIG, he is not entitled to the treatment plans in dispute, as they propose goods and services that fall outside the MIG and the $3,500.00 funding limit for a minor injury.
Is the applicant entitled to a non-earner benefit of $185.00 per week from January 1, 2024, to ongoing?
34The Tribunal finds that the applicant has not met his onus to establish entitlement to an NEB from January 1, 2024, to the present.
35Section 12(1) provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident, if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391, which generally focuses on a comparison of the applicant’s pre- and post-accident activities.
36The applicant asserts that he is entitled to an NEB and primarily relies on the opinion of Dr. Brooks, who concluded that the applicant is unable to carry on a normal life due to physical and psychological impairments resulting from the accident.
Pre-accident functioning
37The applicant testified that before the accident, he lived independently and managed his personal care without assistance. He also stated that he performed household chores, such as cleaning and doing laundry, on his own; walked regularly in the community; rode his bicycle almost daily; and socialized with friends.
38At the time of the accident, the applicant testified that he was not employed. Although he had previously worked through temporary employment agencies, he was limited by medical issues related to pre‑existing conditions.
Post-accident functioning
39The applicant testified that immediately after the accident, he experienced increased neck and back pain, along with a temporary decline in his functional abilities. He stated that during this initial post‑accident period, he needed assistance with household chores, depended on others for cleaning, and limited his physical activities due to pain.
40Prior to the accident, the applicant testified that he lived independently, carried out all household chores, including laundry and cleaning, walked daily, cycled nearly every day, and socialized often with friends. After the accident, he testified that he stopped cycling for about five months, paused socializing, and resumed walking around two months later. He also stated that, during this period, his girlfriend helped with household chores.
41The applicant also testified that within a few months of the accident, he resumed several of his pre‑accident activities. Specifically, he stated that he resumed walking, returned to household chores such as laundry and light cleaning, and continued to live independently in the same apartment. Although he continued to report pain and limitations with heavier lifting. In our minds, this evidence indicates that many of his core daily activities returned to levels comparable to his pre‑accident routine.
Medical and occupational evidence
42Dr. Brooks, whose report we identify as carrying less weight, reported that the applicant has difficulty with activities of daily living, especially with repetitive tasks, sitting or standing for extended periods, lifting more than 2–3 kilograms, and walking for over 30 minutes. Dr. Brooks concluded that the applicant is unable to maintain a normal life, with decreased social and recreational involvement, and attributed these impairments to both physical and psychological effects of the accident. In our minds, Dr. Brooks’ opinion does not sufficiently reconcile the applicant’s demonstrated ability to perform several of his usual pre‑accident activities with the NEB entitlement requirement that he is continuously prevented from engaging in substantially all of the activities in which he ordinarily engaged before the accident.
43The statutory test for NEB entitlement is a high threshold. It requires proof of a complete inability to carry on a normal life, not simply pain, reduced endurance, or difficulty performing certain activities.
44Applying the comparative analysis required by Heath, the Tribunal finds that the applicant’s own evidence shows inconsistencies between his description of significant post-accident limitations and his reported level of functioning. Although the applicant testified to ongoing pain and restrictions, he also admitted that within months of the accident, he resumed core pre-accident activities, including laundry, light cleaning, walking, and independent personal care. His evidence, therefore, reflects a return to essentially similar daily functioning, despite ongoing pain complaints.
45In contrast, in his s.44 report dated May 24, 2024, Dr. Dinesh Krishna, a general practitioner, noted that the applicant reported independence with all personal care activities and lighter household tasks. The applicant also stated that he had resumed recreational walking at his pre‑accident level. Dr. Krishna did not identify any functional restrictions indicating an inability to carry on a normal life.
46Mr. Jonah Pataki, an occupational therapist, provided a detailed comparison of the applicant’s functioning before and after the accident. He confirmed that, prior to the accident, the applicant was independent in self-care, household management, community mobility, and leisure activities. Based on his assessment, Mr. Pataki concluded that although the applicant continues to report neck and low back discomfort, these symptoms have not resulted in a complete inability to live normally. He emphasized the applicant’s ongoing participation in self-care, household tasks, community mobility, and leisure activities.
47In light of Heath, the Tribunal finds that the applicant has not demonstrated that the accident caused a continuous inability to engage in substantially all of his pre‑accident activities. The evidence shows that the applicant was still able to manage his personal care, perform household tasks, and participate in community mobility and recreational walking. These activities made up a significant part of his life before the accident.
48Accordingly, on a balance of probabilities, the Tribunal finds that the applicant has not met the statutory test for entitlement to an NEB.
Interest
49Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since no benefits are payable, the applicant is not entitled to interest.
ORDER
50For the above reasons, it is ordered that:
i. The applicant’s injuries remain within the MIG; therefore, the MIG’s monetary limit applies.
ii. The applicant has not met his onus to establish entitlement to NEB.
iii. Because the applicant remains within the MIG, we do not need to assess the reasonableness of the disputed treatment plans beyond the MIG limits.
iv. The applicant is not entitled to interest.
Released: May 7, 2026
Timothy Porter
Adjudicator
Harouna Saley Sidibé
Adjudicator