Simran Sembhi v. Intact Insurance Company, 2026 CanLII 45571

Citation: Sembhi v. Intact Insurance Company, 2026 ONLAT 24-013485/AABS

Licence Appeal Tribunal File Number: 24-013485/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:

Simran Sembhi

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR: Caley Howard

APPEARANCES:

For the Applicant: Monika Krumins, Paralegal

For the Respondent: Karman Dhuga, Counsel

HEARD: By way of written submissions

OVERVIEW

1Simran Sembhi, the applicant, was involved in an automobile accident on October 14, 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?

ii. Is the applicant entitled to the assessments/treatment plans proposed by Physiomed Erin Mills Inc., as follows:

a) $2,926.00 for chiropractic services, in a treatment plan/OCF-18 ("plan") submitted January 2, 2024?

b) $2,626.50 for physiotherapy services, in a plan submitted November 13, 2024?

c) $2,966.00 for physiotherapy services, in a plan submitted November 21, 2023?

iii. Is the applicant entitled to the assessments proposed by Downsview Healthcare., as follows:

a) $2,486.00 for an orthopaedic assessment, in a plan submitted January 17, 2024?

b) $2,486.00 for a psychological assessment, in a plan submitted January 25, 2024?

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?

3The applicant withdrew her claim to a non-earner benefit prior to the hearing.

RESULT

4I find that:

i. The applicant remains within the MIG;

ii. Therefore, it is not necessary to determine whether the disputed treatment plans are reasonable and necessary;

iii. The applicant is not entitled to interest; and

iv. The respondent is not liable to pay an award under s. 10 of Reg. 664.

ANALYSIS

The applicant remains in the MIG

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.

The applicant does not suffer from chronic pain with a functional impairment that warrants removal from the MIG

7The applicant submits that she suffers from chronic pain to her neck, upper back and shoulders as a result of the accident, which impairs her ability to sleep, perform self-care and participate in routine activities. In support, she relies on the clinical notes and records (CNRs) of her family doctor, Dr. Tarek Shokr, an MRI report relating to her cervical spine and a one-page note from Dr. Puneet Phull, Neurologist, located in Punjab.

8The respondent submits that the applicant has not proven that she suffers from chronic pain with functional impairment as a result of the accident. In support, the respondent relies on the Insurer's Examination (IE) reports of Dr. Mohamed Lamine, physician, dated January 26, 2024 and February 29, 2024 and of Dr. Charnjit Sandhu, Internal Medicine Specialist, dated December 18, 2024 and April 24, 2025. Dr. Lamine and Dr. Sandhu both opined that the applicant's accident-related injuries fell within the MIG.

9The CNRs of Dr. Shokr confirm that the applicant reported experiencing neck pain as a result of the accident in December 2023 and again in May 2024, when Dr. Shokr ordered an MRI. On June 27, 2024, the applicant saw Dr. Shokr in order to discuss the results of the MRI, which showed mild degenerative changes and prompted Dr. Shokr to recommend further monitoring, heat and stretches. The notes indicate that after June 27, 2024, the applicant does not discuss the neck pain with Dr. Shokr again. I also find that there are no references in the CNRs of Dr. Shokr to any functional limitations caused by the applicant's pain.

10The applicant also relies on a one-page note from Dr. Phull, dated July 2, 2024, which states that the applicant will be under the care of Phull Neuro and Multi-specialty Hospital for the treatment of nerve compression issues and cervical radiculopathy. I find that the note is vague and is not accompanied by CNRs. It does not indicate when or if the applicant was assessed or treated by Dr. Phull.

11I give this note little weight as it is not clear whether Dr. Phull ever assessed the applicant, either in person or virtually, or what his diagnosis was based on. As noted above, Dr. Phull is located in Punjab. While the applicant submits that Dr. Phull's letter is corroborated by "objective EMG findings", these EMG results were not before me nor were they mentioned in Dr. Phull's letter or in the CNRs of Dr. Shokr. Dr. Phull's note also does not discuss any functional limitations caused by the applicant's pain.

12In addition, Dr. Phull's findings were contradicted by Dr. Sandhu's report of April 24, 2025. Dr. Sandhu's report indicates that the applicant had no focal neurologic deficit in her upper extremities and a negative Spurling test during her assessment. Also, her MRI showed no nerve root impingement. I give more weight to Dr. Sandhu's findings as they were based on a physical examination of the applicant and Dr. Sandhu's review of the applicant's MRI results. Dr. Sandhu also had access to Dr. Phull's CNRs and EMG results.

13As a result, I find that the applicant has not proven, on a balance of probabilities, that she suffers from chronic pain with a functional impairment, as a result of the accident, that would warrant her removal from the MIG.

The applicant does not suffer from a psychological condition that warrants removal from the MIG

14The applicant submits that she suffers from driving anxiety, fatigue, loss of motivation, sleep issues, flashbacks, low mood, diminished interest in social activities and depression as a result of the accident. In support, the applicant relies on the CNRs of Dr. Shokr, the Psychological Assessment Submission Letter of Dr. Jacqueline Brunshaw, Psychologist, dated January 5, 2024, and the Psychological IE Report of Dr. Marc Mandel, Psychologist, dated March 25, 2024.

15The respondent submits that the applicant has not proven that she sustained a psychological impairment that would warrant her removal from the MIG, as a result of the accident. In support, it relies on the Psychological IE report of Dr. Mandel.

16I note that the applicant reported to Dr. Shokr on December 28, 2023 that she had been avoiding driving since the accident. The clinical note does not specify whether this was due to physical or psychological symptoms. Aside from this one report, which is ambiguous as to whether it addresses the applicant's psychological condition, I find that the CNRs of Dr. Shokr contain no reports of psychological symptoms.

17Dr. Brunshaw's assessment letter was based on the results of a pre-screen questionnaire designed to determine whether a psychological assessment is warranted. Dr. Brunshaw indicates that the applicant reported a variety of psychological symptoms via a questionnaire, including falling and staying asleep, nightmares, low energy/fatigue, depressed/low mood, lack of motivation, feeling anxious, panic attacks, driver anxiety, passenger anxiety and pedestrian anxiety. I note that Dr. Brunshaw does not offer any opinion other than a belief that a psychological assessment is warranted. She does not diagnose the applicant with a psychological condition.

18I give less weight to Dr. Brunshaw's letter as she does not provide an opinion as to whether it is appropriate for the applicant to remain in the MIG, and her letter was based solely on the applicant's responses to a questionnaire, with no context gained through a clinical interview, observations of the applicant, psychological test results or a review of her medical file.

19In contrast, Dr. Mandel conducted a psychological assessment of the applicant that included a clinical interview, a review of the applicant's medical file and the applicant's responses to psychological tests. During her interview with Dr. Mandel, the applicant denied the majority of the psychological symptoms that she endorsed in the pre-screen questionnaire she completed for Dr. Brunshaw. The sole exception is that while she noted no sadness or prolonged low mood to Dr. Mandel, she stated that she will feel down if her pain is severe. Dr. Mandel concluded that there was no indication that the applicant sustained a psychological impairment as a result of the accident or required services beyond what is available within the MIG, from a psychological perspective.

20I give significant weight to Dr. Mandel's opinion, which was based on a full assessment of the applicant, including a clinical interview and psychological test results. Dr. Mandel's opinion is also consistent with the applicant's description of her current status at the time of the assessment, as set out in Dr. Mandel's report.

21The applicant submits that her psychological symptoms have worsened since Dr. Mandel's assessment. However, she did not direct me to any subsequent medical records regarding her psychological symptoms.

22As a result, I find that the applicant has not proven, on a balance of probabilities, that she sustained a psychological condition as a result of the accident that warrants removal from the MIG.

23I have found that the applicant remains subject to the MIG, therefore it is not necessary to determine whether the disputed treatment plans are reasonable and necessary.

Interest

24Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefits, the applicant is not entitled to interest.

Award

25The 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. As there are no benefits withheld or delayed, the respondent is not liable to pay an award.

ORDER

26I find that:

i. The applicant remains within the MIG;

ii. Therefore, it is not necessary to determine whether the disputed treatment plans are reasonable and necessary;

iii. The applicant is not entitled to interest; and

iv. The respondent is not liable to pay an award under s. 10 of Reg. 664.