Licence Appeal Tribunal File Number: 24-012187/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:
Maria Abkarian
Applicant
and
The Dominion of Canada General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Aric Bhargava
APPEARANCES:
For the Applicant:
Monika Krumins, Paralegal
For the Respondent:
Saly Botelho, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Maria Abkarian, the applicant, was involved in an automobile accident on May 9, 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, The Dominion of Canada General 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 section 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 $3,622.73 for chiropractic treatment, proposed by MacKenzie Rehabilitation Centre in a treatment plan/OCF-18 (“plan”) submitted May 17, 2023?
iii. Is the applicant entitled to $282.06 ($1,300.00 less $1,017.94 approved) for chiropractic treatment, proposed by MacKenzie Medical Rehabilitation Centre in a plan submitted August 17, 2023?
iv. Is the applicant entitled to $2,023.03 for chiropractic treatment, proposed by MacKenzie Medical Rehabilitation Centre in a plan submitted October 31, 2023?
v. Is the applicant entitled to $2,000.00 for a psychological assessment, proposed by Life Point Medical in a plan submitted September 26, 2023?
vi. Is the applicant entitled to $2,200.00 for an orthopaedic assessment proposed by Life Point Medical in a plan submitted February 27, 2024?
vii. Is the applicant entitled to $2,200.00 for a chronic pain assessment, proposed by Life Point Medical in a plan submitted March 4, 2024?
viii. Is the applicant entitled to $7.94 ($45.00 less $37.06 approved) for an ambulance fee, submitted on an Expenses Claim Form (OCF-6) on December 15, 2023?
ix. Is the applicant entitled to interest on any overdue payment of benefits?
x. Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?
3In her submissions the applicant did not address issues viii) and ix) listed in the Case Conference Report and Order (“CCRO”). Also, the respondent submits the disputed amounts were approved April 3, 2025. As such, I find these issues are not in dispute and I will not address the issue of ambulance fees in the amount of $7.94 submitted on an Expense Claim Form (OCF-6) dated December 15, 2023 and transportation expenses in the amount of $83.66 submitted on an Expenses Claim Form (OCF-6) dated December 15, 2023.
RESULT
4The applicant is subject to the MIG.
5As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
6As there are no overdue benefits, the applicant is not entitled to interest.
7The applicant is not entitled to an award under section 10 of Regulation 664 because no payments were unreasonably delayed or withheld.
PROCEDURAL ISSUES
Respondent’s request to exclude applicant’s amended submissions
8Subsequent to the parties’ written submissions being filed, the applicant filed an amended submission on February 17, 2026, reformatted to include individually labelled tabs. The amended submissions were filed six months after the submission date noted in the CCRO.
9In an email dated February 17, 2026, the respondent requested that the Tribunal exclude the amended submissions, as they were filed past the submission deadline noted in the CCRO. The respondent refers to the submissions as “reply submissions”; however, the amended document is the applicant’s submissions, reformatted. The respondent argues that the applicant should not be permitted to file submissions after a set deadline unless a motion is brought first, allowing the respondent the opportunity to respond. While the respondent has not stated what prejudice would result from allowing the amended submissions, I infer the respondent’s position is that it is procedurally unfair to the respondent to allow the amended submission.
10I deny the respondent’s request to exclude the applicant’s amended submissions. While I agree with the respondent that it may be procedurally unfair to allow the applicant to file its submissions six months past the deadline, this is not the case here. In this case, the applicant filed its submission in a timely manner, and the amended filing is not late or new, only amended to include tabs. Also, the respondent has not established that it suffered any prejudice as a result of the amended submission, and I find there is none. In contrast, excluding the amended submission would limit the applicant’s ability to participate in the proceedings. Therefore, I deny the respondent’s request to strike the amended submissions and will consider them in their entirety.
ANALYSIS
Application of the Minor Injury Guideline
11I find the applicant’s injuries are predominantly minor injuries in accordance with the Schedule and subject to treatment within the MIG.
12Section 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 of subluxation and includes any clinically associated sequelae to such an injury.”
13The applicant may be removed from the MIG if she can establish her accident-related injuries fall outside of the MIG or, under section 18(2), that she has a documented pre-existing condition combined with compelling medical evidence stating that the condition precludes maximal recovery if she is kept within 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.
14The applicant submits that her accident-related injuries include ongoing neck, upper back, bilateral shoulders, bilateral arms, chest, and lower back pains, with headache, driving anxiety, fatigue, loss of motivation, sleep issues, and depression. The applicant submits she should be removed from the MIG, I infer, on the grounds of chronic pain, and psychological injuries.
Does the applicant have chronic pain with functional impairment?
15I find the applicant has not demonstrated that she suffers from a chronic pain condition with a functional impairment that would warrant removal from the MIG.
16The applicant submits that she should be removed from the MIG because she suffers from chronic pain in her neck, shoulders, and migraine pain due to the accident. The applicant relies on the clinical notes and records (“CNRs”) of Dr. Armen Boyrazian, family physician, Dr. Oare Alufohai, walk-in clinic physician, the CNRs of Sunnybrook Health Sciences Centre, and on Applicant v. Aviva General, 2018 CanLII 81912 (ON LAT), 18-001508 v. Security National Insurance Company, 2019 CanLII 63353 (ON LAT), and Bossio v. Intact Insurance Company, 2023 CanLII 110937 (ON LAT).
17Specifically, the applicant refers to the CNRs of the family physician, Dr. Boyrazian, and Sunnybrook Health Sciences Centre, for the period of May 9, 2020 to March 6, 2025. However, I am not directed to specific entries within the CNRs. The applicant’s first visit with her family doctor is 17 days after the accident and the doctor notes “had some chest discomfort, no fractures, will improve with time.” The applicant visited her family doctor again on June 19, 2023, April 13, 2024, August 10, 2024, and once with Dr. Alufohai on December 6, 2024. On each visit, and over the course of roughly 15 months, the applicant complained of accident-related neck, back, or shoulder pains. I find the applicant has ongoing neck, back, and shoulder pain; however, I am not directed to evidence in support of a functional impairment as a result of her ongoing pain.
18Also, the applicant’s MRI dated August 9, 2024 and the primary care physician’s CNRs do not refer to a functional impairment as a result of the accident or the accident-related ongoing pain in her neck, back and shoulders. The MRI diagnoses the applicant with mild degenerative disc disorder, but that is not accident-related.
19I am not bound by other decisions of the Tribunal, and I find the cases referred to by the applicant are not persuasive. In Applicant v. Aviva General the applicant was removed from the MIG because there was evidence of ongoing pain and consistent reporting to medical practitioners of continuous pain and functional impairment for an extended period of time. However, in the current case, the applicant has not established that she suffers a functional impairment.
20In 18-001508 v. Security National Insurance Company the applicant’s injuries also included back, neck, and shoulder pain that fell outside of the MIG despite not having a chronic pain diagnosis. However, in that case the applicant’s evidence included an orthopaedic surgeon’s report that the applicant suffered functional limitations and it identified how her pain was aggravated by engaging in her day-to-day activities. In the current case, I am not directed to a functional impairment as a result of the applicant’s ongoing accident-related pain.
21Finally, in Bossio v. Intact Insurance Company the applicant was removed from the MIG because the applicant had pain that was endured for a long time and the prognosis for a full recovery was unlikely. However, in this case, I am not directed to medical evidence that the prognosis for the applicant’s full recovery is unlikely, or that the applicant has suffered a functional limitation as a result of the ongoing pain. I find the Tribunal decisions referred to by the applicant are dissimilar in their circumstances and not supportive of the applicant’s arguments in this case.
22The respondent submits the applicant has not provided clear, objective evidence that she suffers from chronic pain or that she has a functional impairment as a result of her accident-related injuries. The respondent relies on the section 44 independent medical evaluation dated October 21, 2024, prepared by Dr. Ahmad Belfon. Dr. Belfon notes the applicant has sustained uncomplicated, soft-tissue injuries and she still reports residual myofascial pain in the affected areas, however, no objective impairment was identified.
23In her reply submissions the applicant submits that her physiotherapy and rehabilitation records from May 2023 to present demonstrate she has ongoing pain, restricted mobility, and functional limitations. I was not directed to the physiotherapy records or rehabilitation records, or any other evidence in support of this argument.
24While there is evidence of accident-related pain, given that the applicant has not established that she has a functional impairment, I find the applicant has not met her evidentiary onus to prove that she suffers from chronic pain with a functional impairment that warrants removal from the MIG.
Does the applicant have a psychological impairment?
25I find the applicant has not met her burden to prove that she suffers from a psychological impairment that warrants removal from the MIG.
26To establish accident-related psychological impairments the applicant relies on the CNRs of Dr. Boyrazian, and the pre-screening report dated September 8, 2023, prepared by Dr. Mandeep Singh, psychological associate.
27I place little weight on Dr. Boyrazian’s CNRs because there is one entry nine months after the accident, on February 3, 2024 that notes a complaint of sleeping issues and, there is no mention of this issue being accident-related. Also, I am not directed to any specific entries in the CNRs of anxiety, or low mood, as noted by a medical practitioner. In my view, a single complaint, nine months after the accident, does not meet the threshold to support her position that she suffers a psychological impairment as a result of the accident.
28I place little weight on Dr. Singh’s pre-screening report because the report does not include any objective measures in the assessment, and no evidence is included to support the provisional diagnosis of post traumatic stress disorder and adjustment disorder with anxiety and depressed mood.
29The respondent submits the applicant has not met her onus and relies on the section 44 psychology insurer examination report dated February 21, 2024, prepared by Dr. Jay McGrory, psychologist. The section 44 report includes a clinical in-person interview, the Beck Depression Inventory – 2, and the Beck Anxiety Inventory. Dr. McGrory notes the applicant is not experiencing significant accident-related psychological difficulties and any emotional sequalae from the accident can be addressed within the MIG. I put weight on this evidence because it includes the administration of necessary objective testing by the psychologist to reach the final conclusion on the applicant’s overall psychological state.
30I find on a balance of probabilities that the applicant has not met her burden to establish that she has a psychological impairment as a result of the accident.
Are the treatment plans reasonable and necessary?
31Having found that the applicant is subject to the MIG, I do not need to consider whether the treatment plans in dispute are reasonable and necessary.
Interest
32Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. As no benefits are owed,
Award
33The applicant sought an award under section 10 of Regulation 664. Under section 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. The Tribunal has determined that an award is justified where the delay or withholding of benefits by the insurer is unreasonable conduct, meaning “behaviour which is excessive, imprudent, stubborn, inflexible, unyielding or immoderate.” The onus is on the applicant to prove, on a balance of probabilities, that the respondent’s conduct meets this threshold.
34I find the applicant has not established that an award is appropriate. The applicant’s submissions are silent on the issue of an award, and her reply submissions are also silent on this issue. As a result, no award is payable.
ORDER
35The applicant is subject to the MIG.
36As the applicant is subject to the MIG, it is not necessary to consider if the treatment plans in dispute are reasonable and necessary.
37As there are no overdue benefits, the applicant is not entitled to interest.
38The applicant is not entitled to an award under section 10 of Regulation 664 because no payments were unreasonably withheld or delayed.
39The application is dismissed.
Released: May 12, 2026
Aric Bhargava
Adjudicator