Licence Appeal Tribunal File Number: 25-000747/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:
Puneet Saini
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Lisa Holland
APPEARANCES:
For the Applicant:
Bianca Pirrotta Iaccino, Paralegal
For the Respondent:
Rajvir Dhillon, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Puneet Saini, the applicant, was involved in an automobile accident on October 7, 2022, 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, Aviva Insurance Company of Canada, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
Is the applicant entitled to $3,244.58 for chiropractic services, proposed by Alma Rehab Clinic Inc., in a treatment plan/OCF-18 (“plan”) dated February 7, 2023?
Is the applicant entitled to $3,512.56 for chiropractic services, proposed by Alma Rehab Clinic Inc., in a plan dated August 16, 2023?
Is the applicant entitled to the assessment and plan proposed by Ontario Independent Assessment Centre, as follows:
i. $2,394.75 for a chronic pain assessment, in a plan dated July 2, 2023; and,
ii. $5,132.71 for driving therapy, in a plan dated July 26, 2024?
- Is the applicant entitled to interest on any overdue payment of benefits?
3In his written hearing submissions, the applicant submits that issues 3 (ii) and 3 (iii) listed in the CCRO dated May 6, 2025 are no longer in dispute. Therefore, I have removed these issues from the listed issues in dispute.
RESULT
4The applicant is not entitled to the disputed treatment plans for chiropractic services, a chronic pain assessment and driving therapy.
5As there are no delayed or overdue benefits, no interest is payable.
ANALYSIS
Entitlement to treatment and assessment plans
6To receive payment for a treatment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. The applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving the same are reasonable.
a) The applicant is not entitled to chiropractic services
7I find that the applicant is not entitled to $3,244.58 and $3,512.56 for chiropractic services.
8The first treatment plan for chiropractic services, dated February 6, 2023, was completed by Dr. Alexander Moretto, chiropractor, and requested funding for $3,244.58 for chiropractic manipulation, therapy, exercise, massage therapy and exercise equipment. The goals of the treatment plan were listed as pain reduction, increase in strength, increased range of motion and a return to the activities of normal living, return to modified work activities, and return to pre-accident work activities.
9The second treatment plan for chiropractic services, dated August 15, 2023, was completed by Dr. Roger Singh, chiropractor, and requested funding for $3,512.56 for chiropractic manipulation, therapy, exercise, massage therapy and exercise equipment. The goals of the treatment plan were listed as pain reduction, increase in strength, increased range of motion, return to activities of normal living, and return to pre-accident work activities.
10The applicant submits generally that the disputed plans are reasonable and necessary because he has been removed from the Minor Injury Guideline (“MIG”), and the proposed treatment will alleviate his pain symptoms involving his neck, back, left shoulder and left knee. The applicant does not direct me to any evidence in support of whether the plans are reasonable and necessary, and instead, he argues that the Insurer Examination (“IE”) report dated August 10, 2023, by Dr. Hashmat Khan, general practitioner does not provide a recommendation for pain relief, despite his findings of sprain/strain type of injuries of the applicant’s neck, back, left shoulder and left knee.
11The respondent relies on the IE report dated August 10, 2023, by Dr. Hashmat Khan, general practitioner and his opinion that further treatment is not reasonable and necessary for the applicant’s uncomplicated soft tissue injuries.
[12]
12I find the applicant has not established that he has accident-related pain that these plans would alleviate. I find that the applicant does not address how the treatment plan goals would be met to a reasonable degree, nor on the overall costs being reasonable, and he simply attacks the respondent’s IE report by Dr. Khan. I find that the applicant is unable to meet his onus by undermining the respondent’s case alone.
13Therefore, I find on a balance of probabilities that he is not entitled to these treatment plans for chiropractic services.
b) The applicant is not entitled to a chronic pain assessment
14I find that the applicant is not entitled to $2,394.75 for a chronic pain assessment.
15The applicant has the onus of proving there are reasonable grounds to believe that a condition exists that would warrant further investigation by way of an assessment.
16The treatment plan for a chronic pain assessment, dated July 26, 2023, was completed by Narmin Shirin, registered nurse, and requested funding for a chronic pain assessment by Dr. Khal Efala, in the amount of $2,394.75. The goals of the treatment plan were not listed and in the additional comments, the assessment is recommended based on the length of time of the applicant’s symptoms since the accident.
17The applicant submits generally that the disputed plan is reasonable and necessary when the objectives are to improve level of function and alleviate limitations. The applicant does not direct me to any corroborating evidence from his doctors in support of his position other than he has reported pain symptoms to assessors during a period greater than six months since the accident.
18The respondent points to the IE reports dated August 10, 2023, by Dr. Khan, and the IE report dated July 15, 2024, by Dr. Mohamed Lamine, general practitioner. The respondent submits that on examination, both Dr. Khan and Dr. Lamine found normal range of motion in the applicant’s neck, back, left shoulder and left knee, and they opined that the applicant has no accident-related physical impairment. The respondent further submits that in Dr. Khan’s paper review report dated September 12, 2023, Dr. Khan concluded that a chronic pain assessment is not reasonable and necessary in the absence of compelling medical findings.
19The respondent submits that the applicant does not meet 3 out of 6 criteria under the American Medical Association’s Guides to the Evaluation of Permanent Impairment, (the “Guides”) since he has returned to work and he does not have a dependence on healthcare providers, excessive use of prescription drugs, physical deconditioning or withdrawal from social milieu. Although the respondent argues that the applicant does not meet 3 out of the 6 criteria under the Guides, this is not required to establish entitlement to a chronic pain assessment.
20I find that the applicant has not met his burden or provided evidence to address whether a chronic pain assessment is reasonable and necessary as a result of the accident.
c) The applicant is not entitled to driving therapy
21I find that the applicant is not entitled to $5,132.71 for driving therapy.
22The treatment plan for driving therapy services dated July 25, 2024, was completed by Narmin Shirin, registered nurse, and requested funding for driving therapy by Marcaila Taylor, social worker, in the amount of $5,132.71. The goals of the treatment plan were listed as pain reduction, return the applicant to his activities of normal living, and return to his pre-accident level of psychological functioning.
23The applicant relies on a psychological report dated October 17, 2023, by Dr. Konstantinos Papazoglou, psychologist. The applicant reported to Dr. Papazoglou on September 21, 2023, that he has never been in any previous accidents, he works at Amazon in the warehouse, and he has resumed driving to work. The applicant also relies on progress reports dated March 18, 2024, June 18, 2024, September 30, 2024, and April 12, 2025, by Dr. Papazoglou, which indicate the applicant reported to treatment provider, Ulviyya Javanshir, social worker that he did not return to driving until June 2024, and he continues to avoid driving.
24The applicant also relies on the driving anxiety assessment report dated May 31, 2024, by Dr. Akanksha Tripathi, psychologist and Dr. Harinder Mrahar, psychologist in which the applicant reported that he has an A-Z drivers’ licence, but he avoids driving and he carpools to work.
25The respondent relies on the clinical notes and records of the applicant’s family physician, Dr. Viola Hanna, which indicate on October 21, 2022, the applicant returned to work one week after the accident and he resumed driving long hours as a truck driver at 8-10 hours per day. The respondent also points to the IE report dated August 10, 2023, by Dr. Khan, in which the applicant reported to Dr. Khan that he returned to work as a truck driver a week after the accident at Runway Transportation. The applicant further reported to Dr. Khan that in May 2023 he changed jobs to Kapila Transport, but he continued to work as a truck driver. The applicant also reported to Dr. Khan that he has not been involved in any prior accidents.
26The respondent also relies on IE report dated July 10, 2024, by Dr. Mohammad Nikkhou, psychologist, and progress report dated September 30, 2024, by Dr. Papazoglou. The respondent submits that both Dr. Nikkhou and Dr. Papazoglou indicate that the applicant has returned to driving. The respondent submits that in his progress report, Dr. Papazoglou indicates that the applicant no longer avoids driving and he feels more comfortable while driving.
27I find that the applicant has provided conflicting reports to his doctors and assessors regarding the nature of his employment and whether he returned to work as a truck driver after the accident. The applicant reported to Dr. Hanna and Dr. Khan that he returned to work as a truck driver one week after the accident. The applicant also reported to Dr. Papazoglou that he has returned to driving to work. However, the applicant reported to Dr. Tripathi that although he has an A-Z driver’s licence, he has a desk job at Amazon and he avoids driving to work. By April 2025, the applicant reported to Ulviyya Javanshir that he no longer avoids driving.
28I find that the report of Dr. Papzoglou is based on unreliable information reported by the applicant. Although the applicant denied his involvement in any prior accidents, the CNRs of Dr. Hanna mention two prior accidents on or about October 6, 2021, and April 5, 2022. I prefer the evidence contained in the CNRs of Dr. Hanna, because there is evidence of prior accidents and the applicant’s return to long hours of driving shortly after the accident.
29I find that Dr. Papazoglou’s report carries little weight since the medical evidence the applicant relies upon contradicts the evidence in his family physician’s records regarding the applicant’s level of driving after the accident.
30I find on a balance of probabilities that the applicant has not established entitlement to driving therapy. Therefore, the applicant has not established whether the plan for driving therapy is reasonable and necessary.
Interest
31Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since no benefits have been unreasonably withheld or delayed, there is no interest payable.
ORDER
32For the reasons outline above, I find that:
i. The applicant is not entitled to the disputed plans for chiropractic services, a chronic pain assessment, and driving therapy.
ii. No interest is payable.
iii.
iv. The application is dismissed.
Released: May 19, 2026
Lisa Holland
Adjudicator