Citation: Minaei v. Certas Home and Auto Insurance Company, 2026 ONLAT 25-000496/AABS

Licence Appeal Tribunal File Number: 25-000496/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:

Siamak Minaei

Applicant

and

Certas Home and Auto Insurance Company

Respondent

DECISION

ADJUDICATOR: Rachel Levitsky

APPEARANCES:

For the Applicant: Soroush Seifi, Counsel

For the Respondent: Stuart Borenovich, Counsel

HEARD: By way of written submissions

OVERVIEW

1Siamak Minaei, the applicant, was involved in an automobile accident on January 24, 2020, 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, Certas Home and Auto 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 $1,328.00 for chiropractic services, proposed by Dr. H. Nayeri in a treatment plan dated January 3, 2024?

iii. Is the applicant entitled to $2,200.00 for a GP assessment, proposed by Dr. H. Nayeri in a treatment plan dated December 4, 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?

RESULT

3The applicant has not sustained an injury that would warrant his removal from the MIG.

4As I have found that the applicant is not removed from the MIG, it is not necessary for me to determine whether the treatment plans in dispute are reasonable and necessary pursuant to s. 15(1) of the Schedule.

5The respondent is not liable to pay an award.

6The applicant is not entitled to interest.

ANALYSIS

Application of the Minor Injury Guideline

7I find that the applicant has not met his onus to prove, on a balance of probabilities, that he should be removed from the MIG.

8Section 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.”

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 that he suffers from chronic pain, and that he satisfies the criteria for chronic pain as set out in the American Medical Association Guides (“AMA Guides”). While I am not bound by the AMA Guides, I find it helpful as an interpretive tool. The AMA Guides states that at least three of the following criteria must be met for a diagnosis of chronic pain:

i. Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances.

ii. Excessive dependence on health care providers, spouse, or family.

iii. Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain.

iv. Withdrawal from social milieu, including work, recreation, or other social contracts.

v. Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs.

vi. Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.

11The applicant submits that he has been using prescription drugs beyond the recommended duration to treat his accident-related symptoms. He submits that he is continuously prevented from engaging in his pre-accident social and vocational activities of daily living, which he indicates was reported by Dr. Nayeri, chiropractor. He also submits that he has developed significant psychological impairments because of the accident, which he alleges is corroborated by his healthcare providers.

12The applicant has not explained which prescription medication he is taking as a result of the accident, explained how long he was taking it for, or pointed to evidence that he has been using medication beyond the recommended duration. Submissions are not evidence. I am accordingly not convinced that the applicant satisfies this criterion.

13The applicant indicates that his chiropractor, Dr. Hooman Nayeri, diagnosed him with anxiety and depressive mood in an OCF-3 dated October 14, 2020. Not only is the OCF-3 referred to by the applicant not before me, but chiropractors are not qualified to make psychological diagnoses. The applicant has not directed me to evidence from any other practitioner indicating that he is experiencing psychosocial sequelae. I am accordingly not persuaded that he satisfies this criterion.

14The applicant relies generally on the clinical notes and records of his family physician, Dr. Afshin Jafarian, orthopaedic surgeon, Dr. Farshid Tabloei, and emergency department visits. However, I note that his submissions either inaccurately refer to the clinical notes, or attribute injuries to the accident without evidence that they are connected.

15The applicant submits that he visited Dr. Jafarian on February 7, 2020, for a post-accident assessment, and that he reported pain in his neck, head, and upper extremities, consistent with soft tissue injuries. However, the clinical note from that visit does not mention the accident, pain, or a diagnosis, and only indicates that he was a new patient. The applicant also submits that he visited Dr. Jafarian on March 10, 2020, during which he discussed his ongoing musculoskeletal pain and the need for further monitoring. Again, this is inaccurate. Dr. Jafarian conducted a physical exam, and the musculoskeletal examination was normal. There is no mention of pain or the accident in this note.

16On September 20, 2020, the applicant visited Markham Stouffville Hospital due to back pain after playing soccer with his family the day before. The note from that visit states that the applicant was previously healthy, works in construction, and had no history of chronic back pain. The note indicates that the applicant’s back pain was likely secondary to a herniated disc, and he was advised to follow up with his family physician. The applicant submits that his symptoms “represented a recurrence and exacerbation of injuries sustained in the motor vehicle accident”, and that his back pain was “consistent with a flare-up of pre-existing post-accident lumbar injuries”, but this is not indicated anywhere in the record. Given that the note does not mention a previous accident or injury, I do not accept that the applicant’s submissions in this regard are accurate.

17On October 30, 2020, the applicant visited Dr. Jafarian and advised that he had neck and back pain which started “a few weeks ago”. This was the first time the applicant complained of pain to Dr. Jafarian, and the accident was not mentioned in the clinical note. The applicant complained of intermittent lower back pain to Dr. Jafarian on February 16, 2021, and lower back pain was again mentioned on March 24, 2021. There is no indication in these notes as to whether the applicant was prevented from engaging in his pre-accident activities, or whether this pain was accident-related. The applicant’s back pain was not mentioned again by Dr. Jafarian until December 11, 2024, and again the accident was not mentioned. In fact, the first time the accident was specifically mentioned to Dr. Jafarian was on March 11, 2025.

18The applicant notes that he had imaging of his left ankle performed, which showed mild soft tissue swelling. However, the applicant’s ankle pain and swelling was not mentioned by Dr. Jafarian until December 11, 2024. Further, on March 11, 2025, the applicant advised Dr. Jafarian that his ankle pain had a recent onset of 3-4 months. The applicant has not otherwise pointed to evidence indicating that this left ankle injury was caused by the accident. Given that the applicant did not mention this issue to his treating practitioners until years after the accident, I am not convinced that his ankle pain was caused by the accident.

19The applicant submits that Dr. Jafarian’s clinical notes demonstrate continuing complaints of pain and functional limitations attributable to the accident. I disagree. Not only is it unclear whether the applicant’s pain was caused by the accident, he has not pointed to evidence within Dr. Jafarian’s records that he has functional limitations as a result.

20The applicant had a consultation with Dr. Tabloei on April 8, 2022, due to a right third mallet finger. He was given a cortisone injection and prescribed an oral anti-inflammatory. The applicant submits that these records confirm ongoing orthopaedic symptoms and the need for continued therapeutic intervention. However, the applicant has not directed me to evidence that his finger issue is related to the accident. In fact, Dr. Tabloei’s note states that the applicant “does not recall any history of trauma”. Further, Dr. Tabloei states that the applicant had pain for “almost a year”, but the accident was over two years prior. Without compelling evidence, I do not accept the applicant’s suggestion that his right finger issue was caused by the accident.

21In addition, the applicant attended Southlake Regional Health Centre on November 30, 2023, due to a head injury and cut to his left forehead. He submits that this laceration was due to a work injury. Confusingly, the applicant states that this “injury caused neck pain, headache which healed symptoms brought back from the subject MVA” [sic]. It appears he is misinterpreting the test for establishing causation, which is the “but for” test (Sabadash v. State Farm et al., 2019 ONSC 1121). Even if the applicant sustained neck pain and a headache from the work injury, which is not mentioned in the records before me, he appears to acknowledge that the symptoms would not have been “brought back” but for the workplace incident. I accordingly do not accept the suggestion that the alleged symptoms stemming from the workplace injury were caused by the accident.

22Aside from generally referring to Dr. Nayeri’s notes, the applicant has not explained how his vocational activities have been affected by this accident. Dr. Nayeri’s note from October 14, 2020, indicates that the applicant worked before the accident but was unable to work after the accident. This is contradicted by the note from Markham Stouffville Hospital from September 20, 2020, which states that the applicant works in construction and was healthy with no history of chronic back pain. I am accordingly not convinced by Dr. Nayeri’s note. The applicant has not otherwise directed me to evidence or provided an explanation as to how his vocational activities were affected by the accident.

23The applicant also submits that Dr. Nayeri indicated that his symptoms interfere with daily activities, including household chores, and increased his fatigue. I have reviewed the records before me from Dr. Nayeri, and there is no mention of fatigue or a difficulty with household chores. In addition, despite the applicant’s assertion that Dr. Nayeri mentioned impairments to his social activities, this is not apparent from the records before me, and no further details were provided.

24For the above reasons, I am not convinced that the applicant satisfies the three criteria under the AMA Guides that he alleges he meets. The applicant has not otherwise pointed to a diagnosis of chronic pain, and I am not persuaded that he suffers from functional impairments as a result of the accident. Further, I am not persuaded that he suffers from a psychological condition as a result of the accident, or that he sustained any other injury as a result of the accident that would remove him from the MIG. Ultimately, I find that the applicant has not met his onus to prove, on a balance of probabilities, that he should be removed from the MIG.

25As I have found that the applicant is not removed from the MIG, it is not necessary for me to determine whether the treatment plans in dispute are reasonable and necessary pursuant to s. 15(1) of the Schedule.

Interest

26Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since no benefits are owing, interest is not payable.

Award

27The 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 no benefits are payable, it follows that the respondent is not liable to pay an award.

ORDER

28The applicant has not sustained an injury that would warrant his removal from the MIG.

29As I have found that the applicant is not removed from the MIG, it is not necessary for me to determine whether the treatment plans in dispute are reasonable and necessary pursuant to s. 15(1) of the Schedule.

30The respondent is not liable to pay an award.

31The applicant is not entitled to interest.