Licence Appeal Tribunal File Number: 25-000697/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:
Rayyan Al-Zetawi
Applicant
and
Definity Insurance Company
Respondent
DECISION
ADJUDICATOR:
Jeff Chatterton
APPEARANCES:
For the Applicant:
Kameliya Stancheva, Paralegal
For the Respondent:
Ainsley Shannon, Counsel
HEARD: In Writing
May 21, 2026
OVERVIEW
1Rayyan Al-Zetawi, the applicant, was involved in an automobile accident on February 2, 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, Definity 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 (“the MIG”) limit?
ii. Is the applicant entitled to a non-earner benefit (NEB) of $185.00 per week from October 23, 2023, to February 2, 2025?
iii. Is the applicant entitled to $2,517.07 for Physiotherapy Services proposed by Mavis Eglington Physiotherapy in a treatment plan/OCF-18 ('plan') dated August 2, 2023?
iv. Is the applicant entitled to $5,210.34 for Physiotherapy Services proposed by Mavis Eglington Physiotherapy in a plan dated March 7, 2024?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not met his onus to demonstrate he should be removed from the MIG.
4The applicant has not met his onus to demonstrate he is entitled to an NEB.
5As the applicant is being held to the MIG, it is not necessary for me consider if the treatment plans in dispute are reasonable and necessary.
6Neither interest nor an award are payable.
7The application is dismissed.
ANALYSIS
Should the applicant be removed from the MIG due to chronic pain with a functional impairment?
8The applicant has not demonstrated he should be removed from the MIG on the basis of chronic pain with a functional impairment.
9Section 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.” An 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 argues he should be removed from the MIG due to chronic pain. To support his claim, the applicant relies on the Clinical Notes and Records (“CNRs”) from his primary-care physician, Dr. Alaa Al-Khafaji, and an X-Ray report from Ontario Diagnostics Centres indicating that he was suffering from muscle spasms, neck and shoulder pain.
11The respondent disagrees that the applicant suffers from chronic pain, and relies on a s.44 Insurer’s Examination conducted by General Practitioner Dr. Mohamed Lamine, dated August 25, 2023. Dr. Lamine found that the applicant had sustained soft-tissue injuries but there was no objective accident-related musculoskeletal impairment.
12I am not persuaded by the applicant’s evidence and find the applicant has not met his onus. I reach this conclusion because:
i. The CNR’s from April 5, 2023 indicate that the patient has suffered pain “primarily in the shoulder on/off for the last around 6 months.” This visit took place only two months after the accident. This does not support the applicant’s position that the shoulder pain is accident-related. I note that the applicant has not argued that he suffers from a pre-existing condition which would preclude recovery if he were to be kept to the MIG.
ii. The applicant visited his primary care physician on February 24, 2023, February 27, 2023, April 5, 2023 and May 10, 2023. But I have not been led to any evidence from after May 10, 2023 showing that the applicant continued to visit his physician, had any ongoing or longer-term complaints, visited a specialist, or filled a prescription for pain medication. This does not support the submission that the applicant is suffering from accident-related chronic pain.
iii. The applicant, despite having the onus to prove that he is suffering from chronic pain, has not led me to evidence that he has ongoing pain, with a functional limitation such that it warrants removal from the MIG. Further, the respondent points out that despite being prescribed pain medication in February 2023, there is no indication that the applicant filled the prescription.
13For these reasons, I find the applicant has not, on the balance of probabilities, met his onus to demonstrate he should be removed from the MIG on the basis of chronic pain with a functional limitation.
Should the applicant be removed from the MIG due to psychological condition?
14The applicant has not met his onus to demonstrate he should be removed from the MIG due to a psychological condition.
15The applicant argues he is suffering from sleep disturbance and anxiety symptoms. To support his claim, he again depends on the CNRs from his family physician, Dr. Al-Khafaji.
16The applicant has submitted the CNRs from a single visit to Dr. Al-Khafaji, dated February 27, 2023, where he complained of anxiety, fear and discomfort.
17Dr. Al-Khafaji conducted two psychological tests – the PHQ-9 (Patient Health Questionnaire) and the GAD-7 (General Anxiety Disorder). The evidence shows that the applicant tested extremely mild, scoring only 5 out of a possible score of 21 on the GAD-7, and 1 out of 27 on the PHQ-9. I further note that Dr. Al-Khafaji did not diagnose the applicant with an accident-related psychological condition.
18I am not persuaded by the applicant’s evidence because I find that self-reports of psychological symptoms are not sufficient evidence to merit removing the applicant from the MIG. It is well established that the MIG acknowledges psychological sequelae may flow from a minor injury.
19The applicant has not included other objective medical evidence, such as a clinical diagnosis or other psychiatric test reports. Although the onus is on the applicant to prove he suffers from a psychological injury, I have not been led to any further evidence that indicates the applicant has suffered an accident-related psychological condition.
20In summary, the only evidence provided to me are a single self-report to the applicant’s doctor, who conducted tests and found the applicant tested extremely mild.
21For these reasons, I find the applicant has not, on the balance of probabilities, met his onus to demonstrate he should be removed from the MIG due to a psychological condition.
Is the applicant entitled to a Non-Earner Benefit?
22The applicant has not demonstrated he is entitled to an NEB benefit.
23Section 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.
24The applicant argues that his pain has led him with an inability to lead a normal life. To support his claim, the applicant relies on Dr. Al-Khafaji’s CNRs.
25The respondent disagrees, and relies on a s.44 Occupational Therapy Assessment conducted September 20, 2023 by Occupational Therapist Ms. Angela Bertolo.
26I am not persuaded by the applicant’s evidence. I reach this conclusion because, while the applicant is claiming an NEB for the time period of October 23, 2023 to February 5, 2025, the evidence submitted by the applicant does not indicate a complete inability to lead a normal life during this period. Furthermore, I do not have evidence of his pre and post-accident activities to conduct the analysis required by Heath.
27In addition, the CNRs of Dr. Al-Khafaji do not support the applicant’s position. I note that Dr. Al-Khafaji filled out a “Limitations to Participation” form for Ontario Works, dated May 11, 2023, where he indicated that the applicant did not suffer from any medical limitations to participating in activities of daily living.
28For these reasons, I find the applicant has not, on the balance of probabilities, met his onus to demonstrate he is entitled to an NEB.
29As I have ruled that the applicant is being held to the MIG, it is not necessary for me to conduct a reasonable and necessary analysis on the treatment plans in question.
Interest
30Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
Award
31The 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 were unreasonably withheld or delayed, no award is payable.
ORDER
32The application is dismissed:
i. The applicant has not met his onus to demonstrate he should be removed from the MIG.
ii. The applicant has not met his onus to demonstrate he is entitled to a non-earner benefit.
iii. As the applicant is being held to the MIG, it is not necessary for me to consider if the treatment plans in dispute are reasonable and necessary.
iv. Neither interest nor an award are payable.
Released: May 22, 2026
__________________________
Jeff Chatterton
Adjudicator