Licence Appeal Tribunal File Number: 25-000238/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:
Kwan Yee Clarice Choi
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Greg Witt
APPEARANCES:
For the Applicant:
Lawrence H. Calenti, Counsel
For the Respondent:
Mark Esteireiro, Paralegal
HEARD: In Writing
OVERVIEW
1Kwan Yee Clarice Choi, the applicant, was involved in an automobile accident on October 18, 2024, 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 limit?
ii. Is the applicant entitled to $3,590.34 for chiropractic services, proposed by North Toronto Rehab in a treatment plan/OCF-18 (“plan”) submitted November 18, 2024 and denied December 5, 2024?
iii. Is the applicant entitled to $1,965.26 for chiropractic services, proposed by North Toronto Rehab in a plan submitted March 26, 2025 and denied April 9, 2025?
iv. Is the applicant entitled to $1,497.97 for chiropractic services, proposed by North Toronto Rehab in a plan submitted April 23, 2025 and denied May 1, 2025?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that:
i. The applicant’s injuries are predominately minor and therefore subject to treatment within the $3,500.00 limit of the MIG.
ii. The applicant is not entitled to the treatment plans in dispute; and
iii. The applicant is not entitled to interest.
ANALYSIS
Applicability of the Minor Injury Guideline (“MIG”)
4The MIG establishes a framework available to injured persons who sustain a minor injury as a result of an accident. A “minor injury” is defined in s. 3(1) of the Schedule as, “one or more of a strain, sprain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
5Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the applicant sustains an impairment that is predominantly a minor injury in accordance with the MIG.
6An applicant may receive payment for treatment beyond the $3,500.00 limit if they can demonstrate that a pre-existing condition, documented by a medical practitioner, prevents maximal medical recovery of the minor injury sustained in the accident if they were kept in the MIG, or if they provide evidence of an injury sustained in the accident that is not included in the minor injury definition in s. 3(1). The Tribunal has also determined that chronic pain with functional impairment or a psychological condition may warrant removal from the MIG.
7It is the applicant’s burden to establish entitlement to coverage beyond the $3,500.00 cap on a balance of probabilities. The applicant submits she suffers from a pre-existing condition which would prevent maximum medical recovery if subjected to the MIG limits. The respondent submits that the applicant has failed to establish that her injuries are not predominately minor and that the injuries can be treated within the confines of the MIG.
Pre-existing Condition
8Section 18(2) of the Schedule provides that insured persons with minor injuries who have a pre-existing medical condition may be exempted from the $3,500.00 cap on benefits. The applicant must provide compelling evidence meeting the following requirements:
(i) There was a pre-existing medical condition that was documented by a health practitioner before the accident;
(ii) The pre-existing condition will prevent maximal recovery from the minor injury if the person is subject to the $3,500 limit on treatment costs under the MIG.
9A pre-existing condition will not automatically exclude a person’s impairment from the MIG, as it must be shown to prevent maximal recovery from the minor injuries within the cap imposed by the MIG.
10The applicant argues that she has a pre-existing condition, neck pain. She submits that this injury was exacerbated as a result of the motor vehicle accident. Accordingly, she submits she should be removed from the MIG.
11The applicant relies on the Clinical Notes and Records (“CNRs”) of the applicant’s family doctor, Dr. Jing Cao, which on August 19, 2024 states the applicant reported neck pain. The applicant further relies on the treatment plan from North Toronto Rehabilitation dated February 24, 2025 that states the applicant has a history of periodic neck pain, which was reaggravated by this pedestrian accident.
12The respondent disagrees with the applicant’s position, insofar that there was a pre-existing condition, arguing that it was resolved prior to the accident. The respondent submits that the August 19, 2024 report of neck pain to Dr. Cao is the only evidence led by the applicant regarding a pre-existing neck condition; and that the applicant achieves short term relief with gentle exercise, sleep on a firm surface, and massage, physiotherapy and/or chiropractic therapy. The respondent submits that on September 23, 2024, Dr. Cao found the applicant’s head and neck to be normal. The respondent submits that the CNRs of Dr. Cao show the condition improved one month prior to the accident to a status of being ‘normal’, thus the condition cannot be characterized as a ‘pre-existing’ medical condition.
13The applicant bears the onus of establishing, on a balance of probabilities, that they had a pre-existing medical condition that would prevent maximal recovery within the MIG. I am not satisfied that the burden has been met. The only contemporaneous evidence advanced in support of a pre-existing condition is a single CNR from the family physician on August 19, 2024 referencing a neck complaint. This reference is brief, lacks diagnostic detail, and is not supported by any further objective findings, investigations or evidence of past or ongoing treatment or imaging. Importantly in this case, contemporaneous medical records indicate that approximately one month later, the same physician, Dr. Cao, determines the applicant’s neck is normal at a routine examination. The CNRs state that the head and neck are ‘normal’, with no continuous complaints noted. This stated improvement undermines the reliability and persistence of the alleged condition.
14I have also considered the applicant’s report, made following the accident to North Toronto Rehabilitation dated February 24, 2025, that they had a prior history of neck pain which was re-aggravated by the accident. I assign this evidence limited weight. It is retrospective in nature, was made in the context of seeking treatment after the accident. In the absence of supporting medical documentation demonstrating an ongoing or functionally significant condition prior to the accident, I am not persuaded that this report reliably established a pre-existing condition.
15Taken together, the evidence does not demonstrate, on a balance of probabilities, the existence of a clinically significant pre-existing condition or that any such condition would prevent maximal recovery within the MIG.
16Accordingly, the applicant had not established that she should be removed from the MIG on this ground.
17The applicant is not entitled to the disputed treatment plans because I find that the applicant has sustained a minor injury and is subject to the MIG, and the parties agreed the MIG has been exhausted. As a result, an analysis of whether the treatment plans are reasonable and necessary is not required.
Interest
18Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since there are no benefits that are payable, interest does not apply.
ORDER
19I find that:
i. The applicant’s injuries are predominantly minor and therefore are subject to treatment within the MIG treatment limit. Therefore, it is not necessary to consider whether the treatment plans are reasonable and necessary;
ii. Interest does not apply; and
iii. The application is dismissed.
Released: May 25, 2026
__________________________
Greg Witt
Adjudicator