Citation: Solis v. Wawanesa Mutual Insurance Company, 2026 ONLAT 25-002752/AABS
Licence Appeal Tribunal File Number: 25-002752/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:
Luis A Solis
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Patrick D'Aloisio, Counsel
For the Respondent:
Aliza Lalji, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Luis A. Solis, the applicant, was involved in an automobile accident on June 23, 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, Wawanesa Mutual 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 an income replacement benefit (“IRB”) in the amount of $400.00 per week from January 16, 2025 to ongoing?
iii. Is the applicant entitled to services proposed by Dr. Chiavaroli & Associates Mobile Service, as follows:
a. $228.10 for physiotherapy treatment in a treatment plan dated August 24, 2023; and
b. $2,230.58 for physiotherapy treatment, in treatment plan dated October 10, 2023?
iv. Is the applicant entitled to $2,700.00 for a Functional Abilities Evaluation Report, proposed by Verity Medical Assessments, in a treatment plan dated February 18, 2025?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and he is therefore subject to treatment within the $3,500.00 MIG limit.
4I find that the applicant is not entitled to the treatment plans in dispute.
5I find that the applicant is not entitled to an IRB.
6I find that the applicant is not entitled to interest.
7I find that the respondent is not liable to pay an award.
ANALYSIS
The applicant sustained predominantly minor injuries as defined under the Schedule
8I find that the applicant sustained a minor injury as a result of the accident and, therefore, is subject to the $3,500.00 funding limit on treatment.
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) of the Schedule defines a “minor injury” 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.”
10An 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) of the Schedule, that they have a documented pre-existing condition combined with compelling medical evidence stating that the condition precludes maximal medical recovery if they are kept within the confines of the MIG. In all cases, the burden of proof lies with the applicant.
11I find that the applicant in his submissions has relied upon general principles of the definition of a minor injury and case law summaries of previous Tribunal decisions and findings in MIG cases. I find that the applicant has not identified any medical basis on which he should be removed from the MIG.
12I find that the applicant has not provided persuasive medical evidence to support the injuries he sustained in the subject accident. The applicant has not provided any treatment records or medical opinions to support that he should be removed from the MIG.
13With respect to the medical evidence, the applicant in his submissions has provided an excerpt of a clinical note from his family physician, dated June 22, 2023, the day before the accident. He has also included in his submissions an excerpt from a clinical note from his family physician dated September 19, 2023, which notes his involvement in an accident on “23/8/23”. I note that this is not the correct date of the subject accident. The note states that he has “pain on both knees, both shoulders and the back. He went to ER, talked to a lawyer and he is on physiotherapy, acupuncture and massage.” He was diagnosed with a back strain.
14I find that other than the note dated September 19, 2023, which references a different accident date, the applicant has provided a copy of the Emergency Record dated June 24, 2023, which notes back pain. I find that the applicant has not provided any further medical evidence to support the injuries he suffered in the subject accident or his removal from the MIG on a medical basis.
15With respect to the decisions summarized and referred to by the applicant in his submissions, I am not bound by previous Tribunal decisions. In addition, while the applicant has provided summaries of previous decisions, he has not connected these decisions to his own injuries or his removal from the MIG.
16For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that he should be removed from the MIG.
Entitlement to Medical Benefits
17As I have found that the applicant’s injuries fall within the MIG, it is unnecessary for me to consider the reasonableness and necessity of the disputed treatment plans.
Entitlement to Income Replacement Benefits
18I find that the applicant is not entitled to an IRB.
19I find that the issue in dispute is unclear. The Case Conference Summary listed the issue in dispute as “is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from January 16, 2024 to ongoing?”. On August 12, 2025, the applicant requested an Amendment Request. His letter requests the amendment of the IRB denial date to January 16, 2025 to date and ongoing. In the applicant’s submissions he is claiming entitlement to an IRB in the amount of $400.00 weekly from January 5, 2024 (denied January 16, 2024). Therefore, it is not clear to me the actual period of time in which the applicant is claiming entitlement to an IRB.
20The applicant in his submissions states that he was working as a bus driver and remained off work until January 7, 2024, due to injuries sustained in the motor vehicle accident. He submits that the respondent has not paid IRBs. The applicant in his submissions has provided a copy of the IRB calculation showing the amount owing as $10,972.00 for the period from June 30, 2023 to January 7, 2024.
21I find that the applicant has not provided any submissions with respect to his entitlement to an IRB except to attach an IRB calculation showing the amount owing as $10,972.00. I find that no submissions are made as to the test of entitlement to receive an IRB. In addition, there are no submissions made as to his entitlement to an IRB based on the injuries he sustained. I find that the applicant has failed to identify the essential tasks of his pre-accident employment and has failed to provide evidence that he has accident-related functional impairments. I further find that the applicant has failed to provide evidence that his impairments would substantially prevent him from carrying out the essential tasks of his pre-accident employment.
22For the reasons outlined above, I find that the applicant has not proved on a balance of probabilities that he is entitled to an IRB.
Interest
23Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefits owing, no interest is payable.
Award
24The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 percent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
25The applicant did not make any submissions as to his entitlement to an award. As I have found that no benefits are owing, I find that there is no evidence to support that the respondent unreasonably withheld or delayed the payment of benefits and no award is payable.
ORDER
26For the reasons outlined above, I find:
i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and he is therefore subject to treatment within the $3,500.00 MIG limit;
ii. The applicant is not entitled to the treatment plans in dispute;
iii. The applicant is not entitled to an IRB;
iv. The applicant is not entitled to interest;
v. The respondent is not liable to pay an award; and
vi. The application is dismissed.
Released: June 4, 2026
__________________________
Melanie Malach
Adjudicator