Licence Appeal Tribunal File Number: 24-015728/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:
Roger Philip
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Rachel Levitsky
APPEARANCES:
For the Applicant:
Kateryna Vlada, Counsel
For the Respondent:
Julianne Brimfield, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Roger Philip, the applicant, was involved in an automobile accident on June 26, 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, Co-operators General 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 $4,987.56 for psychological services, proposed by HM Medical Network Ltd. in a treatment plan dated July 17, 2023?
iii. Is the applicant entitled to $2,460.00 for a psychological assessment, proposed by HM Medical Network Ltd. in a treatment plan dated February 14, 2023?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant remains in the MIG, and is not entitled to the treatment plans in dispute or interest.
ANALYSIS
Application of the Minor Injury Guideline
4I find that the applicant has not proven on a balance of probabilities that he should be removed from the MIG.
5Section 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.
6Section 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.”
7An 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.
8The applicant submits that, having being diagnosed with multiple psychological impairments, his injuries are not minor in nature. He also submits that “the combination of his ongoing physical and psychological impairments clearly removes him from the purview of the MIG.”
9The applicant relies on a report authored by Viktoria Tolmatshov, registered social worker, and Dr. Julie Gosselin, psychologist, based on an assessment from March 15, 2023. In the report, they diagnosed the applicant with Adjustment Disorder with Mixed Anxiety and Depressed Mood, and Specific Phobia, Automobile Fear. For the following reasons, I am not prepared to accept the conclusions of the report and am not persuaded by it:
i. The respondent submits that social workers are not qualified to make psychological diagnoses. The applicant’s psychological report does not indicate whether Dr. Gosselin was present at the assessment, or what their role was in supervising Ms. Tolmatshov. It is unclear to me from the report who made the diagnoses. Despite having the opportunity to address the respondent’s arguments, the applicant opted to not make reply submissions. Without any further explanation, I find that I am not persuaded by the diagnoses in the report.
ii. The applicant has not pointed me to evidence of psychological symptoms within the clinical notes and records before me which would corroborate the findings or symptoms reported by Ms. Tolmatshov and Dr. Gosselin. I have reviewed the records of the applicant’s family physician, Dr. Hoda Rizkalla, and despite the applicant visiting Dr. Rizkalla regularly, there is no mention of psychological symptoms.
iii. The respondent relies on a s. 44 report from Dr. Randy Silverman, psychologist, based on an assessment that took place on September 15, 2023. The applicant’s test scores fell appreciably below clinically significant ranges, which Dr. Silverman indicated was consistent with his self-report. Dr. Silverman opined that the applicant had not developed an accident-related substantive psychological impairment or clinically significant psychological distress. The applicant also advised Dr. Silverman that he was not interested in receiving mental health counselling, which he neither initiated nor requested. I note that the applicant did not address Dr. Silverman’s report in his submissions. I find that Dr. Silverman’s findings are more consistent with the contemporaneous medical records before me, specifically the dearth of reported psychological symptoms. As such, I prefer his conclusions over Ms. Tolmatshov’s.
10Ultimately, I find that there is a lack of persuasive evidence before me that the applicant sustained a psychological condition as a result of the accident which would remove him from the MIG.
11Despite the applicant submitting that he sustained a number of physical injuries which he alleges resulted from the accident, it is unclear to me whether he is alleging that these injuries fall outside the definition of the MIG. Under the section in his submissions entitled “THE LAW AND ANALYSIS”, the applicant only submits that he should be removed from the MIG due to psychological impairments. Although the applicant argues in the last paragraph of his submissions that the combination of his physical and psychological impairments removes him from the MIG, he does not explain this further. In addition, despite the respondent pointing out that the applicant only argues that he should be removed from the MIG due to psychological impairments, the applicant did not provide reply submissions clarifying the matter. It is not appropriate for an adjudicator to go through parties’ evidence to make their cases for them (Dooman v. TD Insurance Co., 2025 ONSC 184).
12As such, I find that the applicant has not met his burden of proving, on a balance of probabilities, that he sustained an injury or condition that would remove him from the MIG.
13Having found that the applicant has not proven that he should be removed from the MIG, I need not consider whether the treatment plans in dispute are reasonable and necessary.
Interest
14Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, interest is not payable.
ORDER
15The applicant remains in the MIG, and is not entitled to the treatment plans in dispute or interest.
Released: June 1, 2026
Rachel Levitsky
Adjudicator