Licence Appeal Tribunal File Number: 25-001611/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:
Bravith Raveendran
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Jeff Chatterton
APPEARANCES:
For the Applicant:
Nav Krishnan, Counsel
For the Respondent:
Paras Gogna, Counsel
HEARD: In Writing
OVERVIEW
1Bravith Raveendran, the applicant, was involved in an automobile accident on December 23, 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, 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 (MIG) limit?
ii. Is the applicant entitled to $3,435.00 for physiotherapy services, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan/OCF-18 (“plan”) dated July 10, 2023?
iii. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan dated October 6, 2023?
RESULT
3The applicant has not met his onus to demonstrate he should be removed from the MIG and is therefore subject to the $3,500 treatment limit.
4As I have ruled that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans in dispute to determine if they are reasonable and necessary.
5The application is dismissed.
ANALYSIS
Should the applicant be removed from the MIG?
6The applicant has not met his onus to demonstrate he should be removed from the MIG.
[7]
7Section 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.”
8An 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.
9Despite the MIG being a live issue in dispute, the applicant has not offered a clear submission to demonstrate why he should be removed from the MIG. Indeed, his submissions are confined to a discussion of the treatment plans in dispute, nor did he provide a rationale in a reply submission. This is despite the Case Conference Report and Order and the initial application indicating that the MIG was in dispute.
10It is well settled that the applicant bears the onus of proof when seeking treatment beyond the MIG. Based on his submissions, while there is no engagement with the MIG, it appears that his position for removal from the MIG, or at least entitlement to the treatment plans in dispute, is based on a combination of chronic pain and a psychological condition, but again, no clear submissions were provided.
Chronic Pain
11The Tribunal has determined that an applicant may escape the MIG if they suffer from chronic pain that causes functional impairment or if they meet three of the six criteria for chronic pain as provided by the AMA Guides. However, here, the Tribunal was not directed to a diagnosis of chronic pain or chronic pain syndrome and the applicant did not engage with any of the criteria under the AMA Guides.
12I find that ongoing pain alone is insufficient to remove the applicant from the MIG, as the pain must be accompanied by functional impairment or disability. I find that the applicant has not proved on a balance of probabilities that his ongoing pain was of a significant level or was accompanied by some functional impairment or disability. I find that the applicant’s pain was merely sequelae or a symptom of his minor injuries.
13I find that there is minimal evidence provided by the applicant to demonstrate that his pain prevented him from pursuing work, family or recreational needs or that he developed psychosocial sequelae.
Psychological Condition
14Finally, although the applicant may claim he is eligible to be removed from the MIG due to a psychological injury, I have not been led to objective medical evidence that indicates the applicant has suffered an accident-related psychological injury or condition.
15I have carefully reviewed the Clinical Notes and Records (“CNRs”) from the applicant’s family physician, Dr. Ibtissam Tadros, and I note that the first and only reference to the accident takes place February 7, 2024, fourteen months after the accident. This notation in the CNR’s makes no reference to psychological concerns, nor I was not led to subsequent reports or complaints of psychological conditions.
Summary
16In the absence of submissions regarding why the applicant feels he should be removed from the MIG, and in the absence of further evidence given the sparse submissions presented to me, I find the applicant has, on the balance of probabilities, not met the onus to demonstrate he should be removed from the MIG.
17As I have ruled that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans to determine if they are reasonable and necessary.
ORDER
18The application is dismissed.
i. The applicant has not met his onus to demonstrate he should be removed from the MIG and is therefore subject to the $3,500 treatment limit.
ii. As I have ruled that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans in dispute to determine if they are reasonable and necessary.
Released: June 2, 2026
__________________________
Jeff Chatterton
Adjudicator