Citation: Rupenthiran v. Gore Mutual Insurance Company, 2026 ONLAT 25-000814/AABS

Licence Appeal Tribunal File Number: 25-000814/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:

Duke Rupenthiran

Applicant

and

Gore Mutual Insurance Company

Respondent

DECISION

ADJUDICATOR:

Roderick Walker

APPEARANCES:

For the Applicant:

Dinesh Shan, Paralegal

For the Respondent:

Aleksandar Tomasevic, Counsel

HEARD:

By Way of Written Submissions

OVERVIEW

1Duke Rupenthiran, the applicant, was involved in an automobile accident on March 31, 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, Gore 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 $2,023.03 for physiotherapy services, proposed by Mackenzie Medical Rehabilitation in a treatment plan/OCF-18 (“plan”) dated September 25, 2024?

iii. Is the applicant entitled to $2,200.00 for psychological services, proposed by Health Spot Assessments in a plan dated August 8, 2024?

iv. Is the applicant entitled to $282.06 for physiotherapy services, proposed by Mackenzie Medical Rehabilitation in a plan dated July 31, 2024?

v. Is the applicant entitled to $4,688.39 for psychological services, proposed by Health Spot Assessments in a plan dated December 13, 2024?

vi. Is the applicant entitled to $2,200.00 for psychological services, proposed by Health Spot Assessments in a plan dated December 16, 2024?

vii. Is the applicant entitled to $1,525.84 for physiotherapy services, proposed by Mackenzie Medical Assessments in a plan dated December 5, 2024?

viii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

ix. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3The applicant’s injuries are predominantly minor in nature as defined in the Schedule, and the applicant remains in the MIG.

4As a result of the applicant remaining in the MIG, an analysis of whether any of the disputed treatment plans are reasonable and necessary is not required.

5The respondent is not liable to pay an award under s. 10 of Reg. 664 or interest.

ANALYSIS

MIG

6Section 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.”

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. In this case, the applicant seeks removal from the MIG due to a chronic pain impairment and/or a psychological condition.

The applicant does not suffer from a chronic pain impairment

8I find that the applicant does not suffer from chronic pain with functional impairment that warrants removal from the MIG.

9The applicant relies on the clinical notes and records (“CNRs”) of Dr. S. Manoharan, family physician; the s. 25 assessment of Dr. C. Eriksen, Psychologist and also the assessment report of social worker, V. Tolmatshov and their report dated November 1, 2024.

10The respondent relies on Physiatrist, Dr. A. Marchie who assessed the applicant in person and prepared a report dated April 1, 2025.

11The applicant submits that following the accident, he experienced persistent physical pain, psychological distress, trauma-related anxiety, and ongoing functional impairment.

12On May 18, 2024, the applicant attended his family physician, Dr. S. Manoharan, and reported pain in his right hand, left shoulder, left side of the neck, and left knee following the March 31, 2024, motor vehicle accident. He demonstrated limited cervical rotation and reported only mild improvement with the use of Tylenol and physiotherapy.

13On July 2, 2024, the applicant again attended his family physician and reported ongoing pain in his right hand and wrist, particularly with movement.

14On January 28, 2025, the applicant reported to his family physician chronic right-wrist pain and right-knee pain characterized by cracking and instability. He rated his knee pain as 3/10 and reported lifting between 100 and 150 lbs while performing squats. His knee range of motion was full. He also reported sleeping late but indicated that he had no sleep issues related to the accident. However, he continued to avoid driving. Due to incomplete physical recovery, a referral to a sports medicine specialist was initiated.

15On May 27, 2025, the applicant reported worsening right-hand pain radiating to the dorsum, with difficulty lifting objects and persistent discomfort despite the use of a brace. He was again advised by Dr. Manoharan regarding sleep-hygiene strategies and encouraged to attend counselling and physiotherapy.

16The respondent submits that the applicant sustained soft tissue injuries that are minor in nature as a result of the motor vehicle accident and fall squarely within the MIG.

17In support of this position, the respondent relies on the s. 44 insurer examination conducted by Physiatrist Dr. A. Marchie, who assessed the applicant in person and prepared a report dated April 1, 2025. Dr. Marchie found that the applicant demonstrated full range of motion in the cervical spine, lumbar spine, shoulders, elbows, wrists, knees, and ankles. Notably, the applicant reported that he continued to play badminton following the accident, which the respondent argues is indicative of maintained functional capacity.

18Dr. Marchie concluded that the applicant sustained soft tissue injuries to the right wrist, knees, neck, and upper back region. Importantly, he found no objective medical evidence of ongoing accident-related impairment. Dr. Marchie opined that the applicant’s injuries were predominantly minor in nature and appropriately treated within the MIG.

19I find based on a review of the totality of the evidence, that the applicant has not established, on a balance of probabilities, that he developed a chronic pain impairment as a result of the accident with a functional impairment.

20Although the applicant reported ongoing pain complaints following the accident, the medical evidence does not support a diagnosis of chronic pain. In particular, the s. 44 insurer examination conducted by Physiatrist Dr. A. Marchie, who assessed the applicant in person and issued a report dated April 1, 2025, is persuasive and well-reasoned. Dr. Marchie found that the applicant demonstrated full range of motion in the cervical spine, lumbar spine, shoulders, elbows, wrists, knees, and ankles, with no objective evidence of accident-related impairment. He concluded that the applicant sustained soft tissue injuries to the right wrist, knees, neck, and upper back, which were predominantly minor and appropriately managed within the MIG.

21I also find that the applicant continued to play badminton following the accident, which is inconsistent with a finding of chronic pain characterized by persistent, disabling functional limitations. While the applicant reported ongoing symptoms in subsequent family physician visits on May 18, 2024, July 2, 2024, November 6, 2024, and January 28, 2025, those subjective complaints are not supported by objective clinical findings demonstrating chronicity, significant functional deterioration.

22Accordingly, I find that the evidence does not establish that the applicant’s condition falls outside of the MIG on the basis of chronic pain impairment.

The applicant does not suffer from a psychological condition

23I find that the applicant does not suffer from a psychological condition that warrants removal from the MIG.

24The applicant relies on the CNR’s of the family physician Dr. Manoharan and the s. 25 assessor Dr. C. Eriksen, Psychologist in her report dated November 18, 2024, as well in the report of Ms. V. Tolmatshov, social worker who assessed the applicant under the supervision of Dr. Erickson.

25The respondent relies on their s. 44 assessor Dr. G. Challis, Psychologist, and his report dated, April 1, 2025.

26The applicant submits that the CNRs of his family physician, Dr. Manoharan support the presence of psychological symptoms stemming from the accident including a referral for counseling dated November 6, 2024. The applicant further relies on the s. 25 Psychological Assessment conducted by Dr. C. Eriksen which confirmed the diagnoses of adjustment disorder with mixed anxiety and depressed mood and specific phobia, passenger fear.

27Ms. Tolmatshov administered tests of the independent psychological assessment which included: Automobile Anxiety Inventory (AAI), PCL 5 Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Outcome Questionnaire (OQ 45.2), WHODAS 2.0 Multidisciplinary Pain Inventory Symptom Checklist 90-R.

28The applicant argues that psychological testing shows clinically significant emotional distress across several areas. He reported moderate anxiety and depression on the Beck Anxiety Inventory and Beck Depression Inventory–II, along with elevated distress on the Outcome Questionnaire (OQ 45.2). The WHODAS 2.0 indicated moderate to severe disability, with impairments in cognition, mobility, life activities, and participation. The Multidimensional Pain Inventory showed increased pain severity, emotional distress, and reduced functioning, while the SCL 90 R suggested under-reporting of symptoms. Based on these findings, Dr. Erickson diagnosed the applicant with adjustment disorder with mixed anxiety and depressed mood, along with pain-related psychological distress and functional limitations.

29The respondent submits that the assessment performed by s. 44 Psychologist Dr. G. Challis, conducted in person with a report dated April 1, 2025, raises significant concerns regarding the reliability and validity of the applicant’s self-reported psychological symptoms. Dr. Challis observed that the applicant’s responses on standardized clinical measures suggested a greater degree of symptom severity than what was supported by his clinical presentation and observable level of functional impairment.

30The respondent also argues that Dr. Challis identified response validity issues across multiple assessment instruments. The applicant produced an invalid profile on the Pain Patient Profile validity scale, attributable to an over-endorsement of symptom severity. Additionally, the applicant demonstrated inconsistent results on the anxiety and depression scales of the Dallas Pain Questionnaire. Dr. Challis opined that these inconsistencies were due to the applicant answering questions in an extreme manner or not accurately reading the questions. Dr. Challis found that these findings significantly undermine the reliability of the applicant’s reported symptom burden.

31The respondent states that from a functional standpoint, while the applicant reported some changes in driving habits, Dr. Challis determined that these complaints did not meet the diagnostic criteria for a driving phobia. The applicant continued to drive independently, which further suggests preserved functional capacity. Likewise, although the applicant reported changes in mood, Dr. Challis found that these symptoms did not materially interfere with the applicant’s recreation, social functioning, or occupation.

32The respondent argues that based on the absence of valid test results, limited functional impact, and lack of corroborating objective findings, Dr. Challis concluded that the applicant did not sustain a psychological condition and as well, he did not meet criteria for any DSM diagnosis, and remained subject to the MIG.

33No further psychological treatment was recommended because the applicant was not participating in therapy or actively seeking treatment at the time of the assessment. The respondent relies on Dr. Challis’ report, which is described as strong expert evidence showing that the applicant’s psychological complaints are unreliable, do not cause functional impairment, and are not supported by objective findings. As a result, the respondent argues that the complaints do not justify removing the applicant from the MIG.

Findings

34I find that the applicant has not established that he suffers from a psychological condition.

35I find that a key piece of evidence in this matter is the insurer’s psychological assessment conducted by Psychologist Dr. G. Challis. Dr. Challis assessed the applicant in person and prepared a report dated April 1, 2025 Dr. Challis administered several standardized psychological measures and testing that included a Dallas Pain Questionnaire and conducted a clinical interview. He carefully compared the applicant’s test results with his observed presentation and reported daily functioning.

36Dr. Challis found that the applicant’s psychological test responses overstated symptom severity and were inconsistent with his presentation and functional ability, resulting in invalid and unreliable test results. These validity concerns significantly reduce the reliability of the applicant’s self-reported psychological symptoms. When comparing the s. 25 report of Dr. Eriksen with the respondent’s s. 44 assessment, I find the evidence of Dr. Challis to be more persuasive because Dr. Challis acknowledged reported changes in driving and mood but concluded that these did not meet diagnostic criteria for a psychological condition and did not significantly interfere with the applicant’s daily functioning, social activities, or employment. Further, the applicant was not engaged in psychological treatment or actively pursuing therapy at the time of the assessment, further supporting this finding. Notwithstanding there was a May 27, 2025, referral for counselling, its connection to accident-related issues is unclear. I prefer the evidence of Dr. Challis dated April 1, 2025, because it is based on an in-person assessment, includes validity testing, and provides clear and consistent reasoning. I find that the applicant continues to drive independently and did not sustain a psychological condition and did not meet the criteria for a psychological diagnosis and remains subject to the MIG.

37The applicant has not established, on a balance of probabilities, that he sustained a psychological condition as a result of the accident, or that his condition falls outside the MIG.

38As I found that the applicant remains in the MIG and the $3,500 funding limit, it is not necessary for me to assess whether the treatment plans are reasonable and necessary.

Interest

39Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. No interest is payable because no benefits are overdue.

Award

40As no benefits have been unreasonably withheld or delayed, the respondent is not liable to pay an award.

ORDER

41I find on the totality of the evidence that:

i. The applicant’s injuries are minor as defined by s. 3 of the Schedule and as such the applicant remains in the MIG.

ii. None of the disputed treatment plans are payable.

iii. The respondent is not liable to pay an award.

iv. No interest is payable under s. 51 of the Schedule.

v. The application is dismissed.