Licence Appeal Tribunal File Number: 25-001278/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:
Parwinder Dhillon
Applicant
and
Belair Insurance Company Inc.
Respondent
DECISION
ADJUDICATOR:
Teresa Walsh
APPEARANCES:
For the Applicant:
Zehra Rizvi, Paralegal
For the Respondent:
Sonia Fabiani, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Parwinder Dhillon, the applicant, was involved in an automobile accident on December 11, 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, Belair Insurance Company Inc. The applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2At the case conference held on May 5, 2025, a preliminary issue and substantive issues were identified. The Tribunal ordered the preliminary and substantive issues to be heard at a single written hearing.
PRELIMINARY ISSUE
3The preliminary issue to be decided is:
- Is the applicant barred from proceeding to a hearing for the following: issue number 1, the Minor Injury Guideline determination, and issue number 3, the physiotherapy services benefit claimed, because the applicant failed to attend two insurer’s examinations under s. 44 of the Schedule?
SUBSTANTIVE ISSUES
4The substantive issues in dispute are:
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? Note: The parties agree the MIG limits have been exhausted.
Is the applicant entitled to $2,530.00 for a psychological assessment, proposed by Complete Rehab Centre in a treatment plan/OCF-18 (“plan”) dated July 13, 2023?
Is the applicant entitled to $2,490.58 for physiotherapy services, proposed by Progressive Rehab in a plan dated May 9, 2023?
Is the applicant entitled to $3,610.50 for psychological services, proposed by Complete Rehab Centre in a plan dated July 26, 2023?
Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5The applicant is barred from proceeding to a hearing on the physiotherapy services benefit claimed, pursuant to s. 55(1) of the Schedule.
6The applicant has not met her onus in proving that she has sustained accident-related psychological impairments that warrant treatment outside the MIG.
7As she has not sustained any accident-related psychological impairments warranting treatment outside the MIG, the applicant is not entitled to the psychological assessment and psychological services benefits claimed.
8As no payments were unreasonably withheld, the respondent is not liable to pay an award.
9As no overdue benefits are payable, interest is not payable.
ANALYSIS
The applicant’s IE non-attendances
10For the following reasons, I find the applicant did not attend a reasonably necessary insurer’s examination (“IE”) that was scheduled and re-scheduled in compliance with the Schedule. The applicant did not provide a reasonable explanation for the non-attendances. This breach of s. 44(1) means that the applicant is barred from proceeding to a hearing on her claim for $2,490.58 in physiotherapy services, pursuant to s. 55(1) of the Schedule.
The parties’ positions
11The respondent submits that the applicant failed to attend an original date and a rescheduled date for an IE to be conducted by a general practitioner (“GP”) physician. The IE was meant to assess the application of the MIG and the applicant’s claim for physiotherapy services. The respondent further submits that the applicant provided no explanation for her non-attendances, nor did she confirm in writing that she would attend a future rescheduled date for the IE.
12The applicant provided no submissions regarding the IE attendance issue, including any explanation for the non-attendances.
Relevant sections of the Schedule
13Section 44(1) of the Schedule provides that:
For the purposes of assisting an insurer to determine if an insured person is or continues to be entitled to a benefit under this Regulation for which an application is made, but not more often than is reasonably necessary, an insurer may require an insured person to be examined under this section by one or more persons chosen by the insurer who are regulated health professionals or who have expertise in vocational rehabilitation.
14The requirements for a compliant IE notice are set out in s. 44(5) of the Schedule. An insurer is required to arrange for the IE at its expense. Further, the insurer must give the insured person a notice setting out the medical and any other reasons for the IE, whether the insured person is required to attend, the name and other information regarding the regulated health professional who will conduct the IE, and the date(s), time(s) and location of the IE.
15Section 55(1) of the Schedule disallows an insured person from proceeding with a Tribunal application if they did not attend a properly scheduled IE. The onus is on the insured person to put forth a reasonable explanation for non-attendance at an IE. However, s. 55(2) provides the Tribunal with discretion to allow a non-compliant applicant to continue with their application.
16In sum, an insured person has a duty to participate in an IE that is reasonably necessary and for which there is a compliant notice. At the same time, the Tribunal retains discretion to allow a non-compliant insured person to proceed with their application.
The applicant did not attend a reasonably necessary IE on two occasions
17As noted above, the applicant did not challenge the respondent’s compliance with s. 44(5) of the Schedule or otherwise provide submissions on the IE attendance issue.
18I find that the IE notice evidence before me establishes that the respondent complied with s. 44(5) of the Schedule. My finding is based on the following:
(a) I did not locate in the hearing evidence a copy of the first IE notice to the applicant reportedly dated May 27, 2024, regarding an IE to take place on June 10, 2024.
(b) However, an IE notice dated June 27, 2024, is in the respondent’s evidence. This notice references the applicant’s non-attendance at the June 10, 2024, IE. It also references the applicability of the MIG and the reasonableness and necessity of the physiotherapy services claimed as the basis for the IE. The notice further indicates that the applicant’s attendance is required for the IE, and it includes details of the GP physician who is to conduct the IE, along with the rescheduled IE date (July 24, 2024), time and location.
(c) The respondent’s evidence also includes a letter to the applicant dated July 29, 2024. In this letter, the respondent references the applicant’s non-attendance at the June 10, 2024, and the July 24, 2024, IEs.
19For the foregoing reasons, I find that while the respondent’s first IE notice reportedly sent to the applicant is not before me, the respondent’s letters to the applicant dated June 27, 2024, and July 29, 2024, satisfy the requirements of a compliant IE notice under s. 44(5) of the Schedule.
20I also note that in the July 29, 2024, letter to the applicant, the respondent advises that the applicant’s claim for physiotherapy services remains denied as not being reasonable or necessary. Further, the respondent advises that it maintains its position that the applicant’s (accident-related) injuries fall within the MIG. Nonetheless, the respondent advises that it is prepared to reschedule the IE if the applicant provides, within 10 days, written confirmation that she will attend the rescheduled IE and a reasonable explanation as to why she was unable to attend the two previously scheduled IE dates.
21There is no evidence before me that the applicant ever attempted to have the IE rescheduled or provided a reason for her non-attendance on the IE dates of June 10, 2024, and July 24, 2024.
22I find that the missed IE was reasonably necessary for assessing the applicant’s claims for funding outside the MIG and entitlement to physiotherapy services. As the respondent advises the applicant in its June 27, 2024, letter, it could not determine these issues based on the treatment plan information and the clinical notes and records provided by the applicant.
23I further find that it was reasonably necessary for the respondent to seek its own GP physician assessment of the applicant’s condition to assess the disputed MIG and physiotherapy services claims.
24Finally, I find that because the applicant has provided no reasonable explanation for her non-attendance, nor has she assisted in rescheduling the IE, it would be unfair to the respondent to engage the Tribunal’s discretionary power under s. 55(2) of the Schedule, to allow the applicant to proceed to a hearing on these disputed issues despite her non-compliance with s. 44(1).
25In conclusion regarding the preliminary issue, the respondent has satisfied me that, on two occasions, the applicant did not attend a reasonably necessary IE scheduled with compliant notices. The applicant has not advanced a reasonable explanation for the non-attendances. Accordingly, the applicant is barred from proceeding to a hearing on the physiotherapy services benefit claimed, pursuant to s. 55(1) of the Schedule.
26I note that a determination on MIG is included as a preliminary issue. However, as the remaining treatment plans for a psychological assessment and services are moving forward, I need to consider the MIG in addressing those plans.
The applicant has not sustained an accident-related psychological impairment warranting treatment outside the MIG
27I find that the applicant has not met her onus to prove on a balance of probabilities that she has sustained an accident-related psychological impairment warranting treatment outside the MIG.
28As the applicant is being held within the MIG, I further find that it is unnecessary to address the applicant’s claims for $2,530.00 for a psychological assessment and $3,610.50 for psychological services.
Psychological impairments and the MIG
29Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured person sustains impairments that are predominantly minor injuries. 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.”
30Psychological impairments, if established, fall outside the MIG, because such impairments are not included in the prescribed definition of “minor injuries” under s. 3(1) of the Schedule.
The parties’ positions
31The applicant submits that due to the accident, she suffers from psychological impairments requiring treatment outside the MIG. In support of her submission, the applicant relies on the July 13, 2023, psychological report of Nicole Presutti, psychotherapist, prepared under the supervision of Dr. Jacqueline Brunshaw, psychologist (the Presutti/Brunshaw report). The Presutti/Brunshaw report is based on an interview of the applicant on May 17, 2023, and the results of seven psychological self-report questionnaires. Ms. Presutti and Dr. Brunshaw opine that the applicant’s presentation is consistent with features of post-traumatic stress disorder, adjustment disorder with anxiety, major depressive disorder, single episode, and a moderate-to-severe level vehicular-related phobia.
32In support of her claims for psychological benefits, the applicant also relies on treating records of her family physicians, Dr. Manohar Krishnan and Dr. Sukhwinderpal Dhaliwal. The applicant asserts that these records document a pre-accident history of anxiety, including a panic attack, approximately four months prior to the accident.
33The respondent submits that the applicant suffers from no accident-related psychological impairments requiring treatment outside the MIG. The respondent submits that support for its position is provided by the October 18, 2024, IE psychological report of Dr. Mohammad Nikkhou, neuropsychologist (the Nikkhou report). The Nikkhou report is based on an in-person assessment of the applicant on October 3, 2024, psychological testing, a review of the family physicians’ treating records and reports prepared on behalf of the applicant, including the Presutti/Brunshaw report referenced above. Dr. Nikkhou finds that psychological test results for the applicant are either invalid, uninterpretable or in some cases, “should be interpreted with extreme caution as the possibility of symptom magnification cannot be ruled out.” Dr. Nikkhou ultimately finds that there is no formal psychological diagnosis for the applicant attributable to the accident. As such, Dr. Nikkhou opines that the plans for a psychological assessment and psychological services are not reasonable or necessary.
34In addition to the Nikkhou report, the respondent relies on the treating records of Drs. Krishnan and Dhaliwal to support its position that the applicant has sustained no psychological impairment due to the accident requiring treatment outside the MIG.
The applicant has not proven an accident-related psychological impairment warranting treatment outside the MIG
35I find that the applicant has not proven, on a balance of probabilities, that she sustained an accident-related psychological impairment warranting treatment outside the MIG.
36I give limited weight to the Presutti/Brunshaw report because:
(a) There is no indication that the report authors considered any medical records regarding the applicant’s psychological and physical health status prior to or following the accident (such as Drs. Krishnan’s and Dhaliwal’s treating records). As noted above, all information in the report regarding the applicant appears to be based on the applicant’s self-reporting during a single interview and her responses to psychological test questions.
(b) There are notable inconsistencies between the applicant’s self-reported health status pre-dating and post-dating the accident as documented in the report, and the treating records of her family physicians. For example, the report indicates that the applicant took no medications and had no “psychological assistance” prior to the accident. However, Drs. Krishnan’s and Dhaliwal’s records reflect that the applicant was prescribed medication before the accident, including a single prescription for medication to treat depression.
(c) The Presutti/Brunshaw report states that the applicant reported full-body pain ratings between 4 to 7 out of 10 with accompanying functional challenges post-accident. This information differs significantly from information in Drs. Krishnan’s and Dhaliwal’s treating records. The treating records document the applicant’s complaints of upper back and abdominal muscle strain at an appointment three days after the accident. At the next two follow-up appointments on January 3 and 14, 2023, the applicant reports left shoulder pain since the accident, mostly with overhead movements. No other physical symptoms are documented and Dr. Krishnan assesses the applicant as having a “likely sprain” of her left shoulder. Drs. Krishnan’s and Dhaliwal’s records for the subsequent 10 appointments with the applicant include no further physical pain complaints suggested to be related to the accident.
(d) None of the applicant’s reported post-accident sleep disturbances, irritability, limited socializing, anxiety, low mood, lack of focus and vehicular phobia referenced in the Presutti-Brunshaw report are corroborated in subjective reports, objective findings or assessments in the family physicians’ treating records. The treating records in evidence include approximately 2.5 years of post-accident appointments with the applicant. During these appointments, her family physicians routinely describe the applicant as looking “well … not in distress.”
(e) The applicant’s self-reported information and psychological diagnoses in the Presutti/Brunshaw report are at odds with her documented consistent work history post-accident.
37Based on the foregoing, I find that the Presutti/Brunshaw report does not assist the applicant in establishing, on a balance of probabilities, that she has an accident-related psychological impairment requiring treatment outside the MIG.
38Additionally, based on the above excerpts provided, I find that the treating records of Drs. Krishnan and Dhaliwal do not support the applicant having sustained any psychological impairments related to the accident.
39As noted above, in support of her claims for psychological benefits, the applicant submits that she has a pre-accident history of “anxiety” including “a panic attack.” I note that during an August 25, 2022, appointment with Dr. Dhaliwal, the applicant describes feeling “low” and “zoned out” for approximately one month. The records indicate that the applicant was prescribed medication for depression by Dr. Dhaliwal at this appointment. The records further indicate that at the next appointment of September 30, 2022, the applicant reports being non-compliant with the medication but nonetheless “feeling well.” The applicant has not pointed to any evidence, and I find none, regarding the applicant’s further reports of or treatment for any pre-accident or post-accident psychological condition.
40Accordingly, I find that the applicant’s single report of depression and the prescription for same prior to the accident provide no support for her claim for psychological benefits due to the accident.
41In summary, I find that the applicant has not proven, on a balance of probabilities, that she sustained any psychological impairments as a result of the accident requiring treatment outside of the MIG.
The plans for a psychological assessment and psychological services
42Based on my finding that the applicant has not sustained a psychological impairment warranting treatment outside the MIG, and as the MIG limits have been exhausted, I find that there is no requirement to review the psychological assessment and psychological services plans to determine if they are reasonable and necessary.
Award
43The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
44The case law establishes that in determining whether an insurer’s conduct in withholding or denying a benefit warrants an award, an insurer’s behaviour must be seen as “excessive, imprudent, stubborn, inflexible, unyielding or immoderate.”
45The applicant submits that her claim for an award relates to the respondent’s refusal to find the Presutti/Brunshaw report and her family physicians’ treating records supportive of accident-related psychological impairments requiring treatment outside the MIG limits.
46As stated above, I find that the Presutti/Brunshaw report and Drs. Krishnan’s and Dhaliwal’s treating records do not assist the applicant in meeting her onus in proving that she sustained a psychological impairment as a result of the accident requiring treatment outside the MIG.
47Accordingly, I find that no payments were unreasonably withheld by the respondent relating to a psychological assessment or psychological services. Therefore, I find that there is no basis for an award.
Interest
48Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I find that there are no overdue benefits payable, no interest is payable.
ORDER
49The applicant is barred from proceeding to a hearing on the claim for physiotherapy services, pursuant to s. 55(1) of the Schedule.
50The applicant is not entitled to the plans for a psychological assessment and psychological services.
51As no payments were unreasonably withheld, the respondent is not liable to pay an award.
52As no overdue benefits are payable, interest is not payable.
53The application is dismissed.
Released: May 29, 2026
Teresa Walsh
Adjudicator