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:
Emmanuel Pobee Applicant
and
Co-operators General Insurance Company Respondent
DECISION
ADJUDICATOR: Timothy Porter
APPEARANCES:
For the Applicant: Monika Krumins, Paralegal For the Respondent: David Raposo, Counsel
HEARD: In Writing March 31, 2026
OVERVIEW
1Emmanuel Pobee, the applicant, was involved in an automobile accident on May 13, 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, Insurer, 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 (“MIG”)? Note: The parties agree the MIG limits have been exhausted.
ii. Is the applicant entitled to the following medical services proposed by Prime Healthcare, as follows:
(a) $3,342.39 for chiropractic services, in a treatment plan/OCF-18 (“plan”) submitted May 30, 2022;
(b) $1,325.62 for chiropractic services, in a plan submitted December 15, 2022;
(c) $1,563.72 for chiropractic services, in a plan submitted August 2, 2023;
(d) $3,192.26 for psychological services, in a plan submitted September 1, 2023;
(e) $101.70 for other assistive devices, in a plan submitted September 6, 2023;
(f) $2,200.00 for a psychological assessment, in a plan submitted July 8, 2022;
(g) $2,000.00 for a functional abilities assessment, in a plan submitted January 12, 2023;
(h) $2,660.00 for a neurological assessment, in a plan submitted May 23, 2023; and
(i) $2,460.00 for a chronic pain assessment, in a plan submitted May 23, 2023?
3Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
4Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
5I find that the applicant’s accident-related injuries are, on a balance of probabilities, minor as defined by the Schedule.
6As the applicant remains within the MIG, he is not entitled to the treatment plans in dispute because they propose treatment outside of the MIG.
7No award is due.
8No interest is due.
ANALYSIS
Minor Injury Guideline
9I find that the applicant’s accident-related injuries are, on a balance of probabilities, minor as defined by the Schedule.
10Section 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.”
11An 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.
12The applicant submits that a psychological injury and chronic pain are non-minor injuries the applicant suffers as a result of the subject accident and relies on walk-in clinic clinical notes and records (“CNRs”) from Dr. Angus Franklin, the MI Clinic and Dr. Popa as well as the psychological report from Ms. Ramnaraine and Dr. Brunshaw.
13The respondent submits that the applicant’s injuries sustained as a result of the subject accident are minor according to the Schedule and relies on the s. 44 assessments by Dr. Zabieliauskas, physiatrist and Dr. Dancyger, psychologist as well as the CNRs of Dr. Popa.
The applicant has not established functionally disabling pain
14The applicant has not met his onus to demonstrate functionally disabling pain.
15The applicant submits that he has chronic pain and points to the CNRs of Dr. Franklin and Dr. Popa.
16In my mind, the walk-in clinic CNRs of Dr. Angus Franklin, of the MI Clinic and Dr. Popa are inconclusive with regard to chronic pain. The walk-in clinic CNRs are limited. What sticks out for me is that the applicant does not appear to have any CNRs from the time period around the subject accident with the first note appearing more than a year post accident. Secondly, the CNRs are punctuated with statements such as “Looks well,” and “appearance normal,” which in my mind does not suggest chronic pain. Finally, the objective diagnostic tests included in the records report no abnormalities or significant pathology identified and suggest they have been requested for more recent misfortunes which are not related to the subject accident. Taken together, the applicant’s CNRs and diagnostic tests are not supportive of the applicant’s position. The word “chronic” appears, in reference to reportedly long-standing pain but there are no referrals for inquiry or follow-up in relation to the notation.
17I have not been pointed to any opinions or evidence that outline functional limitations that are as a result of the pain the applicant is experiencing. In contrast the respondent points to the applicant’s active social media participation, active and regular gym routine, and continued operation of the applicant’s business as evidence there is no functional limitation.
18I find that the applicant has not met his onus to demonstrate functionally disabling pain. The Tribunal has consistently held that ongoing pain is not in and of itself sufficient to remove an applicant from the MIG. The applicant has submitted that he has pain, however he has not shown objective evidence of a functional limitation due to pain that resulted from the subject accident.
19The applicant has not met his onus of proving that he should be removed from the MIG on the basis of chronic pain with functional impairment.
The applicant has not established a psychological injury
20The applicant, on a balance of probabilities, has not established that he suffers an accident-related psychological injury.
21Sandra Ramnaraine, M.Sc., RP and Dr. Brunshaw, psychologist, conducted a s. 25 psychological assessment on May 29, 2023 and issued their report July 17, 2023. I afford this report diminished weight because the opinions expressed by Ms. Ramnaraine and Dr. Brunshaw are far too reliant on the applicant’s self-reports; the report does not detail that any other records were reviewed, which suggests to me that the opinion is entirely based on the applicant’s interview and self-report questionnaires. I am concerned that the assessors are selective and inconsistent about what methodologies or basis they use to ground different constituent elements of their opinion, and that they haven’t explained why they vary between self reports and the clinical interview. For example, the applicant received a below-average pain patient somatization score, which the report suggests demonstrates an “absence of emotional threat and concentrated thought about pain and physical problems;” The report also relates that the applicant received a below average pain patient depression score, his score suggesting “emotional stability, optimism and self-confidence.” The assessors explain away the lower scores and relate that during the clinical interview the applicant indicated that he continues to be emotionally distressed, and the conclusion is that the applicant is emotionally distressed. Finally, based on a review of the applicant’s records, this opinion appears to be an outlier that does not correspond or correlate with the other records pointed to.
22The CNRs of Dr. Angus Franklin, the MI Clinic and Dr. Popa do not offer a diagnosis for, or any inquiries regarding, psychological difficulties. I have not been pointed to any references in the CNRs that detail any psychological issues. In my mind, this is insufficient evidence to establish a psychological condition.
23The applicant, on a balance of probabilities, has not established that he suffers an accident-related psychological injury. The applicant remains within the MIG.
Not entitled to treatment plans in dispute
24The applicant remains within the MIG. The Applicant is not entitled to the treatment plans in dispute because they propose goods and services that fall outside of the MIG and the $3,500.00 funding limit for a minor injury.
Award
25The 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. The applicant did not provide any submission with regard to the s. 10 award dispute. No award is due.
Interest
26As no benefits are owing, no interest is due.
ORDER
27I find that the applicant’s accident-related injuries are, on a balance of probabilities, minor as defined by the Schedule.
28As the applicant remains within the MIG, he is not entitled to the treatment plans in dispute because the proposed treatment is outside of the MIG.
29No award is due.
30No interest is due.
Released: June 5, 2026
Timothy Porter Adjudicator