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:
Hawa Ibrahim
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Timothy Porter
APPEARANCES:
For the Applicant:
Malcolm H. Zoraik, Counsel
For the Respondent:
Emma Duggan, Counsel
HEARD: by Videoconference:
April 13-14, 2026
OVERVIEW
1Hawa Ibrahim, the applicant, was involved in an automobile accident on December 2, 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, 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? Note: The parties agree the MIG limits have been exhausted.
ii. Is the applicant entitled to a non-earner benefit of $185.00 per week from December 12, 2024, to December 6, 2026?
iii. Is the applicant entitled to $2,721.09 for physiotherapy services, proposed by Dhruvi Ghandi in a treatment plan/OCF-18 (“plan”) dated April 30, 2025?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not met her onus and remains within the MIG.
4The applicant has not met her onus and is not entitled to a non-earner benefit.
5The applicant is not entitled to the treatment plan in dispute as she remains within the MIG.
6No interest is due.
ANALYSIS
The applicant remains within the minor injury guideline
7The applicant has not met her onus and remains within the minor injury guideline.
8Section 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.”
9An 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.
10The applicant submits that pre-existing injuries of migraine headaches and various health issues impede her maximal medical recovery and that she should be removed from the MIG. The applicant relies on her testimony, the clinical notes and records of her family physician and the care records of We Care Physiotherapy.
11The applicant testified that prior to the subject accident she had low back pain, a persistent cough, a rib cage issue, asthma, and a gas illness.
12The clinical notes and records (“CNRs”) of Dr. Emmanuel Kanu, family physician, indicate that there was an investigation of a chronic cough that began in records on September 5, 2023 and continue through January 11, 2025; CNRs also indicate the applicant had reported worsening headaches on July 24, 2023 and a prescription was issued. The CNRs also indicate investigation of multiple complaints.
13The applicant visited St. Joseph’s Health Care Hamilton following the subject accident. The CNRs of St. Joseph’s indicate that the applicant was diagnosed with sprains and strains; imaging indicates no fractures. This suggests to me that the applicant’s subject-accident-related injuries were identified as those that match the criteria for the minor injury guideline.
14The applicant visited her family physician Dr. Kanu in the days following the subject accident and reports pain in her neck and back. The applicant received a prescription for pain relief and physiotherapy. In my mind, there was no concern for exacerbation of any previous injuries such as the noted rib cage issue or chronic cough, and the injuries are identified as minor according to the Schedule.
15The applicant undertook physiotherapy with We Care Physiotherapy and upon intake the applicant is diagnosed with “Sprain and strain of cervical and lumbar spine and hip.” On the intake form under “prior medical history” the therapist noted “asthma, eye operation, NO red flags, No PMH,” which I take to mean prior medical history. The care notes, throughout, reflect the applicant’s low back and pain complaints, sometimes improved, sometimes worsened. In my mind the applicant is assessed with accident-related injuries that are categorized as minor in the Schedule and there is no indication of the pre-existing rib cage issue or chronic cough by the applicant to the therapist or by the therapist as affecting treatment in the notes.
16I find that the applicant has been diagnosed with sprains and strains as a result of the subject accident. Sprains and strains are minor injuries according to the Schedule.
17I have not been pointed to any medical opinion that the applicant has a pre-existing condition which would preclude maximal medical recovery should she be treated within the MIG.
18The applicant has not met her onus to demonstrate that a pre-existing condition precludes maximal medical recovery if she is treated within the MIG.
The applicant is not entitled to a Non-Earner Benefit
19The applicant has not met her onus and is not entitled to the non-earner benefit (“NEB”).
20Section 12(1) provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391 (“Heath”), which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities.
21The applicant submits she continues to suffer pain in her neck and back which negatively impacts on her ability to undertake childcare, cleaning, cooking, hygiene tasks, and prayer; and relies on her testimony, the clinical notes and records of her family physician and the care records of We Care Physiotherapy.
22The applicant testified that she is the legal custodian of her two granddaughters and that she was the care giver for the two children pre-accident and that now her eldest daughter takes care of the children; that she can no longer clean, cook or perform hygiene tasks and that she cannot assume the positions for prayer due to pain. The applicant testified that since the subject accident she has had pain in her back and neck, and this pain is the cause of her identified functional limitations.
23We Care Physiotherapy care records indicate upon intake that the applicant had issues with housekeeping, sleeping and social. Childcare is not indicated. The applicant did not point me to any specific notes within the care records, and my review of the package did not locate any follow-up assessment following intake.
24Following the applicant’s initial visit on December 12, 2024, to family physician Dr. Emmanuel Kanu, the doctor’s CNRs do not indicate that the applicant related any of her concerns regarding the subject accident, her recovery timeline or any functional limitations related to the subject accident, in any of her appointments on January 11, 2025, January 16, 2025, February 26, 2025, May 3, 2025, June 14, 2025, or July 12, 2025. There is a single record that notes the subject accident. In my mind, the CNRs of Dr. Kanu do not provide any evidence of a functional limitation or an impairment, other than those categorized as minor by the Schedule, that is as a result of the subject accident.
25The applicant’s testimony regarding childcare was extremely limited, she testified that she can no longer go to the park or get down and play with the children. The applicant has identified some functional limitation in the area of childcare. Turning to the documentary evidence, a January 16, 2025, CNR of Dr. Kanu indicates that the applicant brought one of the children to the doctor. In my mind the limited testimony of the applicant and a single CNR, that indicates some ability, is insufficient to demonstrate a complete inability to undertake childcare responsibilities.
26The breadth of the applicant’s inability in cooking and cleaning is unclear. The applicant testified that she can no longer cook and clean due to pain. The applicant did not identify any specific tasks in cooking or cleaning that she can’t undertake and provided no specifics. Turning to the documentary evidence, I have not been pointed to or located any references of self-reports by the applicant to healthcare providers of any difficulty with or an inability to perform cooking or cleaning tasks. In my mind it is difficult to reconcile the applicant’s evidence for a complete inability in cooking and cleaning with the rigour demanded by the Heath test.
27With regard to hygiene, the applicant testified that she has difficulty showering and requires assistance to get into a shower chair. I have not been pointed to any other evidence of the applicant’s inability in the area of hygiene. I am not persuaded that requiring assistance to get into a shower chair is demonstrative of a complete inability to carry on a normal life.
28The applicant testified that there has been some difficulty in getting to mosque on a regular basis but the identified cause of this is transportation which is not related to the subject accident. The applicant also testified that her pain causes an inability to get into the proper position for daily prayer. The applicant has provided insight into her lived experience, and I accept her report that this is distressing.
29The applicant has not met her onus to demonstrate a complete inability to carry on a normal life. In my mind, the applicant has not gone into sufficient detail about her pre-accident function, and what she can and cannot do post accident. While I agree and acknowledge there are likely some tasks she cannot undertake due to the subject accident, I am not convinced these tasks are substantially most of the activities of the applicant’s pre-accident normal living.
30I find that the applicant has not met her onus to demonstrate her pre-accident activities have been impinged to a substantial degree.
31The applicant has not met her onus to demonstrate entitlement to the NEB.
The applicant is not entitled to the treatment plan in dispute
32The 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.
Interest
33As no benefits are owing, Interest does not apply.
ORDER
34The applicant has not met her onus and remains within the MIG.
35The applicant has not met her onus and is not entitled to a non-earner benefit.
36The applicant is not entitled to the treatment plan in dispute as she remains within the MIG.
37No interest is due.
Released: June 9, 2026
Timothy Porter
Adjudicator