Licence Appeal Tribunal File Number: 25-000735/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:
Norianne Rementizo
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
VICE-CHAIR: Robert Maich
APPEARANCES:
For the Applicant: Dinesh Shan, Paralegal
For the Respondent: Hilary Doyle, Counsel
HEARD: In Writing
OVERVIEW
1Norianne Rementizo, the applicant, was involved in an automobile accident on November 26, 2023, 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, Aviva Insurance Company of Canada, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2By way of written submissions, the parties advised the applicant was removed from the Minor Injury Guideline (“MIG”), that the respondent approved $2,150.24 for chiropractic services, proposed by Wilson Massage, and Physio Ltd. in a treatment plan (“OCF-18”) dated June 1, 2024 and $2,200.00 for a psychological assessment, proposed by Assessment One Inc. in an OCF-18 dated September 1, 2024. The parties agree the remaining issues in dispute are award and interest.
ISSUES
3The issues in dispute are:
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
4The applicant is not entitled to an award.
5The applicant is entitled to interest on the payment of overdue benefits that were in dispute.
ANALYSIS
Legal Test for Award
6Pursuant to section 10 of Reg. 664, an award of up to 50% of the amounts withheld may be payable by the respondent if it is determined that it unreasonably withheld or delayed payment of a benefit. Awards are determined on an individual basis and generally depend on a finding that the respondent’s withholding or delay was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
Award
7I find the applicant is not entitled to an award.
8The applicant submits the following:
i. The applicant was involved in an accident on November 26, 2023. The applicant submitted a Disability Certificate (“OCF-3”) dated December 29, 2023, which noted that she suffers from dizziness, sleep disorder and psychological symptoms. The OCF3 also confirms a substantial inability to perform essential tasks of employment and a complete inability to carry on a normal life. She submits that despite this the respondent- initially classified the injuries under the MIG and proceeded to deny treatment plans submitted in support of physical and psychological care.
ii. On June 1, 2024, an OCF-18 was submitted by Wilson Massage and Physio Ltd. in the amount of $2,150.24; the treatment plan was denied on September 23, 2024. On September 1, 2024, an OCF-18 was submitted by Assessment One Inc. in the amount of $2200.00 for a psychological assessment; the treatment plan was denied on September 23, 2024.
iii. The applicant submits the respondent mainly relied on a s. 44 psychological assessment by Dr. Saghatoleslami to justify its denials. However, this assessment was based on a single session of 1 hour and 50 minutes and he did not review the OCF3. The s. 44 assessor acknowledged that Ms. Rementizo had subclinical anxiety nightmares and social withdrawal but dismissed these symptoms as not meeting DSM-5 criteria. The applicant submits that clinical notes from the family doctor include references to nightmares, night terrors, psychological distress and referrals to psychology on January 9, 2024 and November 23, 2024. The family physician records were provided to the respondent on June 6, 2025 but it did not act on this critical documentation until September 16, 2025, which is over 90 days delay.
iv. The applicant submits the delay is unjustified and highlights a lack of diligence in evaluating the totality of the medical evidence; further, the respondent's failure to consider this medical documentation in its earlier decisions shows a pattern of closing its mind to relevant and available information.
v. The applicant submits in a follow up addendum report dated December 6, 2024, the s. 44 assessor Dr. Saghatoleslami issued a detailed response, not on her own initiative but in direct reply to a legal letter from Shan Legal Services dated November 21, 2024. The assessor was explicitly responding to questions posed by the claimant's legal representative raising concerns about the original denial of the OCF18 for psychological assessment. The applicant submits that the tone and content of the addendum appears highly defensive and litigation-oriented rather than independent and neutral. Throughout the report, the applicant submits that the assessor repeatedly asserts that it is outside the professional qualification of a legal representative to raise concerns about her clinical opinion suggesting an adversarial stance inconsistent with the purpose of a medical evaluation conducted under s. 44 of the Schedule.
vi. Moreover, the applicant submits the assessor's responses demonstrate a rigid adherence to DSM-5 diagnostic thresholds while minimizing or disregarding the claimant's functional impairments which are well documented in the OCF3, family physician records and the applicant’s lived experience. The report does not reflect a genuine re-evaluation of the applicant's condition in light of new evidence; rather, the applicant submits it reads as an attempt to justify a previous denial. This calls into question the objectivity of the addendum and further supports the position that the respondent had closed its mind to other available medical information.
vii. In Applicant v. Portage La Prairie Mutual Insurance Company 2019 CanLII 101649 (ON LAT), a 40 percent special award was granted because the insurer relied on a compliant report from their assessor while disregarding compelling contrary evidence. Rather than independently assessing the claimant’s impairments, the insurer prompted its own assessor to defend their prior denial through a narrowly focused and litigation-driven rebuttal. This undermines the credibility and neutrality expected in s. 44 examinations and the applicant submits that this further supports her claim for a special award under s. 10 of Regulation 664.
9The respondent submits:
i. On October 16, 2024, the applicant attended an assessment at the respondent’s request with Dr. Belfon, who completed an interview and physical evaluation of the applicant. The applicant told Dr. Belfon that she experienced some neck and back pain, and headaches following the accident, but indicated these symptoms had resolved. Dr. Belfon concluded that the applicant had sustained an uncomplicated cervical spine sprain/strain and headaches, which had since resolved; Dr. Belfon concluded no further treatment was required.
ii. The respondent submits on October 29, 2024, the applicant attended a psychological assessment with Dr. Saghatoleslami at the respondent’s request. Dr. Saghatoleslami conducted an interview and completed a number of psychological tests with the applicant. The applicant reported she had no physical pain at the time of the assessment, but reported feeling withdrawn from friends after the accident, and sometimes feeling sad for reasons not related to the accident. She denied feeling angry, irritable, or agitated. She reported maintaining a good relationship with her family, sleeping seven hours a night with no issues, and continuing to travel by public transit (as she did before the accident). She reported some worry as a passenger but denied avoidant behaviour with respect to vehicular travel. She also reported some nightmares after the accident but Dr. Saghatoleslami noted these had resolved. Based on the applicant’s reporting, Dr. Saghatoleslami noted the applicant did not endorse full symptomology to meet the DSM-5 criteria for a mood disorder or anxiety disorder.
iii. The respondent further submits Dr. Saghatoleslami completed psychometric testing of the applicant. Validity testing indicated the assessment findings provided a valid indication of the applicant’s emotional functioning. Results from the pain patient profile (“P-3”), a self-reporting questionnaire, indicated the applicant’s scores on the depression scale, anxiety scale, and somatization scale fell within the below average range. Results from the personality assessment inventory showed that the applicant was not experiencing any psychological distress at the time of the assessment. Based on the applicant’s reporting and testing results, Dr. Saghatoleslami concluded the applicant did not meet the DSM-5 diagnostic criteria for any mental health disorders and opined that a psychological assessment was not reasonable or necessary.
iv. On November 13, 2024, the respondent advised that, per the findings of Dr. Belfon, the treatment plan submitted June 1, 2024, was not payable. On November 20, 2024, the respondent advised that as per Dr. Saghatoleslami’s findings, the assessment proposed in the treatment plan dated September 1, 2024, was not payable. On December 2, 2024, the respondent advised that additional information had been received, and that an addendum assessment would be completed to review new records.
v. The respondent submits that in an addendum report dated December 6, 2024, Dr. Saghatoleslami reviewed the additional documentation, which included the OCF-3 completed by V. Dumasia, physiotherapist, and correspondence from the applicant’s paralegal. Dr. Saghatoleslami noted that the OCF- 3 listed injuries including sleep disorders and other anxiety disorders; however, Dr. Saghatoleslami noted that the OCF-3 was completed by a physiotherapist, and that no new documentation had been submitted that would impact his findings that the applicant’s reporting did not meet DSM-5 diagnostic criteria for any mental health disorders. In a psychology addendum for clarification, dated December 6, 2024, Dr. Saghatoleslami addressed concerns raised directly by the applicant’s paralegal. Dr. Saghatoleslami emphasized that his conclusions were based on the applicant’s reporting, psychometric tests, and medical records provided to date. On December 18, 2024, the respondent provided the addendum reports and the denial was maintained.
vi. Further, the respondent submits on September 16, 2025, following receipt of new medical documentation from the applicant, the respondent advised that it would agree to pay for both plans in dispute.
10I find the respondent’s initial response to the applicant’s request for benefits was to maintain MIG and deny the treatment plans in dispute pending insurer’s examinations. I find there is nothing unusual about the respondent’s approach and the structure of the Schedule anticipates insurers may wish to order examinations before paying a benefit. This does not attract an award. While I note that the applicant took issue with Dr. Saghatoleslami’s approach and submitted it was flawed in the initial assessment, as well as both flawed and inflexible in the addendum, I find that an insurer is entitled to rely on the opinions of its s.44 assessors and an insurer’s denial and should not be held to a standard of perfection.
11I find that as the file developed the respondent addressed the issues raised by the applicant and commissioned reports and an addendum as further information developed. I find this is a significant mitigating factor as it demonstrates the respondent turned its mind to the file and addressed the concerns raised. I find that further evidence of the insurer’s decision to continue to adjust the file in good faith, is evidenced by the respondent’s voluntary decision to remove the applicant from the MIG and approve the treatment plans in dispute.
12The applicant submits that once his family physician’s notes were submitted in June, the respondent should have removed him from the MIG and approved the treatment plans sooner than September, some 90 days later. I find while the applicant takes issue with 90 days for the insurer to adjust the file, I find there is limited evidence to support that this timeline was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate given its ultimate determination that the applicant was removed from the MIG.
13I find that 90 days is not an unreasonable amount of time to process and balance the information provided to make a major decision such as removal from the MIG, in the adjusting of the file. I find it is also an important consideration from a public policy perspective, that voluntary action on the part of the insurer to the benefit of the insured, should be given significant weight when balancing the length of the delay in determining whether an award is warranted.
14I find that the respondent relied on insurer’s examination reports in denying the applicant’s claim and adjusted the file and provided benefits in favour of the applicant upon the submission of new evidence. I do not find that the 90 day delay in considering the evidence and removing the applicant from the MIG was a delay that was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate on the specific facts on this case.
15I find an award is not warranted.
Interest
16Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. I find the applicant is entitled to interest on the payment of overdue benefits that were in dispute, in accordance with s. 51.
ORDER
17The Tribunal’s final Orders:
i. The applicant is not entitled to a special award.
ii. The applicant is entitled to interest on the payment of overdue benefits that were in dispute, in accordance with s. 51 of the Schedule.
Released: June 11, 2026
Robert Maich
Vice-Chair