Licence Appeal Tribunal File Number: 24-014001/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:
Eric Torgbor
Applicant
and
TD General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Timothy Porter
APPEARANCES:
For the Applicant:
Doina Marinescu, Paralegal
For the Respondent:
Yuki Qiu, Counsel
HEARD: In Writing
OVERVIEW
1Eric Torgbor, the applicant, was involved in an automobile accident on December 16, 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.
Procedural ISSUES
2I find that income replacement benefits (“IRB”) is withdrawn as an issue in dispute and a s. 10 award is added to the issues in dispute.
3In their hearing submission the applicant sought to add a s. 10 award to the issues in dispute. The respondent opposed the addition of this issue to the issues in dispute.
4The applicant submits that the respondent’s treatment of the applicant’s accident benefits claim merits an award.
5The respondent submits that it is procedurally unfair as their first notice of an award as an issue in dispute was upon receipt of the applicant written hearing submissions.
6The applicant submits that they first informed the respondent of their intention to seek a s. 10 award on July 10, 2025, and again noted this on September 3, 2025; The applicant submitted their written hearing materials on September 18, 2025; the respondent made their submissions October 3, 2025. Allowing a minimum of 11 business days and as much 84 days according to the applicant’s submission, between the respondent being made aware of the request and their written submission being due, which in my mind is sufficient time to consider the applicant’s position and prepare a defense.
7In addition, the Tribunal provided a separate “Notice of Motion at scheduled event” to provide an opportunity for the respondent to present its objection.
8In 17-006302 v Aviva General Insurance, 2018 CanLII 61159 (ON LAT) adjudicator Maedel set out that s. 10 of Ontario Regulation 664 under the Insurance Act provides the Tribunal the inherent jurisdiction to add an award as an issue in dispute at any part of the hearing process and that the bar for doing so is very low. I agree, the Schedule is consumer protection legislation and in my mind an insurer is legislatively bound to continually adjust the claim and fulfill their obligation; In my mind, the basis for an award can crystallize at any time during the proceedings before the Tribunal and therefore it can be added at any time during the Tribunals process.
9The respondent submits that the applicant is abusing the process and makes procedural arguments regarding s. 23(1) of the Statutory Power Procedure Act, RSO 1990. I am not persuaded that this is an abuse of process; in my mind, the procedural arguments in no way trump the consumer protection elements of the Schedule.
10The applicant has very specifically detailed the award claim and pointed to the specific dates on which decisions of the respondent, in their mind, are unreasonable treatment.
11Based on the above, I find that the respondent has had sufficient notice of the applicant’s claims; I find that the Tribunal has jurisdiction to add a s. 10 award as an issue in dispute at any point in the dispute process being adjudicated by the Tribunal. I add s. 10 award to the issues in dispute, the respondent’s motion is not successful.
12The applicant submitted that they no longer wished to pursue the IRB claim at this time and withdrew the matter from consideration at the hearing.
13I find that income replacement benefits (“IRB”) is withdrawn as an issue in dispute and a s. 10 award is added to the issues in dispute.
ISSUES
14The 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 $2,909.25 for chiropractic services proposed by Seksek Chiropractic PC in a treatment plan/OCF-18 (“plan”) dated March 30, 2023?
iii. Is the applicant entitled to $2,779.75 for other assistive devices proposed by Seksek Chiropractic PC in a plan dated May 2, 2023?
iv. Is the applicant entitled to $2,265.33 for chiropractic services proposed by Seksek Chiropractic PC in a plan dated May 25, 2023?
v. Is the applicant entitled to $2,675.84 for a psychological assessment, proposed by Q Medical in a plan dated March 27, 2023?
vi. Is the applicant entitled to $2,500.13 for a psychiatric assessment, proposed by Q Medical in a plan dated June 29, 2023?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
viii. Is the applicant entitled to an award according to s. 10 of Ontario Regulation 664?
RESULT
13I find that the applicant has demonstrated, on a balance of probabilities, that he should be removed from the MIG because of his accident-related psychological impairment.
14The applicant is entitled to the psychological and psychiatric assessments.
15The applicant is not entitled to the 2 chiropractic treatment plans
16The applicant is entitled to the assistive devices (physiotherapy) treatment plan
17Interest is due on all outstanding and delayed payments.
18No award is due.
ANALYSIS
Minor Injury Guideline (MIG)
19Section 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.”
20An 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 impairment combined with compelling medical evidence stating that the impairment 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 impairment may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
21The applicant argues that he should be removed from the MIG because he suffered a psychological impairment as a result of the accident.
Psychological impairment
22I find that the applicant has proven, on a balance of probabilities, that his injuries are not minor due to a psychological impairment.
23The applicant submits that his psychological impairment is a non-minor injury and relies on the report of Dr. Toneatto and the clinical notes and records (“CNRs”) of Huron Medical Centre.
24The respondent submits that the applicant’s injuries are minor, that causation is in question and that the applicant lacks credibility. The respondent relies on the s. 44 reports of Dr. Cobrin, psychologist, and Dr. Bansal, general practitioner.
25The applicant was assessed by Dr. Toneatto, registered psychologist on May 1, 2023, for a s. 25 report which was issued on June 21, 2023. Dr. Toneatto diagnoses the applicant with Somatic Symptom Disorder with predominant pain, persistent, adjustment disorder with mixed anxiety and depressed mood as well as unspecified trauma and stressor-related disorder. Dr. Toneatto also opines that the prognosis for the applicant is guarded and recommends 12 sessions of cognitive behavioral therapy, a motor vehicle travel desensitisation and reintegration program and an assessment by a psychiatrist to ascertain whether psychotropic medication would benefit the applicant.
26The applicant has raised symptoms of a psychological impairment with his health care provider. The applicant pointed to the CNRs of Huron Medical Centre, a walk-in clinic he regularly attends. The CNRs of January 19, 2024, indicate that the applicant complained of low mood, and on August 8, 2024, the applicant indicated he was suffering anxiety and insomnia. The CNRs also indicate that prescriptions for medications for anxiety and insomnia were issued to the applicant. Taken together, the applicant has been consistently raising complaints of a psychological nature.
27The applicant was also assessed by s. 44 assessor Dr. Peter Cobrin, psychologist on May 11, 2023; Dr. Cobrin issued his report August 10, 2023. I assign a lesser weight to the report of Dr. Cobrin because he administers only 1 psychometric test, which he notes is designed for native English speakers, which the applicant is not. The lesser weight is also assigned due to discrepancies between the original and addendum report statements which will be outlined below. Dr. Cobrin declines to provide a diagnosis stating that the symptoms the applicant is experiencing are subclinical. In the original report Dr. Cobrin relates that the applicant’s test scores on the SCL-90R were as follows: “Seven of the nine scores were either the average or below average range with two of the subscale scores being mildly elevated”. In Dr. Cobrin’s addendum report he opines in relation to the results of the SCL-90R “On this measure, only one of the clinical subscale scores, that measuring symptoms related to depression, attained the level required for finding of clinical significance.” These two statements by Dr. Cobrin are not congruent. In my mind the tests cannot both show below average to mildly elevated and “attained the level required for finding of clinical significance”. Dr. Cobrin did not offer any reason that the findings on psychometric measures between his testing and that of Dr. Toneatto differ, suggesting that it is a mystery.
28I am persuaded by the report of Dr. Toneatto; in my mind, the applicant has established that he is experiencing psychological symptoms and that those symptoms have a negative impact on his functional capacity for social and recreational engagement, cognitive function and sleep initiation.
29The respondent has submitted that the applicant’s complaints are not to be trusted and suggest that the subject accident may not be the cause of the applicant’s symptoms. In my mind there is insufficient evidence to suggest the applicant is not trustworthy. To the question of causation the respondent points to a physical assault that occurred post subject accident as a potential cause of the applicant’s symptoms. In my mind this strains credulity; the applicant did not report any psychological symptoms or diagnoses or receive prescriptions for psychotropic medication prior to the subject accident. Following the subject accident, and the assault, the applicant reports psychological symptoms, has a diagnosis and has been prescribed psychotropic medication. In the CNRs of the Huron Medical Centre there is no reference to the assault in conjunction with the psychological impairment complaints. However, the psychological symptoms are mentioned in conjunction with references to the subject accident in the CNRs of Huron Medical Centre. I also point to the s. 25 report by Dr. Toneatto wherein he recommends a motor vehicle travel desensitisation and reintegration program to return the applicant to normal living. I find that the subject motor vehicle accident is the cause of the applicant’s mental health complaints.
30I find that the applicant has proven, on a balance of probabilities, that his injuries are not minor.
31To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
32The purpose of an assessment is to determine whether an impairment exists. The insured bears the onus to demonstrate that there are grounds on which to believe that an impairment exists that would warrant further investigation by way of an assessment.
2 Mental Health Assessments
33The applicant is entitled to the psychological and psychiatric assessments.
34With regard to the psychological assessment plan. The plan was issued March 27, 2023, by Dan Shlepakov of Q Medical for a total cost of $2,675.84 and recommends a mental health assessment.
35The respondent denied the psychological services assessment plan on April 14, 2023, and cited the applicant’s MIG status as the reason they are unable to approve the goods and services recommended.
36The applicant is no longer in the MIG.
37In my mind the applicant has established, on balance of probabilities, that he suffers a psychological impairment. An assessment to ascertain the correct course of treatment for the psychological impairment is reasonable and necessary.
38I find that the applicant is entitled to the psychological assessment proposed by Q Medical.
39With regard to the psychiatric assessment plan. The plan was issued June 29, 2023, by Dan Shlepakov of Q Medical for a total cost of $2,500.13 and recommends a psychiatric assessment.
40The respondent denied the psychiatric assessment on July 21, 2023, and cited the applicants MIG status as the reason they are unable to approve the goods and services recommended.
41Dr. Toneatto has recommended both a psychological and psychiatric assessment. I am persuaded by the report of Dr. Toneatto, who has diagnosed the applicant with Somatic Symptom Disorder with predominant pain, persistent, adjustment disorder with mixed anxiety and depressed mood as well as unspecified trauma and stressor-related disorder and opined that the prognosis is guarded.
42As the applicant is no longer confined to the limits of the MIG, and he has established on a balance of probabilities that he has a psychological impairment, and Dr. Toneatto has recommended both the psychological and psychiatric assessment plans; I find that the assessments are reasonable and necessary.
43The applicant is entitled to the psychological and psychiatric assessments.
2 Chiropractic treatment plans
44The applicant is not entitled to the 2 chiropractic treatment plans
45With regard to the chiropractic services treatment plan proposed by Seksek Chiropractic, I note that the dispute is in fact over a partially approved treatment plan and the dispute is whether the applicant is entitled to $1,296.75 ($2,909.25 less $1,612.50 approved)?
46The submissions of the applicant did not contain any evidence of this treatment plan, and the respondent’s submissions do not contain the full treatment plan and therefore I am unable to analyze the reasonableness or necessity of the plan
47I find that the applicant is not entitled to the unapproved portion of the partially approved chiropractic treatment plan.
48With regard to the chiropractic services treatment plan proposed by Seksek Chiropractic for a total cost of $2,265.33, I note that the dispute is in fact over a psychological assessment plan issued by this provider for the amount noted in dispute.
49As I have approved a psychological assessment already, it is unknown how a second assessment of the same nature would assist the applicant in returning to a normal life. In my mind a second psychological assessment is not reasonable or necessary.
50The applicant is not entitled to the 2 chiropractic treatment plans
Assistive Devices Treatment plan
51The applicant is entitled to the assistive devices (physiotherapy) treatment plan.
52The plan was issued May 2, 2023, in the amount of $2,779.75. I note that when the dispute was initiated this item was listed as being for assistive devices, however, the plan appears to be largely about physiotherapy with 1 assistive device and 1 topical gel. The goals of the plan are pain reduction, increase in strength and increased range of motion. Under barriers to recovery physiotherapist Panchal notes that psychological symptoms are present and a recommendation of psychological treatment would support recovery.
53The respondent denied the plan on the basis that the MIG limits had been exhausted.
54The applicant is no longer in the MIG, the applicant’s MIG status is not an argument against the reasonableness or necessity of the plan. In my mind, the applicant’s physical pain treatment was being negatively impacted by the psychological impairment, as cited by physiotherapist Panchal. I am persuaded by physiotherapist Panchal’s reasoning. In addition, I note the diagnoses of Dr. Toneatto of Somatic Symptom Disorder with predominant pain, persistent; which in my mind aligns with the notes of physiotherapist Panchal.
55I find on a balance of probabilities that the treatment plan is reasonable and necessary.
Interest
56Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Interest applies on all late and delayed payments.
Award
57The 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. Provide the basis for the award. Identify the response.
58The applicant submits that the respondent failed to continually adjust the claim and that they preferred their s. 44 reports conclusions in the face of contrary medical records. The applicant points to November 2024 entries in the adjuster’s log notes as evidence that the respondent relied on the s. 44 reports in the face of contrary information in submitted medical by the applicant.
59The respondent submits that they have adjusted the claim in good faith.
60The November 2024 log notes indicate that the adjuster reviewed both of the s. 44 assessment reports and that an addendum by Dr. Cobrin also considered the newly submitted evidence of the applicant. In my mind, the respondent considered the new evidence of the applicant and sent it for consideration by their assessor.
61The respondent was relying on s. 44 assessors’ medical opinion and did take the time to have the contrary medical records reviewed by Dr. Cobrin. An award is for serious misconduct, not a difference in opinion or a mistake. I do not see evidence of behaviour that would justify an award.
62I find that the applicant is not entitled to an award.
ORDER
63I find that the applicant has demonstrated, on a balance of probabilities, that his injuries are not minor due to a psychological impairment.
64The applicant is entitled to the psychological and psychiatric assessments.
65The applicant is not entitled to the 2 chiropractic treatment plans
66The applicant is entitled to the assistive devices (physiotherapy) treatment plan
67Interest is due on all outstanding and delayed payments.
68No award is due.
Released: June 5, 2026
Timothy Porter
Adjudicator