Jeyakanthan v. Intact Insurance Company, 2026 CanLII 56656

Citation: Jeyakanthan v. Intact Insurance Company, 2026 ONLAT 25-001608/AABS

Licence Appeal Tribunal File Number: 25-001608/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:

Jeyaramya Jeyakanthan

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR: Jeff Chatterton

APPEARANCES:

For the Applicant: Nav Krishnan, Counsel

For the Respondent: Paras Gogna, Counsel

HEARD: In Writing

OVERVIEW

1Jeyaramya Jeyakanthan, the applicant, was involved in an automobile accident on December 23, 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, Intact Insurance Company, 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 (MIG) limit?

ii. Is the applicant entitled to $3,450.00 for a physiotherapy services, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan/OCF-18 (“plan”) dated July 17, 2023?

iii. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan dated September 11, 2023?

iv. Is the applicant entitled to $2,200.00 for a chronic pain assessment, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan dated September 25, 2023?

v. Is the applicant entitled to $3,182.00 for physiotherapy services, proposed by Scarborough Physiotherapy and Rehabilitation Center in a treatment plan dated July 29, 2024?

RESULT

3The applicant has not met her onus to demonstrate she should be removed from the definition of the MIG, and is therefore subject to the $3,500 treatment limit.

4As I have found that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans in dispute to determine if they are reasonable and necessary.

5The application is dismissed.

ANALYSIS

Should the applicant be removed from the MIG?

6The applicant has not met her onus to demonstrate she should be removed from the MIG.

7Section 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.”

8An 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.

9Despite the MIG being a live issue in dispute, the applicant has not offered a clear submission to demonstrate why she should be removed from the MIG. Indeed, her submissions are confined to a discussion of the treatment plans in dispute, despite the Case Conference Report and Order and the initial application indicating that the MIG was in dispute.

10It is well settled that the applicant bears the onus of proof when seeking treatment beyond the MIG. The applicant’s submissions were further silent as to what basis she was seeking removal from the MIG in her reply submission. Based on her submissions, while there is no engagement with the MIG, it appears that her position for removal from the MIG, or at least entitlement to the treatment plan in dispute, is based on a combination of chronic pain and a psychological condition, but again, no clear submissions were provided.

11In her submissions, the applicant relies on the Clinical Notes and Records (CNR’s) of her primary care physician, Dr. Ibtissam Tadros. I note that the applicant appears to have switched primary care providers, as I was also presented with a letter dated June 27, 2025 which indicates she was seeing Dr. Ramya Ariyahurajah. I have not been provided with CNR’s from Dr. Ariyahurajah.

Chronic Pain

12The Tribunal has determined that an applicant may escape the MIG if they suffer from chronic pain that causes functional impairment or if they meet three of the six criteria for chronic pain as provided by the AMA Guides. However, here, the Tribunal was not directed to a diagnosis of chronic pain or chronic pain syndrome and the applicant did not engage with any of the criteria under the AMA Guides.

13Furthermore, the applicant has not provided us with evidence to demonstrate functional limitations, which would be the second half of the legal test regarding chronic pain.

14I find that ongoing pain alone is insufficient to remove the applicant from the MIG. I find that the applicant has not proven on a balance of probabilities that her ongoing pain was accompanied by some functional impairment or disability.

Psychological Condition

15Finally, although the applicant may claim she is eligible to be removed from the MIG due to a psychological injury, I have not been led to persuasive and contemporaneous evidence that indicates the applicant has suffered a psychological injury.

16I have carefully reviewed the Clinical Notes and Records (“CNRs”) from the applicant’s family physician, Dr. Ibtissam Tadros, and I only note two references to the accident. The first reference, dated January 11 2023, references physical concerns and makes no reference to a psychological condition. The second reference to the accident takes place December 18, 2023, nearly a full year after the accident. Although handwritten, I can legibly read that this notation in the CNRs references an “MVA,” “mood swings” and “trouble sleeping.”

17I place little weight on the letter from Dr Ariyahurajah, because it is dated June 27, 2025, which is nearly two and a half years after the accident occurred. Furthermore, while the letter says the applicant “has been referred to psychiatry for further diagnostic clarification and treatment plan” I have not been led to CNRs or other further, contemporaneous medical evidence which indicates the nature of those concerns, and whether or not they were accident-related.

18In summary, when it comes to psychological concerns, I have a single note in the family doctor CNR’s that references a potential psychological concern, which is not sufficient to remove someone from the MIG. A single note highlighting a potential concern does not carry sufficient weight to remove someone from the MIG without corroborating medical evidence which would, on the balance of probabilities, establish that a psychological condition does indeed exist.

Summary

19In the absence of submissions specific to why the applicant should be removed from the MIG, and after review of the evidence that was presented to me, I find, on the balance of probabilities, that the applicant has not met her onus to demonstrate she should be removed from the MIG.

20As I have ruled that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans to determine if they are reasonable and necessary.

ORDER

21The application is dismissed.

i. The applicant has not met her onus to demonstrate that she should be removed from the definition of the MIG, and is therefore subject to the $3,500 treatment limit.

ii. As I have found that the applicant is being held to the MIG, it is not necessary for me to analyze the treatment plans in dispute to determine if they are reasonable and necessary.