Licence Appeal Tribunal File Number: 24-012455/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:
Andrew McLaughlin
Applicant
and
Certas Home and Auto Insurance Company
Respondent
DECISION
ADJUDICATOR: Robert Fleming
APPEARANCES:
For the Applicant: Georgiana Masgras, Counsel
For the Respondent: Nathan Fabiano, Counsel
HEARD: By way of written submissions
OVERVIEW
1Andrew McLaughlin, the applicant, was involved in an automobile accident on December 13, 2018, 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, Certas Home and Auto 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 limit?
ii. Is the applicant entitled to $2,400.00 for a chiropractic assessment, proposed by Markham Chiropractic Centre in a treatment plan/OCF-18 dated February 20, 2024?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is barred from claiming entitlement to the treatment plan pursuant to s. 20(1)(a) of the Schedule because the treatment plan was submitted more than five years after the accident.
4The applicant is not entitled to interest.
5The Tribunal does not have the jurisdiction to determine MIG as a standalone issue.
ANALYSIS
6Pursuant to section 20(1) of the Schedule and subject to subsection (2), no medical, rehabilitation and attendant care benefit is payable for expenses incurred,
(a) more than 260 weeks after the accident, in the case of an insured person who was at least 18 years of age at the time of the accident; or
(b) after the insured person’s 28th birthday, in the case of an insured person who was under 18 years of age at the time of the accident.
7Subsection 20(2) states that the time limits set out in subsection (1) do not apply in respect of an insured person,
(a) who sustains a catastrophic impairment as a result of the accident; or
(b) who is entitled to optional medical, rehabilitation and attendant care benefits under paragraph 4 of subsection 28 (1) or catastrophic impairments benefits under paragraph 5 of subsection 28 (1).
8The applicant submitted that section 20 of the Schedule must be interpreted in light of the remedial purpose of the legislation, which is to ensure access to treatment that is reasonable and necessary, to reduce or eliminate the effects of the impairment or to facilitate recovery. The applicant also submitted that the MIG should not apply in this matter and so the 260-week limitation is improper. To support their position, the applicant relies on the Schedule, and medical evidence from massage treatment notes and a neurological assessment.
9The respondent argued that the treatment plan was submitted past the 260-week mark and therefore the applicant is precluded from claiming entitlement to it because section 20(1) of the Schedule applies.
10The accident took place on December 13, 2018. The treatment plan was dated February 20, 2024, submitted February 23, 2024 and denied March 5, 2024. There is no dispute that the applicant was over the age of 18 years at the time of the accident. There has been no determination that he sustained a catastrophic impairment, catastrophic determination is not an issue in dispute in these proceedings, nor is there evidence that he purchased optional benefits. Therefore, the exceptions under section 20(2) do not apply. By operation of section 20(1), the last day that the applicant could have submitted treatment plans for this accident was December 7, 2023.
11I find that the applicant is precluded from claiming entitlement to $2,400.00 for a chiropractic assessment, proposed by Markham Chiropractic Centre in a treatment plan/OCF-18 dated February 20, 2024, pursuant to s. 20(1)(a) of the Schedule.
The applicant did not provide any jurisprudence to support their position that benefits are payable past 260 weeks after the accident in such circumstances.
12I am not persuaded by the applicant’s argument that the 260‑week limit in section 20(1)(a) should be set aside. The applicant argued that section 20 should be interpreted in light of the legislation’s remedial purpose—namely, to ensure access to reasonable and necessary treatment to reduce or eliminate impairment or support recovery. I accept that the Schedule is remedial and consumer protection legislation, however, this does not mean that the express time limits stipulated in the Schedule can be ignored. The 2016 amendment to the Schedule reduced the timeframe for applying for benefits from 10 years to 5 years (260 weeks), clearly indicating that the limit is intended to be firm. Accordingly, while I accept the remedial purpose of the Schedule, the legislature’s intent to set a time limit for the application of benefits is clear.
Minor Injury Guideline
13Based on my determination that the applicant is precluded from claiming entitlement to the only treatment plan in dispute, the remaining substantive issue is whether the applicant’s injuries are predominantly minor as defined in section 3 of the Schedule. The respondent submitted that the MIG cannot proceed on its own as an issue in dispute. The respondent refers to Lathan v. TD General Insurance Company, 2023, CanLII 67907 (ON LAT) as support for its argument that the MIG cannot be adjudicated as a standalone issue when there is no treatment plan in dispute. To support its position that the application should be dismissed in its entirety, the respondent cites Audho v. Certas Home and Auto Insurance Company, 2024 CanLII 43436 (ON LAT) and Vimalananthan v. Certas Home and Auto Insurance Company, 2023 CanLII 122901 (ON LAT). The applicant did not provide any reply submissions to address the respondent’s arguments or case law.
14It has been well-established by this Tribunal that the MIG cannot be heard as a standalone issue when there is no medical or rehabilitation benefit in dispute. Based on my findings, there is no longer a benefit tied to the MIG determination. As such, the MIG cannot proceed as an issue in dispute.
Interest
15Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no benefits payable there is no interest payable.
ORDER
16For the reasons set out above, I find that:
i. The applicant is barred from claiming entitlement to the treatment plan for $2,400.00 for a Chiropractic Assessment pursuant to s. 20(1) of the Schedule, and no interest is payable.
ii. The Tribunal does not have the jurisdiction to determine MIG as a standalone issue.
iii. The application is dismissed.
Released: June 11, 2026
__________________________
Robert Fleming
Adjudicator