Citation: Msheiel v. The Dominion of Canada General Insurance Company, 2026 ONLAT 25-002285/AABS

Licence Appeal Tribunal File Number: 25-002285/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:

Marwa Msheiel

Applicant

and

The Dominion of Canada General Insurance Company

Respondent

DECISION

VICE-CHAIR:

Brian Norris

APPEARANCES:

For the Applicant:

Marwa Msheiel, Self-Represented

For the Respondent:

James D. Armstrong, Counsel

Nicole Anozie, Counsel

HEARD: by Videoconference:

February 10, 2026

OVERVIEW

1Marwa Msheiel (“the Applicant”) was involved in an automobile accident on June 18, 2024, and sought benefits from The Dominion of Canada General Insurance (“the Respondent”) 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 and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issues to be decided in the hearing are:

1. Is the Applicant entitled to income replacement benefits (“IRBs”) in the amount of $400.00 per week, for the period from June 25, 2024, to date and ongoing?

2. Is the Applicant entitled to attendant care benefits (“ACBs”) in the amount of $2,879.55 per month, for the period from April 23, 2025, to date and ongoing?

3. Is the Applicant entitled to $3,414.16 for chiropractic services, proposed by Dr. Daugherty Chiropractic in a treatment plan/OCF-18 (“plan”) dated March 25, 2025?

4. Is the Applicant entitled to the assessments proposed by Prime Healthcare, as follows:

i. $2,740.25 for a Chronic Pain Assessment, in a treatment plan dated February 12, 2025;

ii. $2,000.00 for an Attendant Care Assessment, in a treatment plan dated April 2, 2025; and

iii. $2,572.81 for an Orthopaedic Assessment, in a treatment plan dated April 2, 2025?

5. Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the Applicant?

6. Is the Applicant entitled to interest on any overdue payment of benefits?

RESULT

3The Applicant meets the test for IRBs for the period from June 25, 2024 to January 16, 2025, and no time thereafter. However, she has not demonstrated that she is entitled to payment for IRBs as she received employment insurance sickness benefits during the period of claim and these payments, once deducted from the IRBs payable, negate the Applicant’s claim.

4No ACBs are payable.

5That Applicant is not entitled to the plans in dispute.

6No interest or award is payable.

BACKGROUND

7The Applicant was the driver of a vehicle which was struck from behind at a suburban traffic light. She was taken by ambulance from the scene of the accident to the hospital. Ambulance records state that the Applicant complained of “frozen” legs while hyperventilating, but the records note that she was able to move her toes and feet and stand up from the vehicle. It was also noted that the Applicant believed her symptoms to be related to her previously diagnosed anxiety. The ambulance records indicate that the Applicant denied any loss of consciousness, and there is no report indicating that she hit her head during the collision.

8Hospital records state that the Applicant denied any neck pain, arm weakness, or any other injury aside from numbness in her feet. The Applicant however, discharged herself from the hospital after this initial assessment and no further investigations, such as x-ray imaging, was performed.

9The Applicant followed up with her family physician two days later, on June 20, 2024, and complained of left side pain from her neck down to her legs. She was referred for x-rays which revealed a normal left shoulder, elbow and knee, and degenerative changes in her low back at L4-L5. An ultrasound conducted July 3, 2024, indicated that the Applicant had two partial tears of the supraspinatus in her left shoulder joint.

10The Applicant had significant neck and shoulder pain prior to the accident, making it unclear whether the partial tears in her shoulder are as a result of the accident. The Applicant suffered from bilateral frozen shoulders for which she received injections for in 2020 and was advised to engage in physiotherapy at that time but did not. Imaging conducted prior to the accident, in October 2022, demonstrated that the Applicant had a partial tear of her right shoulder. By April 2024, approximately two months prior to the accident, the Applicant’s bilateral shoulder pain and limited movement caused her to request surgical intervention, and she was prescribed Oxycocet for her pain, Cipralex for her mental health, and Baclofen to relax her muscles.

11The Applicant submits that the accident exacerbated her pre-existing bilateral shoulder pain, impairing her function. In addition, the Applicant claims that she now suffers from incontinence and an antalgic gait as a result of the accident. To the Applicant, the partial tears in her shoulder, her antalgic gait due to left knee pain, neurological symptoms, and incontinence preclude her ability to complete the essential tasks of her employment as an educational assistant with the local school board, and as a bookkeeper at her husband’s company.

ANALYSIS

Income Replacement Benefits (“IRBs”)

12I find that the Applicant meets the test for IRBs for the period from June 25, 2024 to December 31, 2024. However, the Applicant has not demonstrated that she is entitled IRBs beyond that period because she has not led evidence to support a finding of an ongoing disability.

13I further find that the Applicant is not entitled to any payment during her period of entitlement as her employment insurance (“EI”) sickness benefits offset the amount payable.

14The onus is on the Applicant to demonstrate entitlement to the benefits claimed. For the first 104 weeks following the accident, she must demonstrate that she suffers a substantial inability to carry on the essential tasks of her employment, pursuant to section 5(1) of the Schedule. The test involves an assessment of the Applicant’s employment at the time of the accident, and whether her accident-related impairments cause a substantial inability to complete the essential tasks of that employment.

15The test for entitlement to IRBs becomes more stringent after 104 weeks following the accident. At that point, the Applicant must demonstrate that she suffers a complete inability to engage in any employment for which she is reasonably suited by education training, or experience.

16Up front, I note that a partial tear, or two small partial tears, in the left shoulder, even if they are as a result of the accident, does not automatically entitle the Applicant to IRBs. Rather, the Applicant must demonstrate that the injury is as a result of the accident and causes her to suffer from a substantial inability to complete the essential tasks of her pre-accident employment as an educational assistant and bookkeeper.

17According to the functional abilities evaluation insurer’s examination (“IE”) report by Dr. B. Souter, chiropractor, dated December 2, 2024, and the Applicant’s testimony, the Applicant was employed as an educational assistant at the local elementary and high schools prior to the accident. She was employed on a casual basis but was working approximately 25 to 30 hours per week. Her duties included working with children with behavioural problems, emotional needs, physical disabilities, and mental disabilities. She was required to work one-on-one with students, some of which were in wheelchairs and required assistance with toileting, dressing, and feeding. She was required to push and pull wheelchairs to mobilize students around the school, and with other students she would sit with them while working on assignments. She was required to report to teachers and provide feedback on the student’s accomplishments. Occasionally, the Applicant’s work as an educational assistant required crisis intervention when children had behavioural outbursts. Dr. Souter noted that the role of an educational assistant is classified as medium level work.

18Additionally, the Applicant was employed as a bookkeeper at her husband’s company at the time of the accident. For that role, the Applicant reported that she worked 10-15 hours per week, from home. Her tasks primarily involved computer and desk work. The Applicant also testified that she would occasionally drive to pick up and/or deliver car parts. Dr. Souter noted that the role of a bookkeeper is classified as sedentary level work.

19Additional to her work experience, the Applicant holds a personal support worker diploma, and a medical laboratory assistance/technician diploma.

20Dr. Souter assessed the Applicant’s function and, in the December 2, 2024 report, opined on her ability to perform work activities. Dr. Souter found that the Applicant demonstrated the ability to perform frequent standing, sitting, carrying at the light strength category, reaching forward and below the waist, handling, fingering, and stooping. Dr. Souter concluded that the Applicant demonstrated the ability to perform occasional lifting from floor to waist and from the waist to shoulder at the sedentary strength category, lifting at the shoulder level at the light strength category, and pushing and pulling at the medium strength category.

21I find that the Applicant’s evidence demonstrated that the Applicant is disabled from working as an educational assistant and bookkeeper during the period from the date of the accident until December 31, 2025. My finding is based primarily on the CNRs of Dr. H. Akladios, family physician, and the recommendation of nurse practitioner, B. Chiwara, dated August 28, 2024.

22I find that the CNRs of Dr. Akladios demonstrate that the Applicant experienced a temporary exacerbation of her pre-existing shoulder and neck pain. The Applicant met with Dr. Akladios on June 20, and July 12, 2024 and reported left side pain from her neck down to her legs. Dr. Akladios examined the Applicant both times and noted her reduced ROM due to pain, as well as irritability and low mood. Dr. Akladios diagnosed the Applicant with impingement syndrome and post-traumatic stress disorder (“PTSD”), and recommended physiotherapy.

23Dr. Akladios referred the Applicant to Dr. K. Ng, psychiatrist. Dr. Ng assessed the Applicant and issued a report, dated August 21, 2024. Dr. Ng concluded that the Applicant suffers from PTSD and has a history of general anxiety disorder with situational depression. However, Dr. Ng never opined that the Applicant’s psychological or psychiatric impairments affect her ability to engage in employment or self employment and there is insufficient information in the report for me to conclude that the Applicant’s psychological or psychiatric symptoms impair her ability to complete the essential tasks of her employment. Throughout the records before me, no other healthcare provider has opined that the Applicant’s psychological or psychiatric injuries impair her ability to work as an educational assistant or a bookkeeper.

24Nurse practitioner Chiwara provided a medical note for the Applicant that states that she was off work since June 18, 2024 and expected her to have a full recovery by January 2025. It appears that nurse practitioner Chiwara works together with Dr. Akladios and that the letter stems from a visit with Dr. Akladios on August 28, 2024. The letter by nurse practitioner Chiwara does not expressly state that the Applicant’s pain is as a result of the accident however the timing of the referral note suggests that it as a result of the accident.

25Dr. Akladios referred the Applicant to Dr. K. Pirzada, a physician at the Hamilton Pain Clinic. Dr. Pirzada assessed the Applicant during the January 16, 2025 visit, and administered nerve block injections to the Applicant to address her ongoing neck and shoulder pain. There are virtually no reports of accident-related impairments made by the Applicant to Dr. Akladios after she consulted with Dr. Pirzada and received nerve block injections.

26The findings of Dr. A. W. Khan, physiatrist, as outlined in the report, dated December 2, 2024, are consistent with Dr. Akladios’ CNRs. Dr. Khan concluded that the Applicant likely suffered from a temporary exacerbation of her pre-existing injuries as a result of the accident. To me, this indicates on a balance of probabilities that the Applicant suffered from an impairment as a result of the accident during the period immediately following the accident. This would support a finding that she suffers a substantial inability to complete her essential tasks as an education assistant and bookkeeper initially following the accident, as documented by nurse practitioner Chiwara in the August 28, 2024 note.

27I find that Dr. Khan’s assessment and report support a finding that the Applicant no longer suffers from a substantial inability to complete the essential tasks of her employment as an educational assistant and bookkeeper. Dr. Khan assessed the Applicant and observed that she had reduced ROM in her shoulders and low back but found no objective pathology that would preclude her from performing her pre-accident duties as an educational assistant, and/or a bookkeeper. Dr. Khan found that the Applicant does not suffer from a substantial inability to perform her pre-accident job duties as of December 2, 2024, the date Dr. Khan issued his report.

28I find that December 31, 2024 is an appropriate cutoff date for the Applicant’s entitlement to IRBs. This is made in consideration of nurse practitioner Chiwara’s recommendation that the Applicant will reach a full recovery by January 2025. I have also considered the opinion in the disability certificate, dated September 9, 2024, which anticipates a period of disability of 9-12 weeks. Lastly, I have also considered Dr. Khan’s recommendation, that the Applicant engage in a gradual return to work.

29The Applicant has not provided a recommendation from a healthcare provider that supports a finding that she is disabled from working after December 31, 2024, as a result of the accident. As noted, the Applicant was given a medical note by nurse practitioner Chiwara for a medical leave in the acute phase of her recovery. The Applicant also submitted a disability certificate completed on her behalf by Dr. H. Noien, chiropractor, dated September 9, 2024. That disability certificate, mentioned previously, states an expected disability period of 9-12 weeks, or until early December 2024. Apart from these two documents, the Applicant has led no medical evidence indicating that she in unable to complete the essential tasks of her employment after December 31, 2024, as a result of the accident.

30I find that the report of Dr. T. Y. Getahun, orthopaedic surgeon, dated June 2, 2025, does not support a finding that the Applicant is unable to complete the essential tasks of her employment as an educational assistant and bookkeeper. Dr. Getahun assessed the Applicant and concluded that she sustained myofascial strains to the neck and back, as well as bilateral shoulder strains and an aggravation of her pre-existing pathology. Dr. Getahun recommended physiotherapy and chiropractic interventions, and further assessments, but never opined on the Applicant’s ability to work, and did not suggest that the Applicant would benefit from time off work or that her recovery would be impacted if she returned to work.

31The medical reports before me conclude that the Applicant can return to work. The December 9, 2024 report by Dr. Khan found no objective pathology that would preclude the Applicant from performing her pre-accident job duties, and no medical contraindications to engaging in her pre-accident employment as an educational assistant and bookkeeper. Dr. Khan issued a second report, dated October 16, 2025, and maintained that the Applicant’s pain-related impairments are attributable to her pre-existing pain and amounted to a temporary exacerbation of her symptoms. Dr. Khan concluded in the October 2025 report that the Applicant is encouraged to engage in housekeeping and home maintenance, and self care without restriction and that it would help build strength and work capacity.

32I find no connection between the subject accident and the Applicant’s reported neurological issues and incontinence. During the hearing, the Applicant highlighted that she suffers from neurological issues and that she now suffers from periodic incontinence. She testified that she had an episode of low back pain in September 2025 which led her to attend the emergency department at the hospital because it was causing her to experience incontinence. She testified that she required a catheter for 6 days following this episode. She attributes these issues to the accident. However, the Applicant has not directed me to any evidence to support a finding that these issues are as a result of the accident. My review of her evidence finds no records that connect the Applicant’s reported incontinence to the subject accident – her complaints occurred more than a year after the accident, and no medical practitioner has opined that the issue is as a result of the accident. In fact, the Applicant denied any acute bowel or bladder dysfunction to Dr. Pirzada, during the January 16, 2025 consultation. Similarly, Dr. Getahun never identified any neurological or incontinence issues in the report dated June 2, 2025. I am unable to find that the Applicant’s reported incontinence is as a result of the accident without a clear connection between the symptoms and the subject accident.

33I find that the Applicant is not impaired due to knee pain and that her knee pain is unrelated to the accident. The CNRs from Dr. Akladios indicate an initial complaint of a sore left knee due to hitting it inside the vehicle during the collision. However, imaging from June 24, 2024, indicated a normal left knee, and the Applicant did not complain of left knee pain in the doctor’s visits that followed in the summer of 2024, including the visit where the Applicant was given a note for sick leave from work.

34The Applicant did not report ongoing knee issues during the IEs and the surveillance evidence does not show the Applicant using a cane, as she reported to Dr. Getahun. The Applicant never mentioned her knee as an issue during consultations with Dr. Souter in the December 2, 2024 report, or Dr. Khan in the December 2, 2024 and the October 16, 2025 reports. On April 23, 2025, the Applicant reported to her treatment facility that she uses of a cane for mobility, and on June 2, 2025 she reported to Dr. Getahun that she uses a cane for ambulation. However, cane use is not reported in any other medical consultations and is not reflected in the surveillance evidence from June 10, 11, and 16, 2025. The surveillance report, dated June 20, 2025, includes video and photos of the Applicant walking with no aides and no observable gait issues.

35The surveillance report and evidence depict the Applicant engaging in activities which she reports to be unable to complete. Throughout the surveillance evidence, the Applicant is walking without any assistive devices or apparent gait issues. She is grocery shopping, including loading cases of drinks onto the bottom of the shopping cart, and then into the trunk of her vehicle. She stands for approximately 30 minutes on one occasion and 15 minutes on another. She is observed to use her left arm to lean on a vehicle. She carries a purse and operates the gate of her vehicle. The Applicant was observed to drive within her community and attend at a warehouse grocery store, complete her shopping, and load items into the trunk of her vehicle. The Applicant was also observed to accompany one of her children’s classes at the local zoo, which included walking around the grounds, eating a packed lunch on the grass, and using her left shoulder to carry a bag and a water bottle. At no time throughout the surveillance evidence is the Applicant observed to use a cane for mobility.

36Considering the above, I conclude that the Applicant has not met her onus to demonstrate on a balance of probabilities that she suffers from a substantial inability to complete the essential tasks of her employment as an educational assistant and as a bookkeeper. Having found that the Applicant does not meet the substantial inability test, it follows that I find she does not meet the more stringent complete inability test that applies after two years following the accident.

Employment Insurance (“EI”) sickness benefits offset any quantum owing to the Applicant

37I find that the Applicant is not entitled to any IRBs payable during the period for which she meets the test of eligibility because any payments are offset by the EI sickness benefits she received during the same period.

38The Respondent, at the outset of the hearing, submitted that in the event the Applicant meets the test for eligibility to IRBs, the quantum owing would be zero because she received EI sickness benefits during this period. The Applicant did not address this during the hearing.

39Section 7(3)a of the Schedule provides that the Respondent may deduct 70% of any gross employment income received by the Applicant from the amount of IRBs payable to the Applicant for the same period. This is confirmed in Aviva Insurance Company of Canada v. Spence, 2022 ONSC 4988, which is binding upon me.

40In this case, the Applicant received EI sickness benefits following the accident and into 2025, as confirmed by the records from Service Canada. Having reviewed the document, I confirm that the Applicant received a weekly benefit of $646.00, which fully offsets the maximum weekly amount of $400.00, claimed by the Applicant. As a result, and pursuant to section 7(3)a of the Schedule, I find that the Respondent is entitled to a deduction of any IRBs payable to the Applicant during the period from the date of the accident and ending on December 31, 2024.

41In conclusion, the Applicant demonstrated on a balance of probabilities that she meets the test for entitlement to IRBs for the period from June 25, 2024 to December 31, 2024. However, the Applicant is not entitled to payment of any IRBs because her losses are offset by the deductions available to the Respondent, as outlined in section 47 of the Schedule.

The Applicant is not entitled to ACBs at the rate of $2,879.55 per month

42I find that the Applicant has not demonstrated that $2,879.55 per month in ACBs is reasonable and necessary as a result of the accident.

43The Applicant claimed entitlement to ACBs on the basis that the Respondent ignored her evidence and that the objective evidence supports her ongoing entitlement to ACBs. She submits that she is unable to repeat tasks and be safe and that she risks worsening her condition if she engages in her self-care tasks. She highlights that reports confirm a loss of independence and a need for assistance.

44From the Applicant’s statements regarding ACBs, and based on the quantum claimed, I infer that the Applicant is relying on the May 1, 2025 report by N. Khramtsova, RN. In that report, nurse Khramtsova recommended $2,879.55 in monthly ACBs for the Applicant on the basis that the Applicant requires assistance with personal care tasks she is currently unable to perform independently without injury aggravation. According to RN Khramtsova, the Applicant requires assistance with dressing and undressing, hair care, nail care, preparing and feeding meals, walking and rising from a seated position, bathroom hygiene, exercise, administering and monitoring medication, and bathing.

45The Respondent submits that the MRIs and other diagnostic imaging is not sufficient to determine an ongoing impairment. It submits that the surveillance evidence shows the Applicant engaging in day-to-day activities such as taking her kids to school, and grocery shopping. The Respondent also highlights that the Applicant never incurred any ACBs during the period from June 2025 to September 2025, when it agreed to pay for all expenses incurred, pending the outcome of an IE.

46I give no weight to the May 1, 2025 report by N. Khramtsova, RN, because it is based on information that is inaccurate or inconsistent with the balance of the Applicant’s medical record. Specifically, RN Khramtsova approached the assessment with the belief that the Applicant was entirely self-sufficient with her activities of daily living prior to the accident, that she uses a cane for ambulation following the accident, and that she uses a sling on her left arm and a brace on her left knee to control accident-related pain. The Applicant reported to Dr. Khan, in the December 2, 2024 report, that her family would help her with dressing and hair care during times of pain flare-ups prior to the accident, and there is no evidence that the Applicant uses a cane or knee brace as a result of accident-related injuries. The Applicant’s self-reports to Dr. Khan are more consistent with Dr. Akladios’ medical records, which document the Applicant’s pre-existing neck, back and shoulder issues, and that she was considering surgical intervention for her shoulder issues prior to the accident. Accordingly, I find RN Khramtsova’s report to be unhelpful and unpersuasive.

47The Applicant’s reported use of a cane, knee brace, and arm sling to RN Khramtsova are not reflected anywhere else in the Applicant’s medical record. Specifically, the Applicant testified that Dr. Akladios recommended that she use a cane for ambulation, but that is not reflected in the CNRs, and is in contrast with the April 1, 2025 consultation note, which found that the Applicant had a normal gait. The Applicant’s reported cane use, documented in Dr. Getahun’s June 2, 2025 report, is also inconsistent with the surveillance evidence captured at that time. The surveillance evidence of June 10, 11, and 16, 2025 includes video of the Applicant taking her kids to school and grocery shopping. However, none of the video or images depict the Applicant using a cane for ambulation.

48I find that the Applicant has not demonstrated that she is impaired from completing her self-care tasks as a result of accident-related injuries. I reiterate my findings with respect to the Applicant’s claim for IRBs. Specifically, that her primary care physician does not endorse an ongoing accident-related disability anytime after December 2024, and that assessing practitioners such as Dr. Khan, concluded that the Applicant had no medical restrictions preventing her from engaging in her pre-accident activities. Moreover, Dr Khan, in the October 16, 2025 report, concluded that the Applicant did not require any ACBs and expressly stated that she is encouraged to engage in her housekeeping and self-care activities without restriction in an effort to build strength, tolerance, and work capacity.

49In addition to the above, I find that the Applicant has not demonstrated that she incurred ACBs as claimed. Pursuant to section 3(7)e of the Schedule, an expense is incurred when the insured person has received the services to which the expense relates, the insured has paid the expense or promised to pay it, and the person who provided the services did so in the course of their employment, occupation or profession in which they would ordinarily have been engaged, but for the accident, or that the service provider incurred an economic loss as a result of providing the services. In this case, the Applicant provided a hand-written note by “Claudia Day”, dated July 16, 2025. The note states that they provided the Applicant with assistance with childcare, housekeeping, grocery shopping, meal preparation, and personal support care “since July 2025”, which contradicts the Applicant’s testimony that she started receiving assistance in February 2025. In addition, the Applicant reported that she paid over $5,000.00 to the service provided but did not have any receipt or other document to corroborate her claims. Here, I have no information on the service provider’s qualifications and/or occupation, and no evidence to support the Applicant’s claim that she paid the service provider. Accordingly, I find that the Applicant has not demonstrated that she incurred ACBs pursuant to section 3(7)e of the Schedule.

50I decline to deem ACBs incurred, pursuant to section 3(8) of the Schedule. The Schedule provides that an expense can be deemed incurred if the Tribunal determines that the benefit was not incurred because the insurer unreasonably withheld or delayed payment of a benefit in respect of the expense. Here, there is no indication that ACBs were unreasonably withheld or delayed because the evidence does not support a finding that the Applicant is impaired from completing her activities of daily living. In addition, the August 13, 2025 letter from the Respondent to the Applicant states that the Respondent agreed to pay for all ACBs incurred during the period from the date of the letter, until the IE reports were issued to her, which occurred on October 27, 2025. Yet, the Applicant never submitted any expenses related to services incurred during that period.

51To me, it cannot be said that the Applicant is unable to complete her self-care tasks as a result of accident-related impairments. The only medical record or note endorsing ACBs stems from RN Khramtsova’s report, which is based on inaccurate and inconsistent reporting and holds no weight. On the other hand, the Applicant’s primary care physician, Dr. Akladios, did not endorse time away from work, or document an impairment with respect to her ability to complete her self-care tasks at any time after January 2025. Overall, I agree with Dr. Khan’s recommendation that the Applicant reengage in her pre-accident activities, such as her housekeeping and home maintenance and self-care activities, without restriction and in an effort to build strength, tolerance, and work capacity.

52Accordingly, I find that the Applicant has not demonstrated that ACBs are reasonable and necessary as a result of the subject accident.

The Applicant is not entitled to the medical and rehabilitation benefits claimed

53For the medical and rehabilitation benefits claimed, she must demonstrate that the plans in dispute are reasonable and necessary as a result of the accident.

$3,414.16 for a chiropractic treatment plan, dated March 25, 2025.

54I find that the Applicant has not demonstrated on a balance of probabilities that this plan is reasonable and necessary as a result of the accident.

55The Applicant claims that the chiropractic plan is reasonable and necessary because the treatment receives from it is useful for her condition and the exercises her chiropractor gives her help her with her pain flare ups. The chiropractic plan seeks funding for 18 one-hour chiropractic sessions, 18 one-hour massage therapy sessions, and a form fee. The plan was generated to address the following injuries: post-concussion syndrome, cervical disc disorder, lumbar disc disorder with radiculopathy, sprain and strain of the shoulder, and knee contusion.

56I find that the chiropractic and massage therapy plan addresses injuries that are not as a result of the accident. There is no indication in the medical evidence that the Applicant sustained a concussion as a result of the accident, yet this plan lists concussion treatment as the primary concern. Further, the plan lists radiculopathy as an issue, yet radiculopathy is not an accident-related issue reflected in the CNRs of the Applicant’s family physician. The Applicant has not directed me to any evidence to support a finding that she sustained a concussion in the accident or suffers from neurological impairments as a result of the accident, and that chiropractic and massage therapy is reasonable and necessary to treat those injuries.

57Accordingly, I find that the Applicant has not met her onus to demonstrate that this plan is reasonable and necessary as a result of the accident.

$2,740.25 for a chronic pain assessment plan, dated February 12, 2025

$2,873.03 for an attendant care assessment plan, dated April 8, 2025

$2,572.80 for an orthopaedic assessment plan, dated April 4, 2025

58I find that the Applicant has not met her onus to demonstrate on a balance of probabilities that these plans are reasonable and necessary as a result of the accident.

59The first plan seeks funding for a chronic pain assessment, a form fee, and interpretation services. The Applicant submits that this assessment is reasonable and necessary due to her multiple injuries which, she submits may involve nerve issues. The second plan seeks funding for an in-home assessment, form fees, as well as mileage and travel time fees. The Applicant did not address why the second assessment is reasonable and necessary. The third plan seeks funding for an orthopaedic assessment at $2,000.00, and other ancillary fees. The Applicant submits that the third assessment is reasonable and necessary to provide her with information on her condition in addition to her MRI reports.

60The Respondent denied funding for these assessments based on the December 9, 2024 report by Dr. Khan. It held that the Applicant’s pre-existing impairments were likely temporarily exacerbated as a result of the accident, and that the Applicant should gradually return to her pre-accident activities and duties.

61I find that the Applicant has not demonstrated on a balance of probabilities that chronic pain and orthopaedic assessments are reasonable and necessary as a result of the accident. This is because the Applicant met with an OHIP-funded pain specialist, Dr. Pirzada on January 16, 2025 to address ongoing neck and bilateral shoulder pain, and seek recommendations on how to deal with that pain. Dr. Pirzada administered nerve block injections and advised the Applicant to engage in a gradual progression of a ROM and core strength training. It would be an unnecessary duplication of services for the Applicant to engage in a second chronic pain assessment, or a similar orthopaedic assessment, as soon as a month after participating in an OHIP-funded pain assessment, which provided her with the treatment and recommendations she is looking to receive from engaging in the chronic pain and orthopaedic assessments.

62I find that the Applicant has not demonstrated that she suffers from an accident-related injury which causes a functional impairment or that her ongoing presentation warrants further investigation. The Applicant’s position is that the objective MRI evidence shows partial tears in her shoulder and degenerative changes in her neck and back. However, the MRIs do not depict a change in function which would warrant an attendant care assessment, and the MRI reports do not recommend further orthopaedic examination. The Applicant consulted with OHIP-funded specialists through her family physician and the overwhelming consensus is the Applicant is encouraged to be more active and engage in her pre-accident activities. Given that the Applicant has participated in the same or similar assessments, funded through OHIP, receives ongoing care from her family physician, and is encouraged to be more active, I conclude that ongoing assessments are not reasonable and necessary as a result of accident-related impairments.

63Accordingly, I find that the Applicant has not met her onus to demonstrate on a balance of probabilities that these plans are reasonable and necessary as a result of the accident.

Interest

64Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. Having found no benefits payable, it follows that no interest is payable.

Award

65Under section 10 of Regulation 664, 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.

66Here, I have found that the Applicant is not entitled to any overdue payment of benefits. Accordingly, no award is payable.

CONCLUSION AND ORDER

67The Applicant meets the test for IRBs for the period from June 25, 2024 to January 16, 2025. However, she has not demonstrated that she is entitled to payment for IRBs as she received employment insurance sickness benefits during the period of claim and these payments, once deducted from the IRBs payable, negate the Applicant’s claim.

68No ACBs are payable.

69That Applicant is not entitled to the plans in dispute.

70No interest or award is payable.