Citation: Pashalidis v. Unifund Assurance Company, 2026 ONLAT 24-008022/AABS

Licence Appeal Tribunal File Number: 24-008022/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:

Steven Pashalidis

Applicant

and

Unifund Assurance Company

Respondent

DECISION

ADJUDICATOR:

Tami Cogan

APPEARANCES:

For the Applicant:

Steven Pashalidis, Self-represented

For the Respondent:

Jaskiran Gill, Counsel

HEARD:

In Writing

OVERVIEW

1Steven Pashalidis, the applicant, was involved in an automobile accident on December 20, 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, Unifund Assurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2At the time the application was filed on June 26, 2024, and at the case conference, on November 19, 2024, the applicant was represented. The matter was set down for a written hearing and scheduled to be heard on August 1, 2025. On January 27, 2025, the applicant’s representative removed herself from the record and the applicant remains self-represented. On August 1, 2025, the applicant filed a request, for a nine-month adjournment, on consent. Due to inadvertence, the Tribunal did not process the request at the time. On January 29, 2026, the adjournment was granted, and the hearing was re-scheduled for May 1, 2026.

ISSUES IN DISPUTE

3The issues to be decided are:

1. 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?

2. Is the applicant entitled to the treatment plans/OCF-18s (“plan”) proposed by Integral Health Group, as follows:

i. $4,239.55 for psychological services, in a plan submitted June 26, 2023, and denied July 20, 2023;

ii. $344.10 ($2,608.99 less $2,264.89 approved) for chiropractic services, in a plan submitted January 23, 2023, and denied March 22, 2023;

iii. $1,839.48 ($3,022.47 less $1,182.99 approved) for chiropractic services, in a plan submitted April 3, 2023, and denied April 28, 2023; and

iv. $2,400.00 for a psychological assessment, in a plan submitted April 4, 2023, and denied April 14, 2023?

3. Is the applicant entitled to interest on any overdue payment of benefits?

4. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

RESULTS

4For the reasons that follow, I find:

1. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and therefore he is subject to treatment within the MIG limit.

2. The applicant is not entitled to the plans proposed by Integral Health Group.

3. No interest is owing.

4. The respondent is not liable to pay an award under s. 10 of Reg. 664.

PROCEDURAL ISSUES

Applicant’s Second Adjournment Request

5On April 25, 2026, the applicant filed his reply-submissions one day late, and also filed a request for a 30 to 60 days adjournment. The stated purpose of the adjournment was to permit time for the respondent to obtain a psychiatric assessment in reply to the evidence he submitted. The adjournment request was not on consent, and it was denied on May 5, 2026.

Applicant’s Non-compliance with CCRO and Respondent’s Request to Exclude Evidence.

6In its response dated April 17, 2026, the respondent submits that the applicant has not complied with the CCRO and any submissions “made beyond the limits outlined in the CCRO” should be disregarded. Also, that records located at Tabs 1-2, and 4-14 should not be given any weight due to the applicant’s non-compliance because they were not served at least 45 days prior to the hearing. It was unaware of the existence of these documents until they were filed with the applicant’s submissions on April 1, 2026, and this creates prejudice to the respondent because it did not know the case that must be met. The respondent does not have an opportunity to cross-examine the authors, and therefore the documents should be given no weight.

7The applicant submits that he did not receive proper guidance from the case management officer at the Tribunal, and without guidance he was limited in meeting procedural expectations. The applicant also submits that he did not inform the respondent he was obtaining a new assessment and documents because he does not trust them. The applicant did not provide any other reason for not serving the documents on the respondent earlier.

8The CCRO at paragraph 13 limits each party to a maximum of 10 pages. At paragraph 18 the CCRO required the evidence and authority briefs filed with the Tribunal to be double-spaced, indexed, bookmarked/tabbed and consecutively paragraph and page numbered. At paragraph 19, the CCRO states that the hearing adjudicator has the discretion to determine whether to consider submissions that do not comply with the Tribunal’s requirements. Further, pursuant to Rule 9.4.2 of the Licence Appeal Tribunal Rules 2023 (“the Rules”) the parties must disclose all documents that are being relied on at the hearing 45-days before the hearing, which in this case was March 17, 2026.

9I find that the respondent is not prejudiced by the formatting of the applicant’s materials because it has had the opportunity to respond and it did not seek leave to make extended submissions. For clarity; the applicant’s submissions included several parts, some of which are narrative in emails, and all are single spaced. For the August 1, 2025 hearing date, the applicant filed submissions in two parts. Then for the May 1, 2026 hearing date the applicant filed additional submissions in a third part. On April 25, 2026, the applicant filed his reply. Each part had its own document brief. He also filed a response and sur-reply (without leave) to the respondent’s motion of May 1, 2026. There are several documents submitted that by title and submissions, appear to be communication between the applicant and his former counsel, as well as his extended health care benefits provider, which are unrelated to the issues in dispute.

10I acknowledge that the applicant is self-represented and that he may not have been aware of the Rules. However, the applicant has acknowledged receiving his case file from his former counsel in July 2025, and I have not heard submissions that the applicant did not have the CCRO. Further, the applicant did attend the case conference during which the requirement to exchange documents and the timelines for doing so were discussed.

11I find that the applicant’s submission of fresh evidence in his third submission, which had not been previously disclosed to the respondent does cause prejudice to the respondent. It is clear from the dates on the documents that the applicant was in possession of them in advance of April 1, 2026, which was his deadline to file his submissions for the May 1, 2026 hearing date. Although he may not have been aware of the Rules, it is reasonable to expect the parties to provide their evidence to the opposing party in advance of presenting their evidence to the Tribunal.

12I find that the Divisional Court has been clear that evidence cannot be relied upon unless the opposing party has an opportunity, if they so choose, to challenge the evidence in cross-examination: see, for example, Vivekanantham v. Certas Direct Insurance Company, 2024 ONSC 6198 at paras. 62-68. I am granting the respondent’s request to give no weight to the documents contained in the applicant’s submissions and brief (Part 3); Tab 1, the s.25 psychiatric assessment report of Dr. Kia Azar dated December 12, 2025; Tab 2, a new letter in Support by Sydney Hildebrandt, written in February 2026; Tab 4, a Letter Explaining Graves Disease, from Dr. Vladimir Milosevic; Tab 5, list of Medications from 2022 to 2025; Tab 6, 7, 8 9, 10, 11, and 13, correspondence with Greenshield; Tab 12, statement for psychotherapy from 2025-2026; and Tab 14, statement for chiropractic from January 7, 2025 to February 24, 2026. By presenting these documents to the Tribunal without service to the respondent, the applicant has prevented it from knowing the case that it must meet, and responding accordingly.

Respondent’s Motion to Strike Reply Submissions or Leave to File Sur-Reply Submissions

13On May 1, 2026, the respondent filed a motion requesting the applicant’s reply submissions be struck, or in the alternative that the new evidence and related submission be struck. In the further alternative, the respondent sought leave to file a sur-reply to address the new evidence. The motion was ordered to be decided at the hearing.

14The respondent sought to have the applicant’s reply submissions struck because they were filed one day late, on April 25, 2026, and the applicant raised new arguments and introduced new evidence. In the alternative, the respondent seeks to have Tabs 4, 7, 10, and 11 excluded; along with submission paragraphs 3 – 7, and 12 – 13, struck. In the further alternative, the respondent seeks leave to file a sur-reply, the content of which is contained at paragraphs 42 – 50 of its notice of motion.

15The applicant objected to his reply submissions and evidence being struck or excluded, and submits that the respondent had the documents in their possession, and therefore no prejudice has been caused to the respondent. The applicant further submits that his submissions and evidence were in direct reply to the respondent’s submissions and were necessary to correct the record. The applicant also submits that the reply submissions was his “first real opportunity to present a complete case. He submits that “[He] was still gathering evidence and verifying it during the time of the written hearing.” The applicant did not object to the respondent filing a sur-reply, so long as his reply is not struck. The applicant continued to put forth submission on the substantive issues, in response to the respondent’s motion.

16The documents the respondent is requesting to be excluded are: Tab 4, the applicant’s father’s MyChart; Tab 7, Neurological Assessment report dated September 4, 2025, conducted by Dr. Jamsheed Desai, of the Mississauga Institute of Neurological Disorders and Strokes (“MINDS”); Tab 10, Letter dated April 1, 2026, of Dr. Bilal Al-Azawi, family physician; and Tab 11, Letter dated March 31, 2026, of Dr. Mike Skilby, chiropractor.

17Although the applicant submits the respondent had the documents in its possession, I did not hear submissions, nor did the applicant direct me to evidence to substantiate when the documents were provided to the respondent, and the respondent denied having received them. I agree that the applicant’s reply does not introduce new issues, however, I find that the applicant has submitted new documents, that ought to have been put forward in his submissions (and disclosed prior to filing his submissions), so that the respondent would have an opportunity to respond to the evidence. It is the applicant’s burden to prove his case in the first instance. The obligation is not on the respondent to request, or file documents that would assist the applicant. A reply should consist only of submissions; it is not a time to put forward new evidence. The time for gathering evidence has long since passed.

18The respondent’s request to strike the applicant’s reply submissions and exclude the additional evidence is denied. I grant leave to the respondent to file sur-reply submissions, and accept paragraphs 42 – 50 of their motion submissions for that purpose. I find that allowing the sur-reply mitigates the prejudice to the respondent.

ANALYSIS

MIG

19For the reasons that follow, I find the applicant’s injuries are predominately minor as defined by the Schedule, and he remains subject to the MIG funding limits for treatment.

20The applicant submits that he has sustained psychological injury as a result of the accident, which removes him from the MIG. The applicant relies on the Insurer’s Examination assessment reports of Ms. Cheryl Miller, clinical psychologist, report dated October 3, 2023; and Dr. Mohamed Lamine, general physician, report dated October 6, 2023. The applicant also relies on the diagnosis made by Mr. Mandeep Singh, during a psychological assessment on June 22, 2023, although the report is not in evidence. The report and diagnosis are referenced in Ms. Miller’s and Dr. Lamine’s reports.

21The respondent submits that the applicant has not met his burden of proof that he has sustained injuries that would remove him from the MIG.

22The MIG establishes a framework for the treatment of minor injuries. The term “minor injury” is defined in section 3(1) of the Schedule 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.” The terms “strain,” “sprain,” “subluxation,” and “whiplash associated disorder” are also defined in section 3(1). Section 18(1) limits recovery for medical and rehabilitation benefits for such injuries to $3,500.

23An 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.

Psychological Impairment

24Psychological impairments are not included in the minor injury definition. A finding that the applicant sustained psychological impairment as a result of the accident would permit him to seek treatment beyond the $3,500.00 funding limit provided by the MIG. An impairment is defined in s. 3(1) of the Schedule as a “loss or abnormality of a psychological, physiological or anatomical structure or function.”

25The insurer’s examination report of Dr. Lamine was an assessment to address entitlement to income replacement benefits. Dr. Lamine’s report references having reviewed the clinical notes and records of the applicant’s family physician, Dr. Thomas Cheung, dated January 10, 2023. These records are not in evidence, and only details of the accident are noted in Dr. Lamine’s report.

26In his report, Dr. Lamine provided a summary of the diagnosis, treatment and recommendations of Mr. Singh in his psychological assessment report;

i. Adjustment Disorder with Mixed Anxiety and Depressed Mood, Persistent;

ii. Major Depressive disorder, Single Episode, Severe;

iii. Somatic Symptom Disorder, with Predominant Pain, Persistent, Moderate;

iv. Specific Phobia, Situational Type.

27Dr. Lamine did not comment on the psychological information summarized. He opined that the applicant did not sustain an impairment as a result of the accident, and the injuries he did sustain were minor and have resolved. I find the EMG testing during the Neurological Assessment conducted by Dr. Desai, corroborated these physical findings. I find that Dr. Lamine’s report does not support that the applicant has an injury that falls outside of the MIG as a result of the accident.

28The psychological assessment conducted on September 5, 2023, by Ms. Miller was used in the production of two reports. One report for the entitlement of income replacement benefits, and the second report for the entitlement of a treatment plan proposed by Mr. Singh, as well as the applicability of the MIG.

29The applicant submits that Mr. Singh’s diagnosis should be preferred over Ms. Miller’s diagnosis. Again, Mr. Singh’s report is not in evidence, and all that is before me is a brief summary in the Insurer’s Examination assessors’ reports.

30I find that Ms. Miller’s report is more persuasive than the diagnosis of Mr. Singh because Ms. Miller’s report is the only psychological report fully in evidence, and Ms. Miller, is a clinical psychologist, who met in-person with the applicant to personally conduct the assessment. Therefore, I give her opinion more weight than the diagnosis of Mr. Singh. I give Mr. Singh’s diagnosis less weight because, according to Ms. Miller’s summary, Mr. Singh’s diagnosis is based on an assessment conducted virtually by Ms. Stacy Yong, psychotherapist, and I am unable to read the full report to understand on what objective evidence the diagnosis is based, or if Mr. Singh had met with the applicant himself.

31Ms. Miller opines that the diagnosis given by Mr. Singh is erroneous because the mechanism of the accident does not meet the DSM-5 threshold for a “traumatic event” that being “exposure to actual or threatened death, serious injury, or sexual violence” and therefore clinically and diagnostically he cannot be diagnosed with Post-Traumatic Stress Disorder (PTSD). I find Ms. Miller’s conclusions are persuasive because they are clearly explained and supported by the DSM-V. Ms. Miller opines that diagnostically speaking a person cannot suffer from both an Adjustment Disorder with Depressed Mood and Major Depressive Disorder at the same time.

32For her own conclusions, Ms. Miller relied on observations during the assessment as well as psychometric testing. The Modified Somatic Perceptions Questionnaire (MSPQ) and the SIMS test have imbedded validity testing. Based on the applicant’s results, Ms. Miller opined that he had over-reported his physical symptoms on the MSPQ, and on the SIMS test, he had embellished his psychological difficulties. Ms. Miller concluded that during the assessment the applicant did not exhibit any signs of distress or cognitive inefficiencies. Also, he did not articulate any symptoms suggestive of any mood disorder, anxiety disorder, adjustment disorder, or somatic symptom disorder. Ms. Miller opined that the applicant does not have any psychological condition which would take him out of the definition of a minor injury.

33I am persuaded by the reports of Ms. Miller and accept her opinion that the applicant does not have a psychological condition which would remove him from the MIG.

34The applicant submits that he was referred to Dr. Kia Azar, psychiatrist, by his family physician, and that Dr. Azar’s diagnosis supports Mr. Singh’s diagnosis. The applicant has not entered the records of his family physician into evidence, nor the report of Mr. Singh. The psychiatric assessment of Dr. Azar has been excluded from evidence as noted above due to its late service on the respondent. The applicant also submits that his diagnosis of Graves disease explains the psychometric testing results from Ms. Miller. I acknowledge Dr. Vladimir Milosevic, endocrinologist’s letter dated February 4, 2026, confirming the diagnosis of Graves disease. However, I find that the letter does not explain why the diagnosis would result in validity concerns with the psychometric testing. Submissions are not evidence and, without the documents to corroborate the submissions, I find the applicant has not met his burden of proof.

35Further, the applicant submits that his treating chiropractor, Dr. Mike Skibby, has provided a letter in support and concludes that the applicant’s injuries are non-minor, based on chronic pain and psychological barriers. I agree with the respondent that the diagnosis of chronic pain and psychological impairment are outside of the scope of a chiropractor. I have not been directed to evidence that would support that Dr. Skibby was relying on a qualified practitioner’s diagnosis in forming his opinion. Without corroborating evidence, I give the letter of Dr. Skibby no weight.

36Based on the evidence to which I have been directed, I find that the applicant has not proven on a balance of probabilities that he has sustained an injury that removes him from the MIG, and therefore, he remains subject to the MIG funding limit.

37The treatment and assessment plans in dispute propose treatment that falls outside the MIG. Thus, the applicant’s entitlement to them is contingent on a finding that his injuries are not included in the minor injury definition.

38I have found that the applicant’s injuries are predominately minor, and treatment is subject to the MIG limits. Given that the applicant remains within the MIG, it is not necessary to determine whether the treatment plans in dispute are reasonable and necessary.

Interest

39As there is no overdue payment of benefits, the applicant is not entitled to interest pursuant to section 51 of the Schedule.

Award

40Under s. 10 of O. Reg. 664, the Tribunal may award up to 50% of the total benefits payable if it determines that the insurer unreasonably withheld or delayed the payment of benefits.

41The applicant submits that he has not been treated fairly by the respondent. He directed me to emails between himself and his former counsel, as well as his extended health care benefits provider, and opposing counsel. He submits that the insurer ignored the diagnosis of Mr. Singh in favour of its own psychological assessor Ms. Miller.

42The respondent submits that the claim has been adjusted fairly, and there have been no unreasonably withheld or delayed payment of benefits, therefore, no award is owing.

43Above I have explained my reasons in finding that Ms. Miller’s conclusion, upon which the respondent relied when maintaining its position on MIG, is persuasive. In consideration that the applicant remains in the MIG, I find that the respondent has not unreasonably withheld or delayed the payment of benefits.

44The applicant has not proven on a balance of probabilities that an award under s. 10 of Reg. 664 is owing.

CONCLUSION AND ORDER

45For the reasons above, I find:

i. The applicant remains subject to the minor injury guideline.

ii. The applicant is not entitled to the proposed treatment plans.

iii. No interest or award are owing.