Sidhu v. Wawanesa Mutual Insurance Company, 2026 CanLII 8138

Citation: Sidhu v. Wawanesa Mutual Insurance Company, 2026 ONLAT 24-007411/AABS

Licence Appeal Tribunal File Number: 24-007411/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:

Parmpal Sidhu

Applicant

and

Wawanesa Mutual Insurance Company

Respondent

DECISION

ADJUDICATOR: Brian Norris

APPEARANCES:

For the Applicant: Harry Steinmetz, Counsel

For the Respondent: Harkamal Hehar, Counsel

HEARD: By way of written submissions

OVERVIEW

1Prampal Sidhu ("the Applicant") was involved in an automobile accident on March 16, 2021, and sought benefits from Wawanesa Mutual Insurance Company ("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. Are the Applicant's injuries predominantly minor injury as defined in section 3 of the Schedule and therefore subject to treatment within the Minor Injury Guideline ("MIG") and the $3,500.00 funding limit for a minor injury?
2. Is the Applicant entitled to a medical benefit in the amount of $2,686.00 for psychological services, proposed by Elite Specialist Group in a treatment plan/OCF-18 ("plan") dated September 29, 2022?
3. Is the Applicant entitled to income replacement benefits ("IRBs") in the amount of $400.00 per week for the period from February 7, 2023 to-date and ongoing?
4. Is the Applicant entitled to interest on any overdue payment of benefits?

RESULT

3The Applicant sustained a minor injury as a result of the accident. She is subject to the MIG and the $3,500.00 funding limit for a minor injury.

4The Applicant is not entitled to the psychological plan in dispute because it proposes goods and services that fall outside the MIG and beyond the $3,500.00 funding limit for a minor injury.

5No IRBs are payable.

6No interest is payable.

7The application is dismissed.

BACKGROUND

8The Applicant was the driver of a vehicle which was struck on the driver's side while proceeding through an intersection. She reports that police and ambulance attended at the scene of the accident, but she was not taken to hospital and instead went to the collision reporting centre via tow truck. She followed up with her family physician, Dr. J. Sandhu, a few days later, on March 19, 2021, with complaints of neck and shoulder pain. The Applicant was prescribed pain medication and referred to physiotherapy to treat her accident-related injuries.

9The Applicant submits that she has developed low back pain following the accident, which now impairs her functionality. To the Applicant, her pain is chronic and not a minor injury. The Applicant also submits that she has experienced psychological symptoms following the accident, warranting a psychological assessment.

10The Respondent disagrees and submits that the Applicant's accident-related impairments fall within the definition of a minor injury, and that her psychological complaints are not as a result of the accident.

11For the following reasons, I find on a balance of probabilities that the Applicant sustained a minor injury as a result of the accident and is not entitled to IRBs.

ANALYSIS

Minor Injury Guideline ("MIG")

12The MIG establishes a treatment framework available to injured persons who sustain a minor injury as a result of an accident. A "minor injury" is defined in the Schedule and includes sprains, strains, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. The MIG provides that a strain is an injury to one or more muscles and includes a partial tear. Under section 18 of the Schedule, injuries that are defined as minor are subject to a $3,500.00 funding limit on treatment.

13The onus is on the Applicant to demonstrate that she sustained an injury that is not included in the minor injury definition outlined in section 3 of the Schedule.

14For the following reasons, I find that the Applicant has not demonstrated that she sustained an injury in the accident that is not included in the minor injury definition.

Chronic pain condition

15I find that the Applicant has not met her onus to demonstrate on a balance of probabilities that she suffers from a chronic pain condition as a result of the accident.

16Chronic pain conditions are not included in the minor injury definition. To demonstrate that she has a chronic pain condition, the Applicant should provide evidence that her pain causes a functional impairment which adversely affects her well-being, or that she meets the criteria for chronic pain according to the American Medical Association Guides to the Evaluation of Permanent Impairment (the "AMA Guides"). While it is not part of the Schedule, the Tribunal has generally accepted the AMA Guides when assessing whether a person suffers from a chronic pain condition. To meet the criteria, the person must demonstrate that they likely meet three of the following six criteria: withdrawal from social milieu (including work, recreation, or other social contracts); use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances; development of psycho-social sequalae after the initial incident; excessive dependence on healthcare providers, spouse, or family; secondary physical deconditioning due to disuse; and a failure to restore pre-injury function after a period of disability.

17I find that the Applicant does not meet the criteria for a chronic pain condition, as outlined in the AMA Guides. The Applicant has led no evidence indicating a withdrawal from social milieu. There are no reports that she no longer engages in social activities. She was not working at the time of the accident and reports that she has not returned since. There is no indication that the Applicant is abusing drugs or using them beyond the recommended duration. The Applicant sees her family physician infrequently, which is not suggestive of a dependence on healthcare providers. No assessor has opined that the Applicant's muscles have atrophied or deconditioned due to disuse.

18I find that the Applicant's psychological symptoms are minimal and do not rise to a level that impairs the Applicant. The Applicant complained of low mood, anxiety symptoms, and poor sleep during the assessment with Dr. Z. Waseem, physiatrist, in the report dated May 21, 2025. However, none of the CNRs before me indicate that the Applicant mentioned these psychological symptoms to her family physician. Moreover, the Applicant was assessed by C. Miller, psychological associate, who issued an insurer's examination report, dated August 22, 2022. Psychological associate Miller concluded that the Applicant was not experiencing any psychological condition as a result of the accident. In the report, it was noted that the Applicant is independent in performing her personal care activities, many of her housekeeping chores, continues to visit the park with her children, and continues to drive. Psychological associate Miller concluded that such a degree of functioning would contraindicate substantial psychological distress.

19The Applicant's family physician's CNRs do not suggest that the Applicant suffers from a chronic pain condition. The Applicant produced CNRs from both family physician clinics she attends, for the period pre-dating the accident to June 2023. However, there are no accident-related visits to either clinic after August 26, 2021, when the Applicant complained of pain in the neck, shoulders, and back, and that the pain radiates down both arms and legs, and the Applicant was advised to engage in physiotherapy following that meeting. The Applicant has not made any accident-related complaints to her family physicians for the period from August 26, 2021, at least until June 2023, when the CNRs were disbursed, and possibly beyond that date since records for the subsequent period are not in evidence. In addition to the lack of accident-related complaints, the Applicant has not made any complaints of a neurological impairment, and the IE report of Dr. M. Lamine, general practitioner, dated August 15, 2022, found a grossly normal neurological examination and no potential neurological impairment on assessment.

20I prefer the IE report of Dr. Lamine, dated August 15, 2022, over the report by Dr. Z. Waseem, physiatrist, dated May 21, 2025. Dr. Lamine observed that the Applicant exhibited full and pain free ROM in the lower extremities, and that she did not report any limitations in her activities of daily living ("ADLs"), self-care tasks, or household chores. On assessment, Dr. Lamine noted that the Applicant reported some mild tenderness to palpation of the back, and right foot, mild pain in the hip, but otherwise had a grossly normal musculoskeletal and neurological examination. In conclusion, Dr. Lamine found no objective accident-related musculoskeletal or potential neurological impairment on assessment and concluded that the Applicant met the definition of a minor injury. Dr. Lamine's findings are consistent with the CNRs from the Applicant's family physicians, which include no radicular or neurological complaints after August 26, 2021.

21The May 21, 2025 report by Dr. Waseem is less persuasive than Dr. Lamine's report because Dr. Waseem overstates the Applicant's accident-related impairments. Dr. Waseem concluded that the Applicant suffers from chronic pain in the form of chronic discogenic lower back pain with irritation of the lumbar spine nerve root consistent with right L5 radiculitis. Yet, as noted, there is no record indicating the Applicant visited a family physician since August 26, 2021, and no indication in those records that the Applicant exhibited neurological or radicular symptoms as a result of the accident. Dr. Waseem notes that the Applicant has reduced ROM in her low back of about 5-10°, which is characterized as a functional impairment. This is inconsistent with Dr. Lamine's examination, who observed full ROM and no functional impairment, consistent with the Applicant's lack of complaints of any functional impairment to her healthcare providers after 2021. On examination, Dr. Waseem noted a minor reduction in low back ROM, and increased pain with repetitive flexion, and concluded these issues are unlikely to resolve because they persistent over the four years following the accident. Dr. Waseem does not adequately bridge the gap between the Applicant's complaints in 2021 and the present assessment nearly four years later to corroborate that the symptoms have been persistent for four years. I find it unlikely to be the case considering the lack of pain complaints since August 26, 2021, and no other records were provided to corroborate ongoing pain following the accident.

22Accordingly, I find that the Applicant has not developed a chronic pain condition as a result of the accident.

Psychological impairment

23I find that the Applicant has not demonstrated that she suffers from a psychological impairment as a result of the accident.

24When assessing the Applicant's psychological function, I give no weight to Dr. Waseem's report of psychological symptoms. The Applicant tendered no submissions on the issue, but directed me to Dr. Waseem's report, which notes that the Applicant has been experiencing symptoms of mood disturbance and generalized anxiety. The psychological symptoms noted are not supported by or referred to in the other medical evidence. In fact, there are no details of mood or anxiety issues in Dr. Waseem's report to corroborate the fundings.

25Having never address any psychological symptoms with her family physician, combined with the unsubstantiated opinion by Dr. Waseem, I conclude that the Applicant has not suffered from a psychological injury which is not sequalae of her soft-tissue injuries.

26Accordingly, I find that the Applicant has not demonstrated that she sustained an injury that is not included in the definition of a minor injury. Thus, I conclude on a balance of probabilities that she is subject to the MIG and the $3,500.00 funding limit for a minor injury.

27The treatment plan dated September 29, 2022 proposes goods and services that fall outside of the MIG and the $3,500.00 funding limit for a minor injury. Having concluded that the Applicant is subject to the MIG and the $3,500.00 funding limit, it follows that she is not entitled to the plan in dispute.

Income replacement benefits ("IRBs")

28I find that the Applicant has not met her onus to demonstrate entitlement to IRBs for the period claimed.

29To be eligible for IRBs, the Applicant must demonstrate on a balance of probabilities that she suffers a substantial inability to complete the essential tasks of her employment as a packager in a warehouse. To demonstrate this, the Applicant should provide a clear description of her employment and the essential tasks it involves and explain how her accident-related injuries prevent him from completing those tasks.

30The eligibility test for IRBs becomes more stringent after 104 weeks following the accident. To qualify for IRBs after 104 weeks from the accident, the Applicant must demonstrate that she suffers a complete inability to engage in any employment or self-employment for which she is reasonably suited by education, training, or experience, pursuant to section 6(2)(b) of the Schedule.

31To determine the Applicant's essential tasks of employment, I rely on the Physical Demands Analysis report by Dr. J. Ikonomakis, chiropractor, dated December 13, 2022. The Assessment by Dr. Ikonomakis included a direct interview with the Applicant and a review of her medical records, as well as reference to the National Occupation Classifications and the Dictionary of Occupational Titles. Dr. Ikonomakis concluded that the Applicant's pre-accident employment included filling containers and bottles with various products, sealing the containers, and boxing up the product. She was permitted to sit during her entire shift and was not required to lift the boxes of product. Dr. Ikonomakis considered this work to be sedentary work. Dr. Ikonomakis' assessment of the Applicant found that she is capable of performing the essential tasks of sedentary employment. The Applicant demonstrated an ability to sit for 75 minutes and stand for approximately 45 minutes during the assessment. She was observed to walked with a normal gait and carry 10 pounds.

32The Applicant relies solely on Dr. Waseem's May 21, 2025 report, which I maintain is less persuasive than the IEs. As previously discussed, Dr. Waseem's assessment findings are an outlier when compared to the other assessments, and the lack of complaints by the Applicant to her family physicians. As noted, Dr. Waseem observed minor functional impairments in her low back, which are not repeated elsewhere, and concluded that they would cause a substantial inability to complete the essential tasks as a packager in a warehouse.

33I place the greatest weight on the report of Dr. R. J. Zabieliauskas, physiatrist, dated January 19, 2023, because it is consistent with the balance of the Applicant's medical records. During the assessment with Dr. Zabieliauskas, the Applicant was able to sit through the examination with no overt signs of discomfort. She demonstrated full ROM in her neck and did not report pain with movements, and only reported some tenderness with palpation. The Applicant demonstrated full ROM of her back with no reports of pain on motion or palpation, and the remainder of her body was exhibited full ROM without issue. Dr. Zabieliauskas concluded that the Applicant's current symptoms are not manifesting themselves in any overt organic pathology suggestive of any physical impairment of physical disability attributable to the accident. Dr. Zabieliauskas opined that it is safe for the Applicant to resume her previous employment duties without any physical restrictions or functional limitations.

34Lastly, I note that there is no evidence indicating that the Applicant is impaired from completing the essential tasks of her employment due to psychological injuries. Dr. Miller, in the paper review report, dated December 6, 2022, found no objective evidence of an accident-related psychological impairment. In the report, Dr. Miller noted that the Applicant did not articulate experiencing any psychological disability as a direct result of the accident and is capable of performing tasks of employment.

35Overall, I find that the evidence demonstrates that the Applicant does not suffer a substantial inability to complete the essential tasks of a warehouse packager. Accordingly, I find that she has not met her onus to demonstrate entitlement to IRBs for the period claimed.

Interest

36Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. Having found no benefits payable, it follows that no payments went overdue, and no interest is payable.

CONCLUSION AND ORDER

37The Applicant sustained a minor injury as a result of the accident. She is subject to the MIG and the $3,500.00 funding limit for a minor injury.

38The Applicant is not entitled to the psychological plan in dispute because it proposes goods and services that fall outside the MIG and beyond the $3,500.00 funding limit for a minor injury.

39No IRBs are payable.

40No interest is payable.

41The application is dismissed.

Released: February 3, 2026

__________________________

Brian Norris

Adjudicator