Chavan v. Unifund Assurance Company, 2026 CanLII 8149

Citation: Chavan v. Unifund Assurance Company, 2026 ONLAT 24-007123/AABS

Licence Appeal Tribunal File Number: 24-007123/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:

Kanchan Chavan

Applicant

and

Unifund Assurance Company

Respondent

DECISION

ADJUDICATOR: Timothy Porter

APPEARANCES:

For the Applicant: Serena Rhyman, Paralegal

For the Respondent: Raman Pandher, Counsel

HEARD: In Writing

OVERVIEW

1Kanchan Chavan, the applicant, was involved in an automobile accident on December 11, 2020, 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.

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 a non-earner benefit of $185.00 per week from January 11, 2021, to December 11, 2022?

iii. Is the applicant entitled to $3,747.44 for physiotherapy services, proposed by Midland Wellness Centre in a treatment plan/OCF-18 (“plan”) dated April 15, 2024?

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

RESULT

3I find that the applicant has not met her onus to prove, on a balance of probabilities, 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.

4The applicant has not met her onus to prove entitlement to an NEB. I find, on a balance of probabilities, that the applicant does not suffer a complete inability to carry on a normal life.

5As the applicant remains within the MIG, and the funds remaining within the MIG are insufficient to support the proposed treatment plan, there is no need to explore whether the plan is reasonable and necessary.

6No interest is due.

ANALYSIS

Minor Injury Guideline (MIG)

7I find that the applicant has not met her onus to prove, on a balance of probabilities, that her pre-existing conditions have been exacerbated by the subject accident.

8Section 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.”

9An 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.

10The applicant submits that her pre-existing conditions of diabetes, osteoarthritis, obesity, high blood pressure and back pain have been exacerbated by the subject accident and as a result she should be removed from the confines of the MIG. The applicant relies on her submission and the clinical notes and records (“CNRs”) of Dr. Alireza Semsar, family doctor.

11Dr. Semsar does not opine that the applicant requires treatment outside the confines of the MIG due to her pre-existing conditions. The applicant points to the CNRs of Dr. Alireza Semsar in support of her claim. Diabetes is diagnosed by Dr. Semsar. However, Dr. Semsar does not opine that the applicant’s diabetes or any other pre-existing condition is exacerbated by the subject accident or that these pre-existing conditions would preclude maximum medical recovery if treated within the MIG.

12I have not been pointed to any other contemporaneous or compelling evidence of the applicant’s pre-existing conditions precluding recovery if she is kept within the confines of the MIG.

13Taken together, I find the applicant has not met her onus to prove, on a balance of probabilities, that her pre-existing conditions prevent her recovery if she were kept within the MIG. The applicant remains within the MIG.

Non-Earner Benefit (NEB)

14I find, on a balance of probabilities, that the applicant does not suffer a complete inability to carry on a normal life.

15Section 12(1) provides that an insurer shall pay an NEB to an insured person who sustains an impairment as a result of the accident if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391, which, generally, focuses on a comparison of the applicant’s pre- and post-accident activities.

16Applicant submits that fatigue, anxiety and dizziness prevent her from being fully present for activities such as cooking and sleeping. The applicant relies on her submissions and the CNRs of Dr. Alireza Semsar.

17Dr. Semsar’s CNRs do not demonstrate a complete inability to carry on a normal life. The applicant first visits her family doctor following the subject accident on January 21, 2021; there is no mention of the subject accident. The applicant has subsequent visits on March 22, 2021, May 3, 2021, May 17, 2021, June 7, 2021, August 10, 2021, without any mention of the subject accident. The first mention of the subject accident is February 7, 2022, almost 14 months subsequent to the accident; this reference is a summary which includes statements that suggest sleep disturbance and dizziness have gradually gotten better. The next reference to the subject accident is January 25, 2024, when the applicant relates that she has mild leg and low back pain following her accident. The applicant’s reports of insomnia, dizziness, anxiety and vision issues are not related by Dr. Semsar to the subject accident. In my mind, the CNRs of Dr. Semsar do not describe an applicant that suffers a complete inability to carry on normal life, there are significant gaps in treatment, few mentions of the subject accident and the symptoms related and subsequent investigations do not suggest impairments that continuously prevent the applicant from engaging in substantially all of the activities in which the applicant ordinarily engaged before the accident.

18I have not been pointed to any other contemporaneous evidence of the applicant’s symptoms or functional limitations.

19The applicant has not met her onus. I find, on a balance of probabilities, that the applicant does not suffer a complete inability to carry on a normal life.

20Given that I have determined that the applicant remains within the MIG, she is entitled to treatment up to the MIG limits. At the time of submission there were some funds remaining within the MIG; however, as the applicant remains within the MIG, and the funds remaining within the MIG are insufficient to support the proposed treatment and assessment plan, there is no need to explore whether the plans are reasonable and necessary.

Interest

21As no benefits are owing, no interest is due.

ORDER

22The applicant remains in the MIG.

23The applicant is not entitled to a NEB.

24The applicant is not entitled to any of the treatment plans in dispute.

25No interest is due.