L.F. v. Unifund Assurance Company, 2017 CanLII 148393

Tribunal File Number: 16-001020/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:

L.F.

Applicant

and

Unifund Assurance Company

Respondent

DECISION

PANEL:

Catherine Bickley, Adjudicator

APPEARANCES:

For the Applicant:

Vikram Bhandari, Counsel

For the Respondent:

Courtney Madison and Eric Grossman, Counsel

HEARD:

In Writing on: November 28, 2016

OVERVIEW

1. The applicant, L.F., was injured in an automobile accident on August 10, 2015. She sought benefits from the respondent, Unifund Insurance Company (“Unifund”), pursuant to the provisions of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”).

2. In this application, L.F. appeals Unifund’s denial of $209.61 in weekly income replacement benefits (“IRBs”) from August 18, 2015 to date and ongoing (less amounts paid). She also appeals the denial of two treatment plans: the first seeks $2,000.00 for a social emotional assessment; the second seeks $576.00, the balance of a partially approved functional abilities evaluation. L.F. seeks interest on any overdue payment of benefits.

3. Unifund submits that L.F. does not meet the legal test for receipt of IRBs. In the alternative, Unifund argues that L.F. should not receive IRBs for the period between April 21, 2016 and July 18, 2016 because she failed to attend three s.44 examinations (“IEs”). Unifund further submits that the two denied treatment plans are not reasonable and necessary.

4. I find that L.F. is entitled to IRBs from August 18, 2015 to date and ongoing with the exception of the period between April 21, 2016 and July 18, 2016. Her entitlement is subject to adjustment for amounts already paid by Unifund. I also find that L.F. is not entitled to either of the treatment plans in dispute. Interest is payable on the IRBs.

5. In reaching these decisions, I have considered the parties’ written submissions (including the respondent’s addendum) and attached evidence.

ISSUES

i. Is L.F. entitled to receive a weekly IRB in the amount of $209.61 per week for the period August 18, 2015 to date and ongoing?

ii. Is L.F. entitled to a medical benefit in the amount of $2,000.00 for a social emotional assessment set out in a treatment plan (OCF-18) dated November 30, 2015 recommended by Dr. Mehdi Lotfalizadeh of Pain Management and Mental services Ltd?

iii. Is L.F. entitled to a medical benefit in the amount of $576.00 for a functional abilities evaluation, the balance of a partially approved treatment plan (OCF-18) dated December 15, 2015, recommended by Dr. Justin Guy of Assess Medical Diagnostics Inc.?

iv. Is L.F. entitled to interest on any overdue payment of benefits?

RESULT

i. L.F. is entitled to weekly IRBs of $209.61 from August 18, 2015 to date and ongoing. She is not entitled to IRBs from April 21, 2016 and July 18, 2016. Her IRB entitlement is subject to adjustment for amounts already paid by Unifund.

ii. L.F. is not entitled to a medical benefit in the amount of $2,000.00 for a social emotional assessment set out in a treatment plan (OCF-18) dated November 30, 2015 recommended by Dr. Mehdi Lotfalizadeh of Pain Management and Mental Services Ltd.

iii. L.F. is not entitled to a medical benefit in the amount of $576.00 for functional abilities evaluation, the balance of a partially approved treatment plan (OCF-18) dated December 15, 2015, recommended by Dr. Justin Guy of Assess Medical Diagnostics Inc.

iv. L.F. is entitled to interest on the IRBs.

ANALYSIS AND DECISION

Credibility

6. I have concerns about L.F.’s credibility. Before considering the issues in dispute, I will address the basis for these concerns. I have rejected or given little weight to evidence submitted in support of some elements of L.F.’s application. I have concluded, however, that credible evidence supports other elements of her application.

7. My concerns about L.F.’s credibility arise, in part, from the lack of evidence supporting her not attending three IEs. Her representatives told Unifund that she could not attend IEs in late March 2016 and April 2016 because she needed to be out of the country due to the recent death of her mother.¹

8. Unifund points out that L.F. is recorded as stating in December 2015 that both her parents were deceased.² This raises obvious credibility concerns. If the 2015 note that L.F.’s mother had died sometime before December 2015 was inaccurate, I would have expected L.F. to have addressed that error in her submissions yet she made no reference to this seeming contradiction in either her initial submissions or in her reply.

9. Unifund repeatedly requested documents to confirm that L.F. was out of the country in March 2016 and April 2016. Her counsel agreed in a July 19, 2016 letter and at the September 27, 2016 case conference to produce supporting documents.³ L.F. has not produced these documents and has not explained her failure to do so.

10. L.F. also did not produce a Decoded OHIP Summary (“OHIP Summary”) despite her counsel advising Unifund in December 2015 that one had already been requested.⁴ Unifund sent a cheque to L.F.’s counsel that same month to cover the cost of the OHIP Summary.⁵ L.F. did not produce the OHIP Summary at any time up to the date of this hearing, despite agreeing to do so at the September 27, 2016 case conference.⁶ At one point, L.F.’s counsel referenced a six to nine month timeframe to obtain an OHIP Summary. That timeframe would have elapsed prior to October 26, 2016 (when L.F.’s initial submissions were due) if the OHIP Summary was requested in or before December 2015. L.F. has provided no explanation for not producing the OHIP Summary. Unifund requests that I draw an adverse inference from this failure to produce a relevant document.

11. Unifund also points to the absence of any record of L.F.’s psychiatric treatment at Wellness Centre. This treatment had been approved by Unifund in December 2015.

12. In asking that I draw an adverse inference due to L.F.’s failure to produce relevant documents, Unifund relies on the Supreme Court of Canada’s decision in Levesque for the proposition that when a party fails to bring forward favourable evidence of treatment, “a Court must presume that such evidence would adversely affect her case.”⁷

13. L.F. does not respond to Unifund’s argument on this point in any meaningful way. She submits only that Unifund’s argument is based on “a variety of inconsequential reasons unrelated to the Claimant’s true entitlement to medical and income replacement benefits.”⁸ I disagree. The failure to produce documents confirming the claimed reason for non-attendance at three IEs is not inconsequential. Nor is the failure to produce the OHIP Summary despite representing that it had been ordered long before the hearing.

14. It appears that some records are not available due to circumstances beyond L.F.’s control, i.e., because Wellness Centre apparently closed in February 2016.⁹ I draw no adverse inference with respect to the failure to produce those records. In contrast, I draw an adverse inference from L.F.’s failure to produce the travel documents and the OHIP Summary. In the complete absence of any explanation for this failure, I conclude that either these documents do not exist or they do not support L.F.’s position.

15. L.F.’s lack of credibility with respect to her reason for not attending the March 2016 and April 2016 IEs, combined with her failure to produce other relevant documents, raises concerns about her overall credibility. As a result, to the extent that clinical notes, reports and diagnoses are based on L.F.’s subjective description of her symptoms, I have given them little weight unless the evidence provides other indicia of their reliability.

L.F. is entitled to IRBs

16. Unifund initially paid weekly IRBs of $209.61 to L.F. As noted above, Unifund stopped IRB payments when L.F. failed to attend three IEs in March 2016 and April 2016. After L.F. attended IEs in August 2016, Unifund then denied IRBs entitlement based on reports from the IE doctors.

17. To determine whether L.F. is entitled to IRBs, I must first identify the essential tasks of her pre-accident employment and then determine whether she is substantially unable to perform those essential tasks as a result of the August 10, 2015 accident. If L.F. is entitled to IRBs, I must then decide whether she is disentitled to IRBs between April 21, 2016 and July 18, 2016 because she failed to attend three IEs.

The essential tasks of L.F.’s employment

18. At the time of the accident, L.F. had been working for [“PHCS”] as a personal support worker (“PSW”) since April 13, 2015 (about four months). Her employment status was casual with variable hours of work from week to week.

19. L.F. submits that the work of a PSW is “physically demanding and requires full functional and mental capacity”¹⁰. She highlights the following tasks from her job description:

a) provide personal care and homemaking and related Activities of Daily Living (ADL);

b) provide companionship, emotional support, respite/palliative care or childcare;

c) provide personal care including assisting the client in stabilization with sitting, standing, or walking;

d) assisting with dietary management, homemaking support essential to the client’s health and wellbeing; and,

e) observing the client’s condition on an ongoing basis.

20. Unifund characterizes the essential tasks of L.F.’s employment as “generally to observe clients and ensure their safety”¹¹. It comments that she may also be called on for assistance with self-care and meal preparation.

21. I find that the essential tasks of L.F.’s pre-accident employment included some physical demands, particularly when lifting or assisting clients to transfer. I also find that L.F.’s pre-accident employment required some level of focus and concentration and the provision of emotional support to her clients.

L.F. is substantially unable to perform the essential tasks of her pre-accident employment as a result of the August 10, 2015 accident

22. I conclude that L.F. has established that she is substantially unable to perform the essential tasks of her pre-accident employment as a result of the August 10, 2015 accident. I make this finding based on her psychological impairments and not her physical impairments. I find that L.F. has not met her onus to establish that her post-accident physical impairments are as a result of the August 10, 2015 accident rather than sequelae of her 2007 accident and the related March 2015 surgery. I find, however, that she has established that her post-accident psychological impairments render her substantially unable to perform the essential tasks of her pre-accident employment.

Physical impairment

23. L.F. injured her right shoulder in a 2007 accident¹². The parties disagree about the extent to which L.F.’s pain and impairment from the 2007 shoulder injury had improved prior to the August 2015 accident. L.F. takes the position that her pain and impairment had 95% resolved¹³ or totally resolved.¹⁴ Unifund disagrees that L.F. had substantially recovered by August 2015.

24. The clinical notes and records (“CNRs”) of L.F.’s family doctor¹⁵ document persistent pain in her right shoulder from the time of the 2007 accident until March 2015 when Dr. Michael McKee performed the following surgery¹⁶:

a) Excision of arthritic right distal clavicle

b) Right anterior acromioplasty

c) Right subacromial bursectomy

d) Repair of right rotator cuff tear.

25. I am not convinced, on the evidence before me that L.F. had fully recovered from her 2007 injury and the effects of the March 2015 surgery at the time of the August 2015 accident. Her family doctor’s CNRs show continued and significant pain following the March 2015 surgery. The April 29, 2015 CNRs record that L.F. was experiencing right shoulder pain with difficulty rotating and adducting, that she was relying on Oxycocet, Tylenol and Advil for relief, and that she had been off a “school placement” from April 13 to 28, 2015. This was L.F.’s last visit to her family doctor before the accident.

26. Further, a May 6, 2015 letter to L.F.’s family doctor from the surgeon, Dr. McKee, noted that there was still significant pain in L.F.’s right shoulder. He summarized her limitations as follows:

She has stiff range of motion around the shoulder with abduction and forward elevation, both limited to about 30 degrees. She has significantly limited external rotation and can only external rotate to neutral and her internal rotation is also quite limited with about 30 degrees of internal rotation.

27. Dr. McKee also noted in the May 6, 2015 letter that L.F. had not been involved in any physiotherapy and was “somewhat behind in her expected postoperative course”. He recommended “aggressive physiotherapy”.¹⁷

28. L.F. did not visit her family doctor between April 29, 2015 and August 12, 2015 (two days after the accident). There is no indication that L.F. received any of the physiotherapy recommended by Dr. McKee.

29. L.F. submits that her right shoulder pain “eventually resolved, her range of motion was restored and she was able to execute the physical demands of her employment.”¹⁸ The only supporting evidence she provides is an August 19, 2015 note in her family doctor’s CNRs that the March 2015 surgery “improved and resolved her shoulder limitation”¹⁹. As L.F. did not visit her family doctor between April 29, 2015 and August 12, 2015, that information appears to be based on her self-report rather than any medical finding by her family doctor. Due to the concerns about L.F.’s credibility noted above, I give little weight to this evidence.

30. Given that L.F. was still experiencing significant pain in May 2015 (two months post-surgery and three months before the accident) it seems unlikely that she had totally recovered by the time of the accident. L.F. did not provide any information specifying when her right shoulder pain resolved other than that it was prior to the August 2015 accident. She apparently still had significant pain in May 2015 but, she submits, none by August 2015. Her family doctor and Dr. Getahun relied on her self-reports of improvement. In light of my concerns about L.F.’s credibility, I give little weight to these self-reports.

31. While objective testing confirms that after the August 2015 accident L.F. had some restrictions in her right shoulder range of motion, she had similar if not greater restrictions two months after her March 2015 shoulder surgery. There is no credible evidence that those restrictions had resolved at the time of the accident. In addition, at the time of Dr. McKee’s May 6, 2015 letter, L.F. had returned to work and was working about 20 hours per week.²⁰

32. Although L.F. has some restricted range of motion in her right shoulder, I am not convinced that it is as a result of the August 2015 accident. She had significant pain and restricted range of motion following the March 2015 surgery on her shoulder. She was nonetheless able to work at her pre-accident employment. Her assertions that all her shoulder issues had either 95% or totally resolved prior to the August 2015 accident are simply not credible. Further, there is a period of several months for which there is no evidence of ongoing treatment.

33. Following the August 2015 accident, L.F. did not visit her family doctor at all for more than 11 months. She has failed to produce an OHIP Summary and, as noted above, I have drawn an adverse inference from that failure. In addition, an x-ray of L.F.’s right shoulder in October 2015 showed no evidence of impairment other than structural changes as a result of the March 2015 surgery.²¹

34. For all of these reasons, I find that L.F. is not substantially unable to perform the essential duties of her pre-accident employment due to physical impairment resulting from the August 2015 accident. I turn now to consideration of whether L.F. is substantially unable to perform the essential duties of her pre-accident employment due to psychological impairment resulting from the August 2015 accident.

Psychological impairment

35. The parties’ experts agree that L.F. has experienced some psychological impairment as a result of the August 2015 accident. They disagree on the severity of the impairment and the extent to which it affects L.F.’s ability to perform the essential duties of her pre-accident employment.

36. L.F. relies on an October 2016 report from psychologist Dr. Lotfalizadeh who diagnosed her with Major Depressive Disorder, Severe; Specific Phobia, Situational Type (Driver and Passenger); and, Somatic Symptom Disorder, with Pre-Dominant Pain, Moderate.²² Dr. Lotfalizadeh concludes that L.F.’s “psychological symptomology and presentation are not conducive to successful fulfilment of her role as a support worker to patients in need of constant care and attention.”

37. Unifund relies on an August 2016 IE conducted by psychologist Dr. Chan who diagnosed L.F. with Adjustment Disorder with Mixed Anxiety and Depressed Mood; Occupational Problems; Financial Strain; and, GAF²³ + 65 (current, which does not include impairment due to physical limitations).²⁴ Dr. Chan concludes that L.F.’s psychological impairment was not sufficiently serious to prevent her from performing the essential tasks of her pre-accident employment. He reiterated this conclusion in an addendum prepared in November 2016 after he had had an opportunity to review Dr. Lotfalizadeh’s report.

38. As a result of my concerns about L.F.’s credibility, I have carefully considered the comments of Dr. Chan and Dr. Lotfalizadeh regarding the reliability of the information on which their conclusions are based. Dr. Lotfalizadeh reports that L.F. “did not endorse rare, absurd, or improbable items put to her in order to gauge the integrity of her report”²⁵, and that “her objective testing results were within valid limits”²⁶. Dr. Chan describes L.F. as a “difficult historian” in that she had “some difficulties with explanations and recalling her treatment history”²⁷. Dr. Chan administered the Miller Forensic Assessment of Symptoms Test (M-FAST) which is designed to identify malingering. L.F.’s low score (2/25) led Dr. Chan to opine “it is unlikely that she has an over-endorsing style when responding to an interview based assessment of her current problems and psychiatric symptoms.”²⁸ Dr. Chan observed good congruence between L.F.’s subjective symptom reports and her behaviour although he thought that there was some incongruence between her symptoms and reported problems and the nature and intensity of the August 10, 2015 accident. He rated the overall reliability of the assessment as fair.²⁹

39. I have also considered the consistency of L.F.’s reported symptoms and the assessors’ diagnoses. The December 2015, August 2016 and October 2016 psychological assessments all record sleep disruptions and resulting fatigue and difficulty concentrating. Significant levels of depression are also reported in each of these reports. While these reports are partly based on L.F.’s self-reports, the assessors also tested the validity of those self-reports. Dr. Chan reports that L.F. scored in the severe range for depression and the moderate range for anxiety and stress.

40. I prefer Dr. Lotfalizadeh’s report to that of Dr. Chan. In reaching his conclusion that L.F.’s psychological impairment did not render her substantially unable to perform the essential tasks of her pre-accident employment, Dr. Chan did not consider the non-physical components of L.F.’s job. In contrast, Dr. Lotfalizadeh did turn his mind to the non-physical components of L.F.’s job and concluded that she her psychological impairment rendered her substantially unable to perform the essential tasks of her pre-accident employment.

41. I agree with L.F. that the job of a PSW requires full mental capacity. This is particularly so when, as in L.F.’s case, a single PSW is working alone in the home of a vulnerable client. Unifund, in their submissions, acknowledged that one of the essential tasks of L.F.’s job was to ensure the safety of clients. I find it difficult to see how an individual such as L.F. who is experiencing severe depression, sleep disruptions, fatigue and difficulty concentrating can safely and effectively perform the essential tasks of her pre-accident employment.

42. For all of these reasons, I conclude that as a result of psychological impairment caused by the August 10, 2015 accident L.F. is substantially unable to perform the essential tasks of her pre-accident employment.

Conclusion re IRBs entitlement

43. I conclude that L.F. has met her onus of establishing that she is substantially unable to perform the essential tasks of her pre-accident employment as a result of the August 10, 2015 accident. Although, I have concluded that L.F. has not established that her physical impairment is as a result of the August 10, 2015 accident, I find that she has established that her post-accident psychological impairment renders her substantially unable to perform the essential tasks of her pre-accident employment.

44. Having found L.F. entitled to IRBs, I find her ineligible to receive IRBs between April 21, 2016 and July 18, 2016 due to her failure to provide a credible reason for her non-attendance at the March 2016 and April 2016 IEs, as noted in paragraphs 7 to 9 above.

45. There is no dispute between the parties that the appropriate weekly amount of IRBs is $209.61.

46. Unifund submits that the Tribunal cannot order “ongoing” benefits. It relies on Monachino v. Liberty Mutual Fire.³⁰ In my view that decision dealt with a context quite distinct from the one in this case. At issue there was a future care plan, submitted in conjunction with an insured’s tort action, and about which there was “real doubt”³¹ that the insured intended to implement the plan. In this case, the dispute is over entitlement to IRBs. In ruling that L.F. is entitled to IRBs to date and ongoing, I am simply recognizing that she will remain entitled to IRBs for the period that she continues to meet the test set out in the Schedule.

THE TREATMENT PLANS IN DISPUTE

The applicant is not entitled to $2,000.00 for a social emotional assessment

47. On November 30, 2015, psychologist Dr. Mehdi Lotfalizadeh submitted a treatment plan for a social emotional assessment at a cost of $2,000.00.

48. Unifund submits that this treatment plan is not reasonable and necessary because on November 13, 2015 it had approved a treatment plan for an initial psychological assessment with a different service provider, Wellness Centre. That assessment was carried out in December 2015 and recommended psychological treatment. Unifund approved and funded the recommended treatment. Unifund characterizes the November 30, 2015 treatment plan as redundant.

49. L.F. submits that the November 30, 2015 treatment plan is reasonable and necessary notwithstanding the psychological assessment and treatment. Specifically, she submits that consultation with a social worker is a “more comfortable and accessible method of discussing/treating her psychosocial symptoms as opposed to the strict medical confines of psychological treatment.”³²

There may be situations in which a social worker’s assessment and support is complementary to that provided by a psychologist. L.F. has not, however, persuaded me that that is the case here.

50. In my view, the proposed social emotional assessment is duplicative of the psychological assessment which was approved in November 2015 and completed in December 2015. The December 2015 report from Wellness Centre contains a section titled “Social and Emotional Functioning” indicating that this area of L.F.’s health was assessed and taken into account in making treatment recommendations. Thus, I find that this treatment plan is not reasonable and necessary.

The applicant is not entitled to the $576.00 balance of a partially approved functional abilities evaluation

51. On December 15, 2015, Dr. Justin Guy submitted a treatment plan for a functional abilities evaluation at a cost of $2,152.00. Unifund approved fees in the amount of $1,576.00 and denied the remaining $576.00 stating that the proposed fees were excessive.

52. L.F. states that the unpaid portion of the treatment plan consists of “standard and reasonable ancillary amounts” to the main assessment. As noted above, Unifund takes the position that the unpaid portion consists of fees that are excessive.

53. Neither party has provided any evidence to support their respective positions that the fees are excessive (Unifund) or are reasonable (L.F.). As L.F. has the burden of proof on this point and has submitted no evidence in support of her position that the fees are reasonable, I find that she has not satisfied that burden. As a result, she is not entitled to the unpaid balance of this treatment plan.

Interest

54. Pursuant to s.51 of the Schedule, where a benefit is overdue interest is payable. Thus interest is payable on the IRBs that I have found payable.

CONCLUSION

55. L.F. is entitled to IRBs from August 18, 2015 to date and ongoing in accordance with the Schedule, with the exception of the period from April 21, 2016 and July 18, 2016 and taking into account any amounts already paid by Unifund.

56. L.F. is not entitled to payment of a treatment plan dated December 15, 2015 for a social emotional assessment at a cost of $2,000.00.

57. L.F. is not entitled to payment of the $576.00 balance of a treatment plan dated November 30, 2015 for a functional abilities evaluation.

58. Interest is payable on the IRBs owing.

ORDER

59. Unifund shall pay L.F. IRBs from August 18, 2015 to date and ongoing in accordance with the Schedule, with the exception of the period from April 21, 2016 and July 18, 2016 and taking into account any amounts it has already paid.

60. Unifund shall pay L.F. interest on the IRBs owing.

Released: August 4, 2017

Catherine Bickley

Adjudicator

Footnotes

1. 1Respondent’s Book of Evidence, Tab 1 (Affidavit of Adrian Baldwin, November 9, 2016).
2. 2Respondent’s Book of Evidence, Tab S, s.25 Psychological Assessment, Wellness Centre, December 17, 2015.
3. 3Respondent’s Book of Evidence, Tab H, July 19, 2016 letter from applicant’s counsel. Case Conference Order, September 30, 2016.
4. 4Respondent’s Book of Evidence, Exhibit C
5. 5Respondent’s Book of Evidence, Exhibit D
6. 6Case Conference Order, September 30, 2016
7. 7Levesque v. Comeau, 1970 CanLii 4 (SCC), page 3
8. 8Applicant’s Reply, paragraph 2
9. 9Respondent’s Submissions, paragraph 12
10. 10Applicant’s written submissions, page 9
11. 11Respondent’s written submissions, para 32
12. 12While the medical documentation refers to other physical injuries the almost exclusive focus of L.F.’s submissions is on pain and impairment related to her right shoulder.
13. 13Applicant’s Documents, Tab 9, Report of Dr. Getahun, October 19, 2016, page 4
14. 14Applicant’s submissions, paragraph 9
15. 15Applicant’s Documents, Tab 3, Clinical Notes and Records of Dr. Portugal
16. 16Letter from surgeon Dr. McKee to L.F.’s family doctor, April 29, 2015
17. 17Letter from surgeon Dr. McKee to L.F.’s family doctor, April 29, 2015
18. 18Applicant’s Submissions, para 9
19. 19Applicant’s Documents, Tab 3, Clinical Notes and Records of Dr. Portugal
20. 20Applicant’s Submissions, Tab 16, Employment File, Letter “To Whom it May Concern” from Preferred Health Care Services, dated May 25, 2015
21. 21Respondent’s Book of Documents, Tab BB, Dr. Portugal’s CNRs, Report from Canadian Medical Imaging, October 12, 2015
22. 22Applicant’s Documents, Tab 8, Psychological Assessment Report, Dr. Lotfalizadeh, October 10, 2016. Unifund submitted an earlier s. 25 psychological assessment conducted in December 2015 by Wellness Centre. That report recommended that L.F. receive 12 counselling sessions. A treatment plan for those sessions was approved by Unifund on December 31, 2015 and L.F. attended some but not all of the approved sessions.
23. 23The GAF (Global Assessment of Functioning) rates an individual’s social, occupational and psychological functioning on a scale from 1 to 100; the lower the score, the more impaired the individual.
24. 24Respondent’s Book of Documents, Tab Y, Psychological Assessment Report, Dr. Chan, August 30, 2016
25. 25Applicant’s Documents, Tab 8, Psychological Assessment Report, Dr. Lotfalizadeh, October 10, 2016, page 3
26. 26Applicant’s Documents, Tab 8, Psychological Assessment Report, Dr. Lotfalizadeh, October 10, 2016, page 7
27. 27Respondent’s Book of Documents, Tab Y, Psychological Assessment Report, Dr. Chan, August 30, 2016, page 11
28. 28Respondent’s Book of Documents, Tab Y, Psychological Assessment Report, Dr. Chan, August 30, 2016, page 11
29. 29Respondent’s Book of Documents, Tab Y, Psychological Assessment Report, Dr. Chan, August 30, 2016, page 13
30. 302000 Can LII 5686 (ONCA) at para 17 and 18
31. 31Monachino, supra, para 18
32. 32Applicant’s submissions, para 34