Licence Appeal Tribunal File Number: 24-014285/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:
Devin Mayers
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Frank McNally, Counsel
Vanessa Petronillho, Counsel
For the Respondent:
Robert P. Bowman, Counsel
Heard by Videoconference:
October 14-20, 2025
OVERVIEW
1Devin Mayers, the applicant, was involved in an automobile accident on January 25, 2021, 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, Wawanesa Mutual Insurance 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. Has the applicant sustained a catastrophic impairment as defined by the Schedule, ss. 3.1(1)7 (“Criterion 7”) or 3.1(1)8 (“Criterion 8”)?
ii. Is the applicant entitled to $4,356.24 for psychological services, proposed by Spark Life Care, in a treatment plan/OCF-18 (“plan”) submitted on August 21, 2023?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
3The issues numbered 3 and 4 as listed in the Case Conference Report and Order were withdrawn at the start of the hearing by the applicant.
RESULT
4The application is granted in part. The applicant has sustained a catastrophic impairment as defined by the Schedule under Criterion 8. The applicant is not entitled to the plan proposing $4,356.24 for psychological services or to interest.
ANALYSIS
The applicant sustained a catastrophic impairment as defined by Criterion 8
5I find that the applicant sustained a catastrophic impairment as defined by Criterion 8 because he has a marked impairment in three domains of functioning.
6Criterion 8 relies on the American Medical Associations’ Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (“Guides”). The applicant must prove on a balance of probabilities that, as a result of the accident and due to a mental or behavioural disorder, he suffers from a marked (“Class 4”) impairment in at least three of the four domains of functioning, or at least one extreme (“Class 5”) impairment. The Guides set out the four domains and the levels of impairment as illustrated in the chart below.
Domain or Aspect of Functioning
Class 1: No Impairment
Class 2: Mild Impairment
Class 3: Moderate Impairment
Class 4: Marked Impairment
Class 5: Extreme Impairment
Activities of Daily Living
No impairment is noted
Impairment levels are compatible with most useful functioning
Impairment levels are compatible with some, but not all useful functioning
Impairment levels significantly impede useful functioning
Impairment levels preclude useful functioning
Social Functioning
Concentration, Persistence and Pace
Adaptation (Deterioration in a work-like setting)
7The applicant’s position is that his impairments meet the definition of catastrophic impairment under Criterion 8 because he has a marked impairment in three domains. The applicant relies on a report dated September 8, 2025, by Dr. Emily Gavett-Liu, Psychiatrist, providing a marked impairment rating for the applicant’s activities of daily living, social functioning, and adaptation, and a moderate impairment rating in concentration, persistence and pace.
8The respondent’s position is that the applicant’s impairments do not meet the test under Criterion 8 because he does not have a marked impairment in three domains. The respondent relies on a report dated December 13, 2023 by Dr. Kehinde Adekunle Aladetoyinbo, Psychiatrist, providing a moderate impairment rating for the applicant’s social functioning and for concentration, persistence and pace. Dr. Aladetoyinbo provided a marked impairment for the applicant’s activities of daily living and adaptation.
9I note that Dr. Gavett-Liu and Dr. Aladetoyinbo agree on a marked rating in the domains of activities of daily living and adaptation, and that they also agree on a moderate rating for concentration, persistence and pace. The doctors only disagree on the rating provided for the domain of social functioning. Based on this, the applicant argues the domain of social functioning is the main aspect at issue for my Criterion 8 analysis. The respondent’s position is that it is not conceding the ratings that the two doctors agree on. The respondent argues that I am assessing the issue based on a legal test rather than a medical test, and that the onus is on the applicant. For these reasons, the respondent argues that I must provide my own rating based on all the evidence offered at the hearing. I agree with the respondent that the onus is on the applicant and that I am assessing the issues based on a legal test rather than a medical one. Given that there is a dispute between the parties with respect to all the domains, I have not limited my consideration to only those where there is disagreement between the doctors. However, I am of the view that I am not required to provide my own rating for each domain in the course of determining whether the applicant has met his onus, on a balance of probabilities. I also note that I have no compelling evidentiary basis to doubt opinions on Criterion 8 ratings where the doctors are in agreement.
10As it relates to Criterion 8, I find Dr. Gavett-Liu’s report more persuasive and more helpful for purposes of my determination because it is more detailed and better connects the applicant’s impairment to the Criterion 8 domains in the Guides. I find that the key information that Dr. Gavett-Liu based her opinion on is essentially consistent with the testimony of the applicant and the applicant’s wife, and with the evidence of Occupational Therapists Barbara Moroney and Leanna Haidar as well as the evidence of Carolina Gama, Psychotherapist.
11I find that this consistency is valuable because these health care practitioners were drawing on significant experience assessing or treating the applicant. Dr. Gavett-Liu completed three assessments of the applicant between September 9, 2022, and July 17, 2025. Leanna Haidar treated the applicant between April 2021 and May 2023. Barbara Moroney assessed the applicant on three dates in October 2022 for a catastrophic determination situational assessment and in-home assessment. She also assessed the applicant on June 23, 2025, to provide an updated report. In contrast, the insurer examiners each had a single assessment of the applicant and most importantly, came to a conclusion on Criterion 8 that was inconsistent with the applicant’s overall situation in the social functioning domain.
Diagnoses
12In terms of accident-related diagnoses, Dr. Gavett-Liu diagnosed the applicant with:
i. somatic symptom disorder,
ii. major depressive disorder,
iii. post traumatic stress disorder,
iv. generalized anxiety disorder, and
v. panic disorder.
13Dr. Aladetoyinbo diagnosed the applicant with:
i. unspecified depressive disorder,
ii. unspecified somatic symptom and related disorder,
iii. unspecified cannabis related disorder, and
iv. unspecified trauma and stress related disorder.
Activities of Daily Living
14I find that the applicant has a marked impairment in the domain of activities of daily living.
15The psychiatric reports both refer me to the Guides describing activities of daily living as including “such activities as self-care, personal hygiene, communication, ambulation, travel, sexual function, sleep, and social and recreational activities”. The Guides indicate that these activities are to be assessed in relation to “the context of the individual’s overall situation, the quality of these activities is judged by their independence, appropriateness, effectiveness and sustainability”.
Comparing Reports on Activities of Daily Living
16Both Dr. Gavett-Liu and Dr. Aladetoyinbo note the applicant’s limitations in his activities of daily living as compared to his pre-accident functioning and provide a marked impairment rating. Dr. Gavett-Liu records a wider range of activities of daily living and more details about them such as the applicant’s limitations and reasons for those limitations. This assists me in understanding the applicant’s overall situation and the quality of the activities being assessed, as suggested by the Guides. Dr. Gavett-Liu notes the applicant is limited by pain, amotivation, anergia, and panic attacks. She also notes that the applicant reports initial insomnia and middle insomnia, that he has feelings of being overwhelmed and that he feels he is limited by depression and cognitive difficulties.
17Dr. Gavett-Liu notes the applicant is independent in bathing, feeding, toileting but does not change his clothes, brush, shave, or get haircuts regularly since the accident. He is not interested in seeing people or going out. He can walk without a walker, but it is easier with a walker which allows him to take breaks and sit down, as needed. The applicant does not cook and relied on a PSW for cooking and on his daughter’s godfather who works at a restaurant and brings food home. He relied on a PSW for most household tasks including cleaning and laundry. The applicant and his wife testified that the applicant was previously receiving PSW services but is no longer receiving them, however she continues to receive PSW services at their shared home. I find it reasonable to conclude he continues to be reliant by extension on PSW services to the extent they may be received by his wife for shared responsibilities. The applicant is also reliant on his mother-in-law for household tasks. The applicant’s ability to travel is limited to driving within 10 minutes from his home due to panic attacks which is worse if he is a passenger because he feels a lack of control over the vehicle.
18Whereas Dr. Aladetoyinbo notes his consideration of the applicant’s activities of daily living from a Criterion 8 perspective in eleven sentences, touching on reliance on a PSW, limitations in cooking, no evidence of self-neglect, attendance at all scheduled appointments, no reported history of marked difficulty with hearing, speaking, reading, writing or independent use of his phone. I do not have clear reasons connecting these considerations to his conclusion that the applicant has a marked impairment rating.
19Nonetheless, I find that the conclusions of Dr. Aladetoyinbo in relation to this domain align with those of Dr. Gavett-Liu and are supported by the preponderance of evidence before me. I accept that the applicant has a marked impairment in the domain of activities of daily living.
20In reaching this conclusion, I have considered the respondent’s submission that Dr. Gavett-Liu provided a score of 3 in 2023 and provided a score of 2 in 2025 in the applicant’s Self-Care, Personal Hygiene and Activities of Daily Living subsection on the Psychiatric Impairment Rating Scale (“PIRS”). The respondent argues this is an improvement and should be considered in the Criterion 8 rating for activities of daily living.
21In this regard, I note that the PIRS evaluates the applicant’s functional impairment in six subsections using a five-point scale and is part of a Criterion 7 analysis. Below are Dr. Gavett-Liu’s and Dr. Aladetoyinbo’s PIRS scores for each subsection. For reference, a score of 2 under the PIRS is described as a mild impairment: “Able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-out food.” A score of 3 under the PIRS is described as a moderate impairment: “Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2-3 times per week to ensure minimum level of hygiene and nutrition.”
PIRS Subsections
Functional Impairment Score, Dr. Gavett-Liu’s report dated February 15. 2023
Functional Impairment Score, Dr. Gavett-Liu’s report dated September 8, 2025
Functional Impairment Score, Dr. Aladetoyinbo’s report dated December 13, 2023
Self-Care, Personal Hygiene and Activities of Daily Living
3
2
4
Interpersonal Relationships
3
2
2
Role Functioning, Social and Recreational Activities
3
3
2
Travel
3
3
2
Concentration, Persistence and Pace
3
3
2
Resilience and Employability
4
4
4
22The PIRS scores were provided in their respective reports in the context of a Criterion 7 analysis which requires the use of the PIRS, along with the Brief Psychiatric Rating Scale and Global Assessment of Functioning Scale. Dr. Aladetoyinbo opined that the Criterion 8 ratings in the four areas of functioning should align with the ratings provided in related subsections of the PIRS. Dr. Gavett-Liu opined that the Criterion 8 areas of functioning and the PIRS subsections are not connected although they may have some overlap and that the scores have different meanings.
23I find Dr. Gavett-Liu’s opinion persuasive for the reasons set out above, while also noting that:
i. The Schedule does not base a Criterion 8 analysis on the PIRS.
ii. Where ratings of the four areas of functioning are conclusive for purposes of Criterion 8, Criterion 7 does not base its conclusion exclusively on the PIRS which is only one of many elements that are considered for Criterion 7. Essentially, the two are not comparable in their weight or value when considering catastrophic impairment.
iii. The considerations for the Criterion 8 domain of activities of daily living are not the same as those considered by the PIRS. For example, travel is scored separately under the PIRS but is included within the Criterion 8 domain of activities of daily living. The four Criterion 8 domains are more wholistic.
iv. The scores or ratings have unique definitions and are not interchangeable between the PIRS and Criterion 8.
24Therefore, I accept the rating of marked impairment for the domain of activities of daily living. On a balance of probabilities, I find that the applicant has established a marked impairment in the domain of activities of daily living under Criterion 8.
Adaptation
25I find that the applicant has a marked impairment in the domain of adaptation. As noted above, both psychiatrists provided a rating of marked impairment in the domain of adaptation.
26The psychiatric reports refer me to the Guides describing this domain as follows:
[D]eterioration or decompensation in work or work-like settings refer to repeated failure to adapt to stressful circumstances. In the face of such circumstances the individual may withdraw from the situation or experience exacerbation of signs and symptoms of a mental disorder; that is decompensate and have difficulty maintaining activities of daily living, continuing social relationships and completing tasks. Stressors common to the work environment include attendance, making decisions, scheduling, completing tasks, and interacting with supervisors and peers.
Comparing Reports on Adaptation
27Dr. Gavett-Liu noted her focus on the applicant’s mental state being depressed, anxious, and irritable and the situational assessment of Barbara Moroney in June 2025. Some of her key considerations include the applicant’s inability to return to work even on a modified or graduated basis and his limitations in engaging in regular life activities in which he is significantly impaired. Further, the applicant’s inability to manage life stressors or adapt to stressful circumstances, including conflicts with his wife and family members. The applicant’s tendency to withdraw or avoid stress or conflict otherwise escalating to anger and confrontation.
28Dr. Aladetoyinbo notes that employability is not synonymous with adaptation, but the applicant has not returned to employment. Further, that the applicant is independent in some aspects of his activities of daily living which he can effectively sustain to yield the required results. He also notes that there is no evidence of self neglect and no history of pervasive difficulties with goalsetting, problem solving and independent planning. He concludes the applicant has a marked impairment in this domain based on available information, but I do not have clear reasons connecting these considerations to his conclusion that the applicant has a marked impairment rating.
29Nonetheless, I find that the conclusions of Dr. Aladetoyinbo in relation to this domain align with those of Dr. Gavett-Liu and are supported by the preponderance of evidence before me. I accept that the applicant has a marked impairment in the sphere of adaptation.
30For the reasons above, on a balance of probabilities, I find that the applicant has established a marked impairment in the domain of adaptation under Criterion 8.
Social Functioning
31I find that the applicant has a marked impairment in the domain of social functioning.
32The psychiatric reports refer me to the Guides describing this domain as follows:
[A]n individual’s capacity to interact appropriately and communicate effectively with other individuals. Social function includes the ability to get along with others, such as family members, friends, neighbours, grocery clerks, landlords, or bus drivers. Impaired social functioning may be demonstrated by a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, and social isolation with similar events or characteristics.
Comparing Reports on Social Functioning
33Dr. Gavett-Liu noted that the applicant maintained close relationships with his wife, family and extended family, friends, and coworkers, regularly participated in social activities and attended events prior to the accident. Leanna Haidar’s evidence is that the applicant was socializing two to three times a week. Pre-accident, the applicant was living in a single-family home with his wife and mother since approximately 2013, approximately 7 years pre-accident, and cooked and hosted weekly Sunday dinners.
34Dr. Gavett-Liu notes that the applicant’s post-accident social life is drastically reduced because of barriers including chronic pain, depressive symptoms, irritability, anxiety, fear, and panic attacks.
35I found Dr. Gavett-Liu’s evidence regarding this domain was largely corroborated by the testimony of the applicant and the applicant’s wife, and the evidence of Occupational Therapists Barbara Moroney and Leanna Haidar as well as the evidence of Carolina Gama, Psychotherapist. I find that the applicant has altercations with and avoids interpersonal relationships with those that he was closest with pre-accident. The applicant is socially isolated but takes on the responsibility of providing his daughter with opportunities to play and be social where he can and with the support of others, where needed.
36I accept that a few months post-accident, the applicant’s relationship with his mother deteriorated and she moved out of the house for approximately two years. There was a possibility that the home would be sold by his mother who is part owner of the property which would have left the applicant searching for accommodation for himself, his wife, and his young daughter. That threat of sale did not ultimately materialize; however, the single-family home was converted to create a separate private and enclosed space for the applicant’s mother. The applicant’s mother then moved back in but lives separate and apart from the applicant with little interaction with the applicant.
37Further, the applicant’s relationship with his wife has also deteriorated post-accident and they are now receiving marriage counselling. The applicant is also no longer maintaining relationships with his siblings, his in-laws or his friends. Additionally, while he had a customer-facing job working at a rental car business pre-accident as an assistant manager, he can no longer sustain appropriate and effective interaction and communication with the public as he has become irritable and short tempered, which was not the case pre-accident. Both psychiatrists acknowledge the applicant has not returned to work since the accident.
38The respondent argues that the applicant’s wish to repair his relationships by seeking counselling should be considered in the context of this domain. I find this argument incompatible with the AMA Guides based on the evidence and context of the applicant’s overall situation. I find that the fact the applicant sought counselling is not evidence that he does not have a marked impairment in social functioning. I agree with the applicant that it is the case that the applicant wants his relationship to improve while simultaneously having barriers due to his mental and behavioural impairments that do not allow him to achieve this goal. I accept the applicant’s argument because the position aligns with the evidence regarding this domain that the applicant values his close familial relationships, but they have deteriorated post-accident, nonetheless.
39I acknowledge that the evidence shows that the applicant takes his daughter to activities such as Cosmic Adventures. However, I note that according to the evidence of Leanna Haidar, who treated the applicant for approximately two years, this was part of his treatment. Ms. Haidar would set goals with the applicant to work towards improving his functioning. With a goal of improving his limitations in driving, getting him walking more, and getting him out of the house and into the community, the applicant would drive his daughter to Cosmic Adventures once a week, which is about a 10-to-15-minute drive from home. Leanna Haidar testified that the applicant would never independently take his daughter and would be supported by his wife or someone else. She described the applicant as feeling overstimulated by these outings.
40With respect to Dr. Aladetoyinbo’s moderate rating in this domain, I did not find his social functioning analysis persuasive as it did not align with the evidence presented at the hearing. For example, Dr. Aladetoyinbo notes that the applicant has a good relationship with his wife and family. I did not find this to accurately reflect the preponderance of evidence with respect to the applicant’s family situation, there was no pre-accident and post-accident review of the applicant’s close relationships, and at the time of the assessment his family relationships had already deteriorated. I also find that it is counter to the report of Jean Turgeon, occupational therapist, dated December 13, 2023, who was assessing the applicant in an in-home assessment for a catastrophic determination. I find that Jean Turgeon’s notes for social functioning largely align with the applicant’s evidence and include an observation that the applicant had limited interaction with his 3-year-old daughter despite being present in the same or adjacent room.
41Dr. Aladetoyinbo also noted there is no reported history of dismissal from work, which I find is inconsistent with Dr. Aladetoyinbo’s knowledge of the applicant’s situation documented elsewhere in his report. Dr. Aladetoyinbo indicated, when assessing the domain of adaptation, that the applicant never returned to employment after the accident.
42Further, Dr. Aladetoyinbo considered that the applicant had good relationships with healthcare professionals involved in his care and noted the applicant stated his psychologist and occupational therapist were helping him. I agree with the applicant that health care professionals are paid and trained to be able to have a professional relationship with the applicant while he is in their care. In this context, I am not persuaded that his care providers’ ability to maintain a professional relationship with the applicant is evidence of social functioning as set out in the Guides. Getting along with health care providers is not an example of the type of relationship that is considered for this domain. Rather, the Guides list examples of family members, friends, neighbours, grocery clerks, landlords, or bus drivers.
43The respondent also referred me to evidence from Dr. Direnfeld, Psychologist, who prepared a report dated April 11, 2023 addressing post-104-week income replacement benefit. I give this report little weight in the context of a catastrophic impairment determination because it does not address Criterion 8 and was inconsistent with the preponderance of evidence before me. Further, according to Dr. Direnfeld’s testimony, he is not qualified to do catastrophic assessments.
44For the reasons above, on a balance of probabilities, I find that the applicant has established a marked impairment in the domain of social functioning under Criterion 8.
45In sum, I find the applicant has marked impairments in the domains of activities of daily living, adaptation, and social functioning. Therefore, I find the applicant’s impairments meet the definition of catastrophic impairment under Criterion 8. As I have found the applicant meets the definition under Criterion 8, it is not necessary to consider whether the applicant is catastrophically impaired under Criterion 7.
Is the applicant entitled to $4,356.24 for psychological services submitted on August 21, 2023?
46The applicant has not established that the proposed plan is reasonable and necessary.
47To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
48The parties’ focus at the hearing was the catastrophic impairment issue. The applicant did not make submissions or direct me to evidence in support of this treatment plan.
49For the reasons above, I find on a balance of probabilities that the applicant did not meet his onus in establishing this plan as reasonable and necessary.
Interest
50The applicant is not entitled to interest because there are no overdue benefits on this application to which interest would apply pursuant to s. 51 of the Schedule.
ORDER
51For the reasons above, I make the following orders:
i. The applicant has sustained a catastrophic impairment as defined by the Schedule, under Criterion 8.
ii. The applicant has not established entitlement to a plan proposing $4,356.24 for psychological services and is not entitled to interest.
Released: November 20, 2025
Amar Mohammed
Adjudicator