Licence Appeal Tribunal File Number: 17889/MED

An appeal under subsection 50(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8, from a decision of the Registrar of Motor Vehicles to suspend a licence pursuant to Section 47(1) of the Act.

Between:

Vinay Tiwari

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Vinay Tiwari, Appellant

For the Respondent: Melissa Litrenta, Agent

Held by teleconference: November 14, 2025

OVERVIEW

1Vinay Tiwari (the “appellant”) appeals from the decision of the Registrar of Motor Vehicles (“Registrar”) to suspend his Class G licence under s. 47(1) of the Highway Traffic Act, R.S.O. 1990, c. H.8 (the “Act”) after the Registrar received an unsolicited Medical Condition Report (MCR) from a physician stating that the appellant suffers from a medical condition that may affect his ability to drive safely.

2The Registrar has the authority under s. 47(1)(g) of the Act to suspend or cancel a driver’s licence for any sufficient reason. Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) states that a holder of a driver’s licence must not suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Registrar of Motor Vehicles may require a driver to provide satisfactory evidence that they are able to drive safely.

3The Registrar takes the position that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal, that is likely to significantly interfere with his ability to drive safely and that this provides sufficient reason to suspend his licence under s. 47(1)(g) of the Act.

4The appellant appeals the suspension under s. 50(1) of the Act. He denies he has had seizures due to alcohol withdrawal, but states that he has had seizures that were alcohol-induced. He further denies that he suffers from a medical condition which interferes with his ability to drive safely.

5Pursuant to section 50(2) of the Act, after a hearing the Tribunal may confirm, modify, or set aside the decision or order of the Registrar.

ISSUES

6The issue in this appeal is whether the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a motor vehicle safely.

7To resolve that issue, I will address the following questions:

i. Did the appellant suffer from a seizure due to alcohol withdrawal?

ii. If so, is this likely to significantly interfere with his ability to drive a motor vehicle safely?

8The Registrar bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

9Having considered all the evidence and submissions and for the reasons that follow, I find that the Registrar has satisfied its burden to establish that the appellant suffers from a medical condition that is likely to significantly interfere with his ability to drive a motor vehicle safely and I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.

PRELIMINARY MATTER

10It was discussed at the outset of the hearing whether there was an overlap in the timeframe of the Tribunal’s decision being released, and the appellant meeting the requirements of the Registrar.

11The Registrar was asked whether the appellant would be eligible for licence reinstatement in November 2025 based on their requirements and the medical documentation submitted. The Registrar reported that the appellant had not met the requirement of completing an alcohol treatment program and therefore would not be eligible with the current information received for reinstatement this month.

12The appellant indicated his intention to continue to work with his physician to gather more medical information as well as to proceed with the hearing.

ANALYSIS

Did the appellant suffer from a seizure due to alcohol withdrawal?

13The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely seizures due to alcohol withdrawal.

14The Registrar submitted that the appellant first came to their attention with a previous suspension due to a seizure when Dr. JB submitted an unsolicited MCR dated July 18, 2021. Dr. JB reported the appellant suffered from a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence after the appellant suffered a seizure. It was unclear to Dr. JB why the appellant had a seizure and he was referred to a neurologist. Upon receipt of this information, the Registrar suspended the appellant’s driver’s licence and requested completion of a Seizure and Loss of Consciousness Form.

15This form was completed by Dr. NB and was undated. Dr. NB reported the appellant suffered a generalized seizure due to alcohol use and dehydration; the last seizure had been 6 to 12 months earlier on July 18, 2021, and that this was the appellant’s first seizure. The appellant’s driver’s licence was reinstated by the Registrar following receipt of this form.

16The Registrar continued to monitor the appellant’s condition with cyclical requests for the appellant to submit a completed Seizure and Loss of Consciousness Form. Dr. RA completed this form on December 12, 2022, and documented that the last seizure was greater than 12 months ago, and was provoked by alcohol use, dehydration and sleep deprivation. Dr. RA indicated the appellant suffered from moderate substance use disorder and that alcohol use had stabilized, but the appellant was not abstinent.

17A second unsolicited MCR dated May 31, 2025, was submitted by internist Dr. SH, leading to the current suspension under appeal. The MCR reported the appellant suffered from a disorder that had a moderate or high risk of sudden incapacitation, or that had resulted in sudden incapacitation and that has a moderate or high risk of recurrence after he suffered a seizure due to alcohol/drug withdrawal. Upon receipt of this information, the Registrar suspended the appellant’s driver’s licence due to a seizure due alcohol withdrawal and requested completion of a Substance Use Assessment Form.

18Dr. RA completed this form dated October 6, 2025. Dr. RA reported the appellant had severe substance use disorder due to alcohol, had abstained for four months, had not completed a supervised treatment program, and had suffered an alcohol induced seizure. Upon receipt, the Registrar confirmed the appellant’s suspension and changed the medical condition to alcohol use disorder.

19The appellant submitted a consultation note from neurologist Dr. B dated October 14, 2025. The letter summarizes the appellant’s condition as seizure disorder exacerbated by alcohol misuse. The report documents the appellant’s seizures started in 2021 and three generalized tonic-clonic seizures occurred on May 31, 2025, all in the context of reducing alcohol intake over the previous week. The report further documents that the appellant has been seizure free and abstaining from alcohol since May 2025. The report provides that the appellant could conceivably stop his anti-seizure medication as he has abstained from alcohol, but he would need to abstain from driving for another 3 months, and the appellant chose to remain on his medication. Upon receipt, the Registrar confirmed the appellant’s suspension due to alcohol use disorder.

20The appellant subsequently submitted a hospital discharge report dated June 6, 2025, summarizing a six-day admission. This summary documented the appellant suffered from alcohol use disorder and alcoholic liver disease and presented with three generalized tonic-clonic seizures on May 30, 2025. The summary described the appellant was diagnosed with seizure disorder exacerbated by alcohol misuse and alcohol withdrawal. The summary detailed that he was prescribed an anticonvulsant for seizures and treated with a CIWA protocol for alcohol withdrawal symptoms of hallucinations, confusion, agitation and fever. The appellant was referred to a neurologist and the RAAM clinic and received information on bed-based rehab and several different substance use services.

21The appellant additionally submitted a letter from his family physician, Dr. RA dated November 3, 2025. Dr. RA had written a narrative to clarify the Substance Use Assessment form completed October 6, 2025. She indicated the appellant’s last drink was May 30, 2025, and he would be abstinent for 6 months as of November 30; he had a medically-supervised detox admission May 31 – June 6 after his seizure, and he had been followed by Dr. A at the Bells Corners Recovery program and saw a therapist at that location. Dr. A had prescribed gabapentin and naltrexone and monitored urine tests until June 2025 when Dr. RA took over these prescriptions, and the appellant was now resuming weekly calls with Dr. A, and Dr. RA thought the appellant was forthright regarding his alcohol abstinence.

22The Registrar responded with their latest letter dated November 4, 2025, confirming the suspension due to seizure due to alcohol withdrawal and requiring confirmation of the appellant being seizure free and abstinent from alcohol for a period of one year, but that period could be reduced to six months if the appellant’s healthcare practitioner confirms successful completion of an alcohol treatment program and is supportive of driving privileges. The Registrar submitted that a medically supervised detox program did not satisfy the requirements of an alcohol treatment program, and the appellant would not be eligible for reinstatement at six months with the present medical information on file.

23Under cross-examination, the appellant questioned the Registrar as to the medical condition for the suspension, citing that he had not been reducing his alcohol intake at the time of his latest seizures triggering the suspension, and was consuming alcohol leading up to the seizures. The Registrar responded that the MCR submitted on May 31, 2025, reported the medical condition of alcohol/drug withdrawal. The appellant further argued that the discharge summary from hospital contradicts this. The Registrar stated that she is not a physician, understands what the appellant is asking, and that the MCR was the most applicable report to the appellant’s case.

24Under further cross-examination, the appellant cited that he has a seizure disorder but not ongoing epilepsy. The Registrar agreed that several seizures had occurred.

25The appellant further questioned the Registrar’s authority to suspend his licence under s. 47(1) of the Highway Traffic Act, and that “a mental, emotional or physical condition” did not include a mention of alcohol. The Registrar responded that the appellant’s condition fell under s. 47(1) of the Highway Traffic Act.

26The appellant further questioned the Registrar as to what qualified as an alcohol treatment program. The Registrar responded that from her experience, Alcoholic Anonymous participation did not qualify, but she did not represent the Driver Review Section and could not provide any more specific information as to what qualified as a treatment program.

27The appellant questioned the Registrar why his licence was reinstated at six months with the last suspension due to seizure. The Registrar responded that the medical condition applied to the previous suspension was provoked seizure with no structural brain abnormality which mapped to a different CCMTA section, and the condition outlined by the MCR this time was different and subsequently triggered a different section of the CCMTA Standards.

28The appellant testified that he takes full responsibility for his alcohol addiction and that alcoholism was prevalent in his community. He testified he has been sober since May 2025 and while recovery is not easy, he is supported by his family and they do not consume alcohol in his presence. He testified as to very difficult life events that have occurred recently, including a shoulder fracture, attending physiotherapy far from his house, loss of his job of 16 years and his wife recently passed away, and throughout these events he has maintained his sobriety. He testified as to the renewed relationships he had with his family, including a nephew, that have been fulfilling.

29Under cross-examination, the appellant testified that he had been drinking alcohol since age 16, initially periodically and then gradually increased to daily with his consumption becoming problematic in the last decade. He testified he would drink in the morning to avoid withdrawal symptoms and consume upwards of 10 ounces of vodka per day. He had been asked to leave his employment related to alcohol use. He further testified that he had suffered from eight seizures in total, starting in 2021. He agrees his seizures have been provoked by excessive alcohol use, but denies they are due to alcohol withdrawal.

30In considering whether the appellant has the medical condition of seizures due to alcohol withdrawal or seizure disorder exacerbated by alcohol misuse or even alcohol-induced seizures, I note that the evidence contains references supporting all these characterizations. Having considered the appellant’s testimony and all the supporting medical documentation, I find the Registrar’s position to be supported. All records consistently describe seizures occurring in the context of excessive alcohol use, and the appellant does not dispute this point. Whether the precise mechanism was excessive consumption or excessive consumption followed by a decrease in consumption in the acute period before the seizure is not material to the determination before me; in either case, the evidence establishes the appellant’s excessive alcohol consumption was a key precipitating factor for the seizures.

31Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffers from seizures due to alcohol withdrawal.

Is the appellant’s medical condition likely to significantly interfere with his ability to drive a motor vehicle safely?

32I find that the Registrar has proven on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

33Section 14(1)(a) of O. Reg. 340/94 under the Act (the “Regulation”) states that a holder of a driver’s licence must not suffer from any mental, emotional, nervous or physical condition or disability likely to significantly interfere with their ability to drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Registrar of Motor Vehicles may require a driver to provide satisfactory evidence that they are able to drive safely

34The Registrar relies on the CCMTA Standards, in particular Chapters 17.6.3 (Alcohol Withdrawal Seizures) and 15.6.3 (Substance Use Disorder). Chapter 17.6.3 provides that all drivers are eligible for a licence if:

i. The treating physician has confirmed that the cause of the seizure was alcohol withdrawal (i.e., the driver is not epileptic)

ii. They have undergone addiction treatment and have received a favourable report from an addiction counsellor;

iii. And the criteria for licence reinstatement are met in accordance with the Substance Use Disorder Standard (see 15.6.3).

35Chapter 15 describes substance use disorders in general and the concerns with driving safely with respect to those conditions. Specifically Standard 15.6.3 states that drivers who are under the influence of alcohol would be eligible for a licence if they:

i. Meet the criteria for remission and/or has abstained from the substance for 12 months.

ii. Earlier re-licensing may be considered upon favourable recommendation from an addictions specialist and/or treating physician recognized by the licensing authority, and the successful completion of a drug rehabilitation program.

iii. The functional abilities necessary for driving are not impaired.

iv. Where required a road test or other functional assessment shows that the functional abilities for driving are not impaired.

36The CCMTA Standards further outline the effects of alcohol on the functions necessary for driving including reduced reaction times, blurred or double vision, altered depth perception, reduced judgement and insight, blunted alertness and reduced motor co-ordination. Furthermore, the use of alcohol impairs a driver’s judgment and behaviour towards others, including determining whether they are fit to drive or not. Although a person may, when not under the influence of alcohol, determine never to drive when intoxicated, their assessment of their ability to drive will likely be affected by having consumed alcohol. Furthermore, those with severe alcohol use disorder are at risk for alcohol withdrawal which can include seizures and other neurological presentations.

37The CCMTA Standards indicate that seizures, such as the type of seizure the appellant is reported to have suffered, cause an episodic impairment of the functions necessary for driving and a driver cannot compensate. Thus, experiencing a seizure would significantly interfere with a driver’s ability to drive safely and present a safety risk to the driver themselves and other road users.

38The Registrar stated that these standards have not been met. The Registrar stated that their decision is in line with the national medical standards and in keeping with road user safety.

39Section 14(2)(a) of the Regulation allows the Registrar to consider the CCMTA Standards when determining whether the requirements of s. 14(1) are met. The Tribunal may take the CCMTA Standards into consideration but are not bound by them.

40The appellant argued that he does not have a medical condition that will impair his ability to drive safely. The appellant testified that at no time has he ever been charged with or engaged with operating a motor vehicle while under the influence of alcohol. He testified as to the hardships of not having a driver’s licence for day-to-day tasks and the dependence he now has on others.

41The appellant testified that he attended an intake meeting with the RAAM clinic following his hospital admission, but as he had abstained from alcohol for 30 days at that time, he did not qualify for an inpatient bed.

42He testified he had been attending appointments with Dr. A at the Bells Recovery Program for approximately 1 year prior to his hospital admission. He testified that he stopped attending this clinic in June 2025 because he did not have a licence to drive there, and it seemed like the only reason to go to these appointments was to receive medication refills. He testified he had attended appointments with a therapist at the same clinic but stopped these appointments when the therapist left the clinic. He testified he has recently started attending appointments with Dr. A again in response to the Registrar requiring confirmation of completing a treatment program. He testified he checks in with Dr. RA every 30-45 days.

43Under cross-examination, the appellant was questioned regarding follow up with the services that were recommended in the discharge summary dated June 6, 2025, where three different services were listed in addition to the RAAM clinic. The appellant testified that he had downloaded a support group app and attended one or two of the online meetings but did not continue; he testified he did not pursue AA because he is not religious, and he has found his family has supported him sufficiently to maintain sobriety.

44The appellant was questioned regarding his work with addiction physician Dr. A and whether he had approached Dr. A for a letter of support or to complete the Substance Use Assessment Form. He responded that he had engaged with Dr. A from mid-2024 until shortly after his recent seizures, having stopped seeing Dr. A in June initially due to transportation concerns without his licence. Dr. A had subsequently continued with weekly phone appointments, but the appellant felt that the appointments were merely about providing a prescription, so he stopped attending when Dr. RA took over the prescriptions. He had approached Dr. A about a letter of support when he re-engaged the week prior to the hearing but indicated that Dr. A did not feel comfortable writing a letter as he had not seen in him a prolonged period of time.

45The appellant was questioned about any steps he had taken after his first seizure due to alcohol misuse in 2021. He testified that he had reduced his consumption of alcohol temporarily, but didn’t take the situation seriously at the time.

46The appellant called his sister as a witness. The appellant’s sister testified as to the steps her brother had taken towards his sobriety including living with their mother following his discharge from hospital, attending an appointment at the RAAM clinic and the work with Dr. A. She attested to his sobriety since May 30, 2025, and the hardships of not having a driver’s licence. She described difficulties navigating family functions prior to the appellant becoming sober as he would attend already having consumed alcohol and she had to make the difficult decision to stop attending the same functions to avoid exposing her young children to a situation where he was intoxicated. She testified as to the enjoyment her children now experienced reconnecting with the appellant now that he is sober.

47I considered the appellant’s position that his medical condition will not impact his ability to drive safely. However, this is weighed against the scientific research that alcohol impairs a driver’s judgement, reflex control, alertness and coordination which can impair driving performance, as well as that generalized tonic-clonic seizures can result in complete incapacitation without the ability to compensate.

48While I commend the appellant for his sobriety, I also acknowledge that there is an extensive history of alcohol consumption, as the appellant testified to having excessive alcohol consumption for a decade or longer, has a diagnosis of alcoholic liver disease and has had alcohol interfere with his employment. I also acknowledge that the appellant has a history of continuing to consume alcohol despite suffering significant consequences from alcohol use, including suffering a seizure with subsequent suspension of his driver’s licence in 2021, and the estrangement of family members he cares about. I also appreciate that substance use disorders are chronic relapsing disorders that often require long term pharmacological and psychosocial interventions to prevent relapse. For these reasons, I agree with the CCMTA Standards that require a treatment program be completed to consider early reinstatement. The appellant has attended appointments with Dr. A, but I question the efficacy of these appointments as the appellant continued to drink alcohol for a year or more while attending these appointments, and then discontinued these appointments less than a month after his seizures as he did not find them effective. Furthermore, the appellant did not complete a counseling session through the Bells Recovery Clinic but instead stopped when the therapist relocated. I recognize he has testified as to the support of his family, and this support is undoubtedly beneficial to his sobriety, but family members do not have the skills and training to support addiction recovery as healthcare providers can. Furthermore, I note that while Dr. RA has clarified the appellant attended a detox program, and worked with Dr. A, she has also checked “no” to the question of whether the appellant completed a treatment program on the latest Substance Use Assessment Form. Lastly, I note that the appellant has not provided any medical evidence of a healthcare practitioner supporting reinstatement of his licence. Dr. RA has not added any comment of this nature to her reports, and Dr. A who is an addiction physician who worked with the appellant for over a year, did not have enough information to support the appellant’s licence reinstatement, as per the appellant’s testimony.

49The CCMTA Standards indicate that seizures must be controlled as a prerequisite to driving and the purpose of a seizure free period for a provoked seizure is to establish that the likelihood that the provoking factor has been successfully treated or stabilized. As alcohol use is the provoking factor in this scenario, I am concerned that the process of changing a habit of over a decade can be very difficult; the appellant has a history of not changing his drinking habits despite significant consequences; the appellant has not completed a treatment program, and the appellant does not have support from a healthcare provider for reinstatement of his driver’s licence. Given the complete incapacitation experienced when having a seizure, I accept and apply the CCMTA guidance that having a period of stability of the provoking factor of a seizure is reasonable, and at only half of the recommended period of abstinence passing, I find this relatively short period of time to be insufficient to set aside the suspension in the absence of support from a treating healthcare provider.

50Although not bound by the CCMTA Standards, the Tribunal may consider them when making the decision for the reason that these Standards are the result of a lengthy and intensive process to provide medical standards based on the best evidence available and with a focus on functional ability to drive rather than exclusively on medical diagnoses. While each appeal including this one must be judged on its own merits, I am persuaded to apply the CCMTA Standards here. My review of the evidence shows that the conditions recommended for relicensing outlined in the CCMTA Standards have not been met.

51As such, for the reasons cited, I am satisfied on a balance of probabilities that the appellant’s medical condition is likely to significantly interfere with his ability to drive safely.

Conclusion

52I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely seizure due to alcohol withdrawal, and that condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

53For the reasons set out above, pursuant to subsection 50(2) of the Act, I confirm the Registrar’s decision to suspend the appellant’s driver’s licence.