Citation: Mohammed v. CAA Insurance Company, 2026 ONLAT 25-000178/AABS

Licence Appeal Tribunal File Number: 25-000178/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:

Aziza Mohammed

Applicant

and

CAA Insurance Company

Respondent

DECISION

ADJUDICATOR:

Timothy Porter

APPEARANCES:

For the Applicant:

Sylvia Guirguis, Counsel

For the Respondent:

Anju Sharma, Counsel

HEARD: by Videoconference:

October 27 - 31, 2025

OVERVIEW

1Aziza Mohammed, the applicant, was involved in an automobile accident on January 15, 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, CAA 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?

ii. Is the applicant entitled to attendant care benefits in the amount of $1,425.00 per month from October 3, 2021, to ongoing?

iii. Is the applicant entitled to $3,472.51 for occupational therapy services, proposed by Rehab First Inc. in a treatment plan/OCF-18 ("plan") dated October 22, 2021, and denied November 8, 2021?

iv. Is the applicant entitled to $5,337.13 for physiotherapy services, proposed by Rehab First Inc. in a plan dated December 8, 2021, and denied December 23, 2021?

v. Is the applicant entitled to $3,241.66 for occupational therapy services, proposed by Rehab First Inc. in a plan dated December 7, 2022, and denied on December 20, 2022?

vi. Is the applicant entitled to $2,833.14 for psychological services, proposed by the Centre for Psychological Assessment in a plan dated April 14, 2022, and denied on May 30, 2022?

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

RESULT

3I find that:

i. the applicant, on a balance of probabilities, has suffered a catastrophic impairment as defined by the Schedule.

ii. the applicant has not met her onus and is not entitled to attendant care benefits in the amount of $1,425.00 per month from October 3, 2021, to date and ongoing

iii. Based on the finding of catastrophic impairment and new funding limits being available; the applicant is entitled to the attendant care benefits incurred with Attendant with Care Inc from October 3, 2021, to March 15, 2022.

iv. the applicant has not met her onus and is not entitled to the four treatment plans in dispute.

v. the applicant is entitled to interest on all overdue and outstanding payments.

PROCEDURAL ISSUES

4Prior to the hearing the applicant raised a motion to exclude the late delivered addendum report of Dr. Elterman, urologist.

5The applicant submits that the respondent's addendum report from Dr. Dean Elterman was submitted late and outside the agreed timelines for the exchange of evidence, that this has prejudiced the applicant in that it is too late to seek a rebuttal report and that the document should be excluded or in the alternative the timeline to submit a challenge against an expert should be extended.

6The respondent submits that the contents of the report are probative and relevant and that the report should be allowed in.

7The applicant submits that as early as November 8, 2024, she had written to the respondent and identified issues with the original report of Dr. Elterman, requesting that they request an updated or addendum report. Adjuster log notes demonstrate that no request was made of Dr. Elterman at this time. In January 2025, the application in this dispute was filed. On May 14, 2025, a case conference was held and a report and order was issued; the timeline agreed to within the case conference established that the deadline for all responsive materials was July 28, 2025, and the deadline for the exchange of all other materials upon which the party intends to rely must be exchanged by August 12, 2025. The document was exchanged October 7, 2025.

8Turning to Rule 9.3 of the Licence Appeal Tribunal Rules as a guide for my analysis:

i. The substance of the report is largely known to both parties.

ii. The applicant opposes the admission of the late filed report.

iii. The respondent did not identify any reason for the non-compliance with the agreed timelines for the exchange of evidence. In my mind, the timelines are established to ensure a fair and timely exchange of evidence such that parties are prepared for the hearing. The respondent was made aware of concerns with the original Dr. Elterman report by the applicant prior to the filing of the dispute which leads me to conclude there is no reasonable reason for the non-compliance.

iv. In my mind, the fact that the applicant had been raising issues with the original report for 11 months prior to receipt, is quite influential; there was ample time for the respondent to have requested the addendum prior to even the case conference, the respondent was warned. The case conference occurred, and the parties agreed to the timeline, as there was no specific reason for the late delivery pointed to by the respondent, I am left only to balance the addendums probative nature against the prejudice to the applicant.

v. The applicant is prejudiced by the late delivery of the Dr. Elterman addendum as the time to challenge the expert had passed and the time to request an addendum of her own had also passed. The respondent has properly submitted the original report by Dr. Elterman and no specific prejudice was identified by the respondent.

vi. The report discusses the applicant's urinary expert report and therefore is likely relevant to the proceeding. In my mind, this relevance is undermined by the late delivery, the applicant has not been afforded an agreed amount of time to consider the relevance of the report and any action she may take. In my view this is a prejudice which cannot be overcome if the document is admitted.

9I find that the prejudice to the applicant is superior to the relevance of the document. The report is excluded and may not be relied upon at the hearing.

ANALYSIS

Criterion 6 Catastrophic Impairment

10I find that the applicant, on a balance of probabilities, has sustained a 64% whole person impairment ("WPI") under criterion 6 and therefore meets the test and is found to be catastrophically impaired according to criterion 6.

11According to the Schedule a criterion 6 catastrophic impairment is denoted by a physical impairment or combination of physical impairments that, in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (the "Guides"), results in 55 per cent or more physical impairment of the whole person.

12The applicant submits that she is catastrophically impaired with a WPI of 70%, according to criterion 6 in the Schedule and relies on the report by Dr. Becker, physiatrist, Dr. Neu, urologist, Dr. Hastings, physical medicine & rehabilitation specialist, and Dr. Getahun, orthopaedic surgeon.

13The respondent submits that the applicant's claim has been adjusted fairly and that the evidence does not support a finding of catastrophically impaired as many of her impairments should not be rated.

14Chart of findings

Applicant's assessors WPI Ratings

Respondent's assessors WPI Ratings

Medication effects

3%

Not rated

Lumbosacral Spine Impairment

5%

5%

Gait derangement

40%

Not rated

Cervicothoracic Spine

Not rated

5%

Symphysis pubis

15%

5%

Sacroiliac Joint(s)

20%

10%

Bilateral / Right Hip

4%

2%

Left Knee

4%

2%

Right Knee

4%

4%

Bilateral Ankles

6%

Not rated

Mental Status Impairment

14%

8%

Sleep Impairment

5%

Not rated

Headaches

5%

Not rated

Urinary impairment

30%

0%

WPI

70%

35%

Urinary Impairment

15In my mind, the applicant has been consistently experiencing urinary incontinence since June of 2021.The applicant began to complain regarding urinary incontinence to her orthopaedic surgeon Dr. Kreder in the months following her accident-related surgery, and causation is not in dispute. The applicant was referred to Dr. Livia Lee, urologic surgeon, by Dr. Kreder, the Sunnybrook orthopaedic surgeon who repaired her pelvis. Dr. Lee assessed the applicant on June 20, 2021, via virtual platform and opined that the applicant symptoms are a combination of functional incontinence and urge incontinence and arranged for further examinations. Dr. Lee saw the applicant as a patient a second time to perform functional tests on the applicant's bladder on August 26, 2021. Dr. Lee opines that the applicant has developed an overactive bladder, and her urinary incontinence is likely secondary to a combination of overactivity as well as functional incontinence. At this point, the applicant is counselled to undertake timed voiding every 2 hours.

16The applicant has complained to multiple healthcare providers regarding the incontinence. The applicant also complained to Alexandra Leonardelli, OT on May 6, 2021, about urinary leakage when standing. The applicant also complained to Dr. Anthony D'Urzo, family physician on February 3, 2022, about urinary urgency. Taken together, on a balance of probabilities, the applicant has been consistently experiencing urinary incontinence since June of 2021.

17The applicant expressed how the incontinence impairs her quality of life. The applicant testified that she currently employs a timed voiding strategy and still utilizes 4-5 diapers per day as nothing stops the dribbling when she stands.

18I am persuaded by Dr. Stephanie Neu, urologist, who performed a s.25 assessment on the applicant on August 9, 2023, and issued her report August 11, 2023. Dr. Neu opines that the applicant suffers from ongoing urinary incontinence and lower urinary tract symptoms secondary to her trauma, relating these symptoms directly to her pelvic fracture as well as her traumatic brain injury. Dr. Neu, utilizing Chapter 11.3 of the Guides concludes that the applicant has a 30% WPI as a result of the subject accident. I place a high weight on the report and testimony of Dr. Neu because of her explanation of the mechanism of the injury, the injury, the urinary symptoms the applicant is suffering and the implication of the symptoms on daily life, along with quantification of the number of incontinence pads the applicant is using daily. Dr. Neu also had an extensive memory of the applicant and historical clinical investigations of the symptoms. Dr. Neu's opinion, in my mind, aligns with the contemporaneous evidence regarding the applicant's issues with incontinence.

19Dr. Dean Elterman, urologist, performed a s.44 assessment on the applicant on May 23, 2024. Dr. Elterman concedes that the applicant's symptoms have been present for more than 3 years and that the situation is stable and that he had no concerns about the truthfulness of the applicant but declined to provide a rating and it is his contention that the applicant has not yet reach maximal medical recovery. Dr. Elterman's report and testimony is given a diminished weight because he maintained that a rating could not be offered until the applicant had reached maximal medical recovery which is not stated directly or alluded to in the Guides which provide the framework for rating permanent impairments. Dr. Elterman does agree that the symptoms the applicant is experiencing are in relation to the accident, agrees she has an impairment, and that the impairment is permanent and points to the injury to the sacrum as a potential source.

20Taken together, on a balance of probabilities, the applicant has a loss of urinary control that impacts her quality of life. I find that the applicant's WPI rating for urinary impairment is 30%.

Neuro-physiatry/ psychology evaluation

21I accept Dr. Hasting's assignment of 14% impairment of the applicant's mental status. I provide a high weight to the report and testimony of Dr. Hastings because of the doctor's informative review of the applicant's medications, the utility of those medicines and the implication of those medicines on function; Dr. Hastings also clearly drew connections between the subject accident, the symptoms the applicant was experiencing and the outcome of his testing and observations. Dr. Hastings follows the tests and process identified in the Guides and points to test results, performance and observations of the applicant as underpinning his assessed rating. Dr. Hastings provides for the rating at the highest end of the available range opining that the effects of the concussion are seen in her cognitive and functional decline.

22I am persuaded by the testimony and report of Dr. Robert Hastings, physical medicine and rehabilitation specialist who conducted a neuro-physiatry assessment on the applicant on June 14, 2023. Dr. Hastings diagnoses the applicant with mild traumatic brain injury with resultant post-concussive syndrome and L5 transverse process fracture and assigned WPI ratings for medication effects (3%), lumbosacral spine (5%), mental status impairment (14%), sleep impairments (5%) and headaches (5%). Dr. Hastings added that the ratings provided do not appear to capture the severity of the applicant's functional impairments; "her symptoms are beyond what would be expected from a physical perspective."

23I agree with Dr. Hasting's assignment of 3% impairment for medications effects. Dr. Hastings assesses that the applicant's routine use of prescriptions medications for pain which includes narcotic analgesics used up to every 4 hours per day generates risks of use and potential side effects. I note Hydromorphone first appears in the records as a new medication in the Sunnybrook discharge summary of January 29, 2021, and the applicant has regularly reported taking up to 8 tablets of Hydromorphone per day.

24I find that the applicant has been regularly and consistently complaining regarding her lack of sleep and in particular notes issues with initiation and maintenance. Dr. Hasting assesses that the applicant's issues with sleep merit a rating of 5% WPI. I note that the applicant had been complaining to her family doctor Dr. D'Urzo about fragmented sleep beginning on February 18, 2022 and has noted sleep initiation and maintenance as current complaints to Ms. Janki Satyapanthi, physiotherapist on July 29, 2021; to Dr. Alfonso Marino on August 19, 2021; to Matthew Chan, occupational therapist over 4 sessions from July 28- November 1, 2022; and Dr. Ladowsky-Brooks notes that the applicant was falling asleep during neuro-psychological testing on November 16, 2023 and took a break and 10 minute nap during the assessment. Taken together I am persuaded that a rating of 5% is supported by the evidence.

25I am persuaded by Dr. Hasting's opinion and reasoning with regard to his rating for the applicant's headaches at 5% WPI. Dr. Hastings opines that within the context of a diagnosed mild traumatic brain injury with direct head trauma a rating of 5% by analogy to greater occipital neuralgia noting that the headaches typically interfere with day-to-day function. The applicant's complaints regarding headaches have been consistent and regular. For example, on March 25, 2021, the applicant complained of daily headaches to Alexandra Leonardelli, occupational therapist; the applicant complains of regular mild headaches and weekly severe headaches noting that her poor sleep contributes to her headaches to Ms. Janki Satyapanthi, physiotherapist on July 29, 2021; on February 18, 2022, the applicant complains of daily headaches to family physician Dr. D'Urzo; on October 28, 2022 the applicant complains of headaches to Dr. Mendis.

26I understand that Dr. Hastings has applied a rating of 5% for the lumbosacral spine fracture and notes that this is supported by the respondent's orthopaedic assessor Dr. Galimore; however, I am concerned that double counting may occur with the gait derangement rating provided by Dr. Getahun and therefore have not included this 5% rating within this section.

27I am not persuaded by Dr. Ricki Ladowsky-Brooks, neuropsychologist who assessed the applicant on November 16, 2023. I afford Dr. Ladowsky-Brooks report a diminished weight because she reports that the applicant's neurocognitive test results are invalid, and yet offers a WPI score based on a 'benefit of the doubt' approach and the applicant's continued complaints. In my mind, neuro-psychological tests are the foundation of a neuro-psychologist's diagnosis. Dr. Ladowsky-Brooks theorizes that the extremely low-test scores are a result of poor motivation and fatigue, and not reflective of ability. In my mind invalid test results cannot be relied upon to make a diagnosis, especially when the reason for the invalidity is unknown. Dr. Ladowsky-Brooks provides a WPI score of 8% for mental status impairments relating that impairment exists, but the applicant is functionally independent.

28I am not persuaded by the testimony and reports by Dr. Talik Mendis, neurologist, who assessed the applicant on January 12, 2024, because of incomplete testing and incorrect interpretation of the Guides. For example, Dr. Mendis testified that headaches are not ratable in the Guides; this is not entirely correct, the rating of headaches is covered in section 15.9, while a specific rating is not provided for the context of the guides established at page 2 states "An impairment percentage derived by means of The Guides is intended, among other purposes, to represent an informed estimate of the degree to which an individual's capacity to carry out daily activities has been diminished.". Dr. Mendis also stated that sleep impairment is not ratable under the Guides, this is incorrect, this is covered within Chapter 4 The Nervous System at Table 6. In addition, Dr. Mendis opines on catastrophic impairment criterion 2 without having conducted the identified test. Dr. Mendis does not provide any WPI ratings opining that functional limitations and physical restrictions are not based on neurological accident-related injuries.

29Taken together, on a balance of probabilities, the applicant has suffered functional impairments as a result of headaches, medication effects, mental status, and sleep impairments. I find that the applicant's WPI rating for neuro-physiatry/psychology is 26%.

Orthopaedic Evaluation

30I am persuaded by the testimony, report, and rebuttal report of Dr. Tajedin Getahun, orthopaedic surgeon, who assessed the applicant on June 23, 2023, for a s.25 assessment. Dr. Getahun opines that the applicant has lower extremity impairments that include symphysis pubis displaced or separated 15% WPI, left sacrum into sacroiliac joint 10% WPI, right sacrum into sacroiliac joint 10% WPI for a total WPI of 32% WPI in the orthopaedic assessment component of the criterion 6 analysis. Dr. Getahun also offered lower extremity range of motion ratings for bilateral hips restricted range of motion 4% WPI, restricted range of motion bilateral knees 8% WPI, and restricted range of motion bilateral ankles 6% WPI; resulting in a WPI of 17%. Finally, Dr. Getahun finds a rating of 40% WPI for routine use of a walker with gait derangement. All ratings were considered by clinical coordinator Dr. Lisa Becker, physiatrist, who selected 40% WPI for gait derangement and routine use of a walker as the most comprehensive calculation of the applicant's impairment.

31Dr. Christopher Gallimore, orthopaedic surgeon assessed the applicant on December 6, 2023, for a s. 44 catastrophic assessment. Dr. Gallimore opined that the applicant had reached maximal medical recovery, and has impairments, as a result of the subject accident, which have caused functional limitations. Dr. Gallimore assigns the following combined orthopaedic ratings 5% WPI Cervicothoracic Spine, 5% WPI Lumbrosacral Spine, 5% WPI Symphysis Pubis, 10% WPI Sacroiliac Joint, 2% WPI Left Knee, 4% WPI Right Knee, 2% WPI Right hip for a combined rating of 28% WPI.

32I agree with Dr. Becker, on a balance of probabilities, the accurate rating for the applicant's lower extremity impairment is the 40% gait derangement assessment rating provide by Dr. Getahun. Dr. Galimore identifies serious and permanent impairments to the applicant's lower extremities including the lumbrosacral spine, symphysis pubis, sacroiliac joint, knees, and right hip. Dr. Getahun further identifies the second sacroiliac joint, left hip and there are various minor variations in the provided ratings between the two assessors. In addition, the applicant has maintained, since discharge from St. John Rehab Centre in March 2021, that she requires supports in order to ambulate. I also point to the criterion 2 assessment conducted by both orthopaedic assessors wherein the applicant was not able to ambulate the required distance without a walker as further evidence of the applicant's gait derangement and the appropriateness of the rating within the context of the criterion 6 rating.

33On a balance of probabilities, the applicant's orthopaedic impairments are correctly rated at 40% WPI.

Combined Values Analysis

34In accordance with my findings, I applied the combined valued chart to be used in accordance with the AMA Guides to be as follows:

Area Impairment

Tribunal's Finding

Medication effects

3%

Sleep Impairment

5%

Headaches

5%

Mental Status Impairment

14%

Urinary Impairment

30%

Gait derangement

40%

WPI Criterion 6

64%

35I find that the applicant, on a balance of probabilities, has sustained a 64% WPI under criterion 6 and therefore meets the test and is found to be catastrophically impaired according to criterion 6.

Criterion 2 Catastrophic Impairment

36For the reasons that follow, I find on a balance of probabilities that the applicant has sustained a catastrophic impairment according to criterion 2 of the Schedule.

37The Schedule defines a criterion 2 catastrophic impairment as a severe and permanent alteration of a prior structure and function involving one or both legs as a result of which the insured person's score on the Spinal Cord Independence Measure ("SCIM"), Version III, item 12 (Mobility Indoors), as published in Catz, A., Itzkovich, M., Tesio L. et al, A multicentre international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation, Spinal Cord (2007) 45, 275-291 and applied over a distance of up to 10 metres on an even indoor surface is 0 to 5.

38The applicant submits that she is catastrophically impaired according to criterion 2 of the Schedule and relies on the reports and testimony of Dr. T. Getahun, orthopaedic surgeon and Ms. Tanya Krasner-Fisherman, physiotherapist.

39The respondent denies that the applicant is catastrophically impaired according to criterion 2 and relies on the report and testimony of Dr. Chris Gallimore.

40While they did not concede that the applicant had suffered a catastrophic impairment under criterion 2, all assessors found that the applicant did not complete the SCIM without a walker, which would generate a score on the scale that meets the legal test. The dispute centres on whether the applicant has suffered a severe and permanent alteration of a prior structure and function involving one or both legs.

i. Ms. Krasner-Fisherman, physiotherapist observed the applicant ambulate in a straight carpeted hallway that was clearly marked for a 10-meter distance utilizing her walker '"in a slow and cautious pattern", which corresponds to a score of 4 on the SCIM. Ms. Krasner-Fisherman also had the applicant attempt the test with a cane; the applicant was observed to be unsteady and reached for furniture as she attempted to get to the test course, the test was discontinued. I provide a high weight to the report and testimony of Ms. Krasner-Fisherman because she is the only assessor to have completed the identified test correctly and provide a rating that aligned with the scale provided in the SCIM. Ms. Krasner-Fisherman also attempted to have the applicant complete the testing course with a cane, which provides me confidence the SCIM was fully evaluated.

ii. Dr. Getahun testified that the applicant was able to traverse the 10-meter test with a walker during which Dr. Getahun observed the applicant exhibit an abnormal gait. Dr. Getahun assigned a score of 4 on the SCIM but acknowledged that his test course does not meet the course outlined in the test.

iii. Dr. Gallimore opines that the applicant was unable to walk a 10-metre course without a walker but did not provide a SCIM score.

41Taken together, and on a balance of probabilities, I find that the applicant score on the SCIM is 4.

42In the opinion of the post-accident attending surgeon, the injuries suffered by the applicant have resulted in permanent weakness of the pelvis. Dr. Hans Kreder performed the surgery and saw the applicant several times post-surgery for general surgery follow-up and over the following 3 years to assess ongoing pain. On July 29, 2021, Dr. Kreder assessed the recovery progress of the applicant and opined that "from the pelvic perspective, she will have some permanent weakness and lack of endurance". In my mind Dr. Kreder is outlining severe and permanent alteration of a prior structure and function involving one or both legs.

43I provide Dr. Getahun's report and testimony with a high weight because of his detailed knowledge of the AMA Guides and cogent analysis of his testing and observations. Dr. Getahun assessed the applicant on June 23, 2023, and concluded that the injuries to her hips, knees and ankles constitute permanent and serious alteration of prior structure and function. Dr. Getahun also opines that the applicant's use of a walker is consistent with the nature of her injury.

44Dr. Gallimore did not provide a SCIM rating because he believes the reason for the use of the walker is not related to an orthopaedic reason. I provide a diminished weight to the opinion of Dr. Gallimore because there is no such caveat contained within the identified test; further, Dr. Gallimore in the same report, provides lower extremity impairments for his criterion 6 analysis that merit rating under the Guides, which in my mind acknowledges permanent injuries, and yet he does not explain why those rated injuries to the lower extremities do not merit consideration as a serious and permanent alteration to a prior structure.

45I accept the SCIM score rating by Ms. Krasner-Fisherman and I agree with Dr. Getahun that the injuries to the applicant's pelvis, hips, knees, and ankles constitutes a severe and permanent alteration of a prior structure and function involving both legs.

46For the reasons above, I find on a balance of probabilities that the applicant has sustained a catastrophic impairment according to criterion 2 of the Schedule.

Attendant care benefits

47The applicant has demonstrated that attendant care benefits in the amount of $5,190.00 had been incurred between October 3, 2021, and March 15, 2022.

48The applicant, on a balance of probabilities, has not met her onus to demonstrate entitlement to attendant care benefits in the amount of $1,425.00 per month to date and ongoing.

49Section 19 of the Schedule states that an insurer shall pay for all reasonable and necessary expenses incurred by or on behalf of an insured person as a result of an accident for attendant care services (ACBs) provided by an aide or attendant. Section 42(1) of the Schedule provides that an application for ACBs must be in the form of, and contain the information required to be provided in, the version of the document entitled Assessment of Attendant Care Needs ("Form-1").

50The applicant claims entitlement to $1,425.00 in monthly attendant care benefits from October 3, 2021, to date and ongoing. The benefit had been paid by the respondent from the date of the St. John Rehab Centre discharge in March 2021 until policy limits were exhausted in October 2021.

51The applicant submits that she requires attendant care services and relies on the Form 1 and testimony of Alexandra Leonardelli OT, as well as the testimony of the applicant and her sister.

52The respondent submits that the Form 1 is not reasonable and necessary and is not representative of the applicant's current situation.

53The applicant's claim for $1,425.00 in monthly attendant care costs is not supported by a Form 1. I have not been pointed to a Form 1 that outlines the applicant requires $1,425.00 in attendant care support. The Form 1 I have been pointed to outlines $10,476.71 in monthly attendant care costs.

54The applicant's current attendant care needs have not been assessed. Alexandra Leonardelli, OT, undertook an assessment of the applicant's attendant care needs on March 2, 2021, and issued her report March 25, 2021. Ms. Leonardelli also worked as a treating OT with the applicant until October 25, 2021. The Form 1 submitted by Ms. Leonardelli sets out that the applicant requires $10,476.71 in attendant care services per month. Ms. Leonardelli, OT testified that she has not conducted a subsequent Form 1 assessment and cannot provide any insight to the applicant's current needs.

55I see alignment between the evidence before me, from the period in which the Form 1 was completed, six days post discharge from St. John's Rehab Centre, and the functional limitations identified in the Form 1; however, the evidence before me that is more recent does not align with the functional limitations identified in the Form 1. For example, the applicant did not testify that she currently required assistance with dressing and undressing; Ms. Leonardelli testified that the applicant had shown minor gains between the Form 1 assessment and when her care relationship ended in October of 2021 such as walking in her apartment with a four-point cane; and Ms. Abubeker, the applicant's sister testified that she assists with some grooming activities such as post shower drying and toe nail clipping and often leaves the applicant on her own for more than 8 hours at a time. Although the Form 1 identified $10,476.71 in monthly attendant care needs, evidence demonstrates that the applicant had not utilized more than $3,000.00 in monthly attendant care services at any point while receiving in-home supports. Taken together, the Form 1 is not an accurate reflection of the applicant's current attendant care needs and therefore is not reasonable and necessary.

56I find that the applicant has not met her onus to demonstrate, on a balance of probabilities, that she is entitled to $1,4245.00 in attendant care benefits.

57While the applicant has not met her onus for the attendant care benefit to date and ongoing I have been pointed to invoices and timesheets submitted by Attendants with Care Inc. Invoices and timesheets cover the period from March 3, 2021, to March 15, 2022:

i. October 3, 2021 – November 2, 2021, $1,425.00

ii. November 3, 2021 – December 2, 2021, $1,500.00

iii. December 3, 2021 – January 2, 2022, $1,305.00

iv. January 3, 2022 – February 2, 2022, $480.00

v. Feb 16, 2022 – March 15, 2022, $480.00

58I find that these expenses have been incurred.

59The Form 1 and attendant care invoices align and are congruent with contemporaneous evidence. The invoices submitted by Attendants With Care Inc. detail the duties performed as dressing and undressing, medication administration, grooming, extra laundering, feeding, hygiene and bowel care, basic supervisory, exercise, mobility, and bathing. The Form 1 from Ms. Leonardelli assesses that the applicant requires assistance with dressing and undressing, medication administration, grooming, extra laundering, hygiene, and bowel care, basic supervisory, exercise, mobility, and bathing. In my mind, the timesheets provided, and duties being performed align exactly with the Form 1 and with the evidence of the applicant's function from October 2021 to March 2022 as seen in the contemporaneous care notes of Janki Satyapanthi, physiotherapist and the CNRs of family physician Dr. Anthony D'Urzo. Taken together, I find that these attendant care expenses were reasonable and necessary.

60I have also been pointed to evidence that the respondent paid invoices that averaged $3,000.00 per month from March 3, 2021, to October 2, 2021. In a letter from the respondent to the applicant dated March 22, 2021, the respondent stated that based on the Form 1, they agreed to pay for all attendant care benefits up to the non-catastrophic policy limits of $3,000.00 per month. In my mind, the respondent was paying the invoices because the applicant was entitled. On December 9, 2021, the respondent sent another letter relating that they had received an invoice for $1,425 for attendant care service and informing the applicant that they would not be paying the invoice because policy limits had been exhausted. The reason for denial does not relate to functional limitation but only to funding limits.

61Ms. Abubeker has also testified that she provided attendant care services and receipts have been submitted. These receipts do not meet the standard for payment, Ms. Abubeker has not identified that she has any skills, training, or experience in providing attendant care services and no evidence has been pointed to that Ms. Abubeker lost wages or incurred any financial consequence as a result of the provision of the attendant care services for her sister.

62I find that the applicant has demonstrated that attendant care benefits in the amount of $5,190.00 had been incurred between October 3, 2021, and March 15, 2022, and were reasonable and necessary in light of the applicant's documented functional limitations.

63The applicant, on a balance of probabilities, has not met her onus to demonstrate entitlement to attendant care benefits beyond March 15, 2022.

Occupational therapy, Physiotherapy & Psychological Treatment Plans

64The applicant has not met her onus to demonstrate entitlement to the occupational therapy services treatment plans of October 22, 2021, or December 7, 2022.

65The applicant has not met her onus to demonstrate entitlement to the physiotherapy services treatment plan of December 8, 2021.

66The applicant has not met her onus to demonstrate entitlement to the psychological services treatment plan of April 14, 2022.

67To 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.

68The applicant has not pointed me to the plans in dispute or any other evidence directly related to these treatment plans and did not testify about these plans in specific. I have not been pointed to or heard evidence of these disputes. I find that the applicant has not met her onus to demonstrate entitlement to the four occupational therapy, physiotherapy, or psychological treatment plans.

Interest

69Interest applies on the payment of all overdue benefits pursuant to s. 51 of the Schedule.

ORDER

70I find that:

i. the applicant, on a balance of probabilities, has suffered a catastrophic impairment as defined by the Schedule.

ii. the applicant has not met her onus and is not entitled to attendant care benefits in the amount of $1,425.00 per month from October 3, 2021, to date and ongoing

iii. Based on the finding of catastrophic impairment and new funding limits being available; the applicant is entitled to the attendant care benefits incurred with Attendant with Care Inc from October 3, 2021, to March 15, 2022.

iv. the applicant has not met her onus and is not entitled to the four treatment plans in dispute.

v. the applicant is entitled to interest on all overdue and outstanding payments.