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:
Ahmad Ebrahim
Applicant
and
Royal Sun Alliance Insurance (RSA)
Respondent
DECISION
ADJUDICATOR:
Timothy Porter
APPEARANCES:
For the Applicant:
Michael Giordano, Counsel
Antonia Hristova, Counsel
For the Respondent:
Raman Pandher, Counsel
Meena Rishihesan, Counsel
HEARD: by Videoconference:
November 10-13, 2025
OVERVIEW
1Ahmed Ebrahim the applicant, was involved in an automobile accident on May 26, 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, Insurer, 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 according to criterion 8, as defined by the Schedule?
ii. Is the applicant entitled to attendant care benefits in the amount of $6,000.00 per month from December 10, 2024, to date and ongoing?
iii. Is the applicant entitled to $7,951.78 for various assistive devices, proposed by Auxilium Wellness Centre Inc. in a treatment plan/OCF-18 (“plan”) submitted November 28, 2024, and denied December 11, 2024?
iv. Is the applicant entitled to $87.19 ($2,082.15 less $1,994.96 approved) for chiropractic services, proposed by Seksek Chiropractic Professional Corporation in a plan submitted May 16, 2024, and denied May 16, 2024?
v. Is the applicant entitled to $87.19 ($2,197.77 less $2,110.58 approved) for chiropractic services, proposed by Seksek Chiropractic Professional Corporation in a plan submitted February 27, 2024, and denied February 29, 2024?
vi. Is the applicant entitled to $120.25 ($3,918.75 less $3,718.50 approved) for physiotherapy services, proposed by Seksek Chiropractic Professional Corporation in a plan submitted February 7, 2024, and denied February 26, 2024?
vii. Is the applicant entitled to $1,873.30 ($3,831.09 less $1,957.79 approved) for psychological services, proposed by Premier Medical Health Centre in a plan submitted April 11, 2023, and denied April 16, 2023?
viii. Is the applicant entitled to $1,995.53 for psychological services, provided by Seksek Chiropractic Professional Corporation in a plan submitted August 22, 2022, and denied September 9, 2022?
ix. Is the applicant entitled to $2,503.39 for chiropractic services, proposed by Seksek Chiropractic Professional Corporation in a plan submitted April 26, 2022, and denied April 28, 2022?
x. Is the applicant entitled to $2,200.00 for occupational therapy services, proposed by Premier Medical Health Centre in a plan submitted May 30, 2023, and denied June 2, 2023?
xi. Is the applicant entitled to $3,918.75 for physiotherapy services, proposed by Seksek Chiropractic Professional Corporation in a plan submitted January 17, 2022, and denied April 28, 2022?
xii. Is the applicant entitled to $5,905.88 for chiropractic services, proposed by Harwood Wellness Centre Inc. in a plan submitted February 1, 2023, and denied February 1, 2023?
xiii. Is the applicant entitled to $1,302.25 ($2,998.50 less $1,695.25 approved) for an attendant care assessment, proposed by Auxilium Wellness Centre Inc. in a treatment plan submitted October 24, 2024, and denied November 8, 2024?
xiv. Is the applicant entitled to $8,957.00 ($21,357.00 less $12,400.00 approved) for a CAT assessment, proposed by Omega Medical Associates in a plan submitted February 26, 2024, and partially denied February 27, 2024?
xv. Is the applicant entitled to $420.69 for prescriptions, submitted on a claim form (OCF-6) dated July 4, 2023, and denied July 17, 2023?
xvi. Is the applicant entitled to $209.98 for prescriptions, submitted on a claim form (OCF-6) dated June 16, 2023, and denied June 30, 2023?
xvii. Is the applicant entitled to $165.58 for prescriptions, submitted on a claim form (OCF-6) on December 10, 2021, and denied January 10, 2022?
xviii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
xix. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant, on a balance of probabilities, is catastrophically impaired according to criterion 8.
4The applicant is entitled to $3,233.31 a month in attendant care costs from December 10, 2024, to date and ongoing.
5The applicant has not met his onus and is not entitled to the four chiropractic treatment plans.
6The applicant has not met his onus and is not entitled to the attendant care assessment plan.
7The applicant has not met his onus and is not entitled to the assistive devices’ treatment plan.
8The applicant has not met his onus and is not entitled to the two physiotherapy treatment plans.
9The applicant has not met his onus and is not entitled to the two psychological treatment plans.
10The applicant has not met his onus and is not entitled to the three OCF-6 claim forms.
11The applicant has not met his onus and is not entitled to the balance of the partially approved CAT determination assessment plan.
12The applicant has not met his onus and is not entitled to the occupational therapy treatment plan.
13Interest applies to all overdue payments.
14The applicant has not met his onus and is not entitled to an Award.
ANALYSIS
Catastrophic impairment
15I find, on a balance of probabilities, that the applicant has suffered a catastrophic impairment as a result of the subject accident and according to criterion 8 in the Schedule.
16Catastrophic impairment is a legal definition and not a medical test, although the legal test involves consideration of medical evidence. The applicant is proceeding under s. 3(1)(8) of the Schedule and in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (the “Guides”). This section of the Schedule explores mental and behavioural impairments that are rated according to how seriously they affect a person’s useful daily functioning, physical impairments have no bearing within these ratings. Chapter 14 of the Guides set out the four spheres of functioning and the classification of impairments as represented in the chart below:
Area 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
(“ADLs”)
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 (“CPP”)
Adaptation (In a
work-like setting)
17The applicant has the burden of proving on a balance of probabilities that they are catastrophically impaired, under criterion 8, as a result of the accident. Given that the accident occurred on July 28, 2021, a catastrophic impairment under criterion 8 requires at least three of the four spheres of functioning to be a Class 4 (marked) impairment or one sphere to be a Class 5 (extreme) impairment.
18The applicant submits that he has suffered a catastrophic impairment, according to criterion 8, and relies on his testimony, the report and testimony of Dr. Gavett-Lui, psychiatrist and the report by Mr. Habash, OT.
19The respondent denies that the applicant is catastrophically impaired and relies on the reports and testimony of Dr. Wiesenthal, psychiatrist and Ms. Wendt, OT.
20The applicant underwent a s.25 catastrophic impairment determination multidisciplinary assessment by Dr. Emily Gavett-Liu, psychiatrist on May 21, 2024. Dr. Gavett-Lui issued her report August 5, 2024, and provided the following ratings of the applicant in the four spheres of function:
Area 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
Marked Impairment
Social Functioning
Marked Impairment
Concentration, Persistence and Pace
Marked Impairment
Adaptation (In a work-like setting)
Marked Impairment
21Dr. Gavett-Lui provides a diagnosis of major depressive disorder with anxious distress, post-traumatic stress disorder and somatic symptom disorder with predominant pain, persistent and severe. I provide a very high weight to the report and testimony of Dr. Gavett-Lui because she offers a detailed explanation of the impact of the emotional dysregulation observed during the mental status exam, and provides an analysis that draws on observed examples, test results and her mental status exam to demonstrate her findings are rooted in the evidence.
22The applicant also underwent catastrophic impairment determination multi-disciplinary assessment by Dr. Stephanie Wiesenthal, psychiatrist on December 4, 2024. Dr. Wiesenthal issued her report on February 14, 2025, and provided the following ratings of the applicant in the four spheres of function:
Area 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
Marked Impairment
Social Functioning
Moderate Impairment
Concentration, Persistence and Pace
Moderate Impairment
Adaptation (In a work-like setting)
Moderate Impairment
23I provide a diminished weight to the report of Dr. Wiesenthal because of her limited analysis of observation, testing or objective performance within the four spheres. For example, within the sphere of concentration persistence and pace Dr. Wiesenthal relates the applicant’s subjective reports and an excerpt from Ms. Wendt’s report and opines only that the applicant’s thought process was logical and coherent. In my mind this is insufficient analysis and does not adequately account for the observations of Ms. Wendt. Without analysis that provides examples it is not clear how Dr. Wiesenthal reached her conclusions.
Activities of Daily Living (“ADL”)
24According to the Guides, ADL includes such activities as self-care, personal hygiene, communication, ambulation, travel, sexual function, sleep, social and recreational activities in the context of the individual’s overall situation, the quality of these activities is judged by their independence, appropriateness, effectiveness, and sustainability. It is necessary to define the extent to which the individual is capable or initiating and participating in these activities independent of supervision or direction. What is assessed is not simply the number of activities that are restricted, but the overall degree of restriction or combination of restrictions.
25There is agreement amongst the assessors that the applicant has a marked impairment of his ADL function, therefore I find that the applicant has a marked impairment within this sphere, and no further analysis will be undertaken.
Social
26According to the Guides an individual’s capacity to interact appropriately and communicate effectively with other individuals includes the ability to get along with others such as family members, friends, neighbours, grocery clerks, lenders, etc... Impaired social functioning may be demonstrated by a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, social isolation, or similar events or characteristics. Strengths in social functioning may be documented by an individual’s ability to initiate social contact with others, communicate clearly and interact and actively participate in group activities, consideration for others, awareness of others’ sensitivities and social maturity.
27For the reasons that follow I find that the applicant, on a balance of probabilities, has a marked impairment of his social function.
28Dr. Gavett-Lui opines that the applicant exhibited signs of emotional dysregulation during her interview becoming unclear in his communication and becoming noticeable fatigued; which the assessor outlined would affect his ability to relate to family, friends and community members. Further evidence of emotional dysregulation can be seen in Mr. Ali Habash, occupational therapist’s (“OT”) report. Mr. Habash assessed the applicant and issued a report April 26, 2024. Mr. Habash relates that during his assessment the applicant exhibited pain behaviours throughout the assessment and had a “dysphoric affect having several bouts of tears and with a vocal tone that was almost constantly that of an individual holding back tears”.
29The applicant is disengaging from social situations. The applicant testified that while he had more than 10 friends’ pre-accident, he has now cut off all social ties and in the last four years has had one friend drive him to Toronto from Windsor for an assessment and visited a friend in London for a cultural festival. Taken together, and on a balance of probabilities, the applicant is isolating himself from social situations.
30The applicant’s relationship with his immediate family have been negatively impacted. Dr. Gavett-Lui opines that pre-accident the applicant was active with his children, engaging in outings and having neighbours’ visit. In contrast Dr. Gavett-Lui testified that the applicant post-accident is barely engaged as a father. Pre-accident the applicant was happily married with five children. Post-accident the applicant reports that “the love is there at the core of it but our manners and approach to each other have changed;…but a lot of times we’re either screaming at the kids or screaming at each other.” The applicant also testified that he is no longer engaging in any intimate activity with his wife, this is corroborated with self-reports to his family physician beginning on July 6, 2021. Taken together the applicant appears to be avoiding interpersonal relations with even his immediate family.
31Dr. Wiesenthal provides a limited analysis of the applicant’s social sphere recounting subjectively reported symptoms and an excerpt from Ms. Wendt’s report. I am drawn to the conclusion by Ms. Wendt, the applicant’s “reported mood was consistent with his demonstrated behaviours during both days of testing.” Ms. Wendt goes on to relate that the applicant was frequently focused on his pain, had inconsistent eye contact, and a restricted affect and did not smile or laugh at any time. These seem to be similar observations as from Mr. Habash and without an alternate explanation of Dr. Wiesenthal’s reasoning, her rating seems out of line with the evidence.
32I am satisfied that the applicant is suffering from a major depressive disorder as diagnosed by Dr. Gavett-Lui. The applicant began to receive referrals for psychological support, from his family physician, Dr. Omar Zghal, due to major depressive disorder in January of 2022; of note “depression”, “major depressive disorder” and “severe depression” appear throughout the records continuously.
33Taken together, the applicant’s ability to interact appropriately and communicate effectively with family, friends and community members has been impaired. On a balance of probabilities, the applicant has suffered a marked impairment of his social function.
Concentration Persistence and Pace
34According to the Guides Concentration, Persistence and Pace (“CPP”) is needed to perform many activities of daily living, including task completion. Task completion refers to the ability to sustain focussed attention long enough to permit the timely completion of tasks commonly found in activities of daily living or a work setting. Strengths and weaknesses in mental concentration may be described in terms of frequency of errors, the time it takes to complete the task and the extent to which assistance is required to complete the task.
35For the reasons that follow I find that, on a balance of probabilities, the applicant has suffered a marked impairment of his concentration, persistence and pace sphere.
36Dr. Gavett-Lui provides multiple examples of the applicant’s functional impairment. Dr. Gavett-Lui opined that the applicant’s concentration ability decreased as her assessment progressed, increasingly requiring repetition of questions, rephrasing of questions and redirection when his answers were off track. Dr. Gavett-Lui related that the applicant’s memory has been negatively impacted; for example, the applicant misplaced a school related field trip permission form, as a result his daughter was not able to attend the field trip; in addition the applicant and his family were evicted from a rental home by the Landlord and Tenant Board, the applicant had forgotten about the hearing and did not attend. Taken together the applicant is demonstrating an elongated time to complete the mental status interview and is regularly asking for assistance to complete the interview both of which demonstrate a weakness in mental concentration.
37The observations of the applicant by the respondent’s assessors does not appear to be aligned. Dr. Wiesenthal provided a rating of moderately impaired for this sphere of function and opines that the applicant did “appeared to be distracted as he was grimacing as if in pain”; she notes that he continues to drive and that his speech was of a normal rate and rhythm during the assessment. In contrast Ms. Wendt observes that the applicant had a reduced ability to sustain his participation in or complete even simple cognitive tasks, Ms. Wendt also observed that the applicant has a limited ability to sustain attention when distractions are present, pointing to his distraction by, what the assessor referred to as, quiet talking by children in another room; he had a slow pace of speech and that his need for regular breaks and repositioning would further slow his pace of task completion.
38Prior to the subject accident the applicant reports most financial transactions were undertaken in cash. Ms. Wendt, OT, conducted an in-home assessment of the applicant which included a series of “Canadian Money Worksheets”. The tasks were largely addition and subtraction tasks that expressly showed the values of various coins. While the applicant was capable of understanding the value of each coin with only 1 error, the sheets that focussed on addition and subtraction were abandoned after an attempt at a single question which the applicant was not successful in answering. The applicant took a break due to a headache and then declined to continue with the task. Taken together, the applicant, on a balance of probabilities, is exhibiting the cognitive difficulties, and anergia that Dr. Gavett-Lui opined would lead to withdrawal or worsening emotional symptoms.
39I find that, on a balance of probabilities, the applicant has suffered a marked impairment of his concentration, persistence and pace sphere.
Adaptation
40According to the Guides, deterioration or decompensation, often referred to in the inverse in work or work-like settings refers to repeated failure to adapt to stressful circumstances. In the face of such circumstances the individual may withdraw from the situation or experience exacerbation signs and symptoms. He or she may decompensate and have difficulty maintaining activities of daily living, continuing social relationships and completing tasks. Stressors common to the environment include attendance, making decisions, scheduling, completing tasks and interacting with others.
41For the reasons that follow I find that, on a balance of probabilities, the applicant has suffered a marked impairment of his adaptation sphere.
42Dr. Gavett-Lui opines that the applicant was not able to maintain work-appropriate engagement and emotional demeanour during the assessment; exhibiting a depressed mental state, had difficulty maintaining his attention and demonstrated difficulties with memory retrieval. Dr. Gavett-Lui finds that the applicant has severe stress intolerance, as stress seems to cause either withdrawal and/or worsening emotional symptoms.
41Mr. Habash, OT, observed that the applicant struggled with emotional regulation through the assessment and demonstrated deterioration during a grocery store outing, withdrawing from the task after only 2 minutes.
42Taken together, and on a balance of probabilities, the observations and opinions expressed by the applicant’s assessors are describing impairment levels that are more serious than compatible with some but not all useful functioning and are within the scope of significantly impeding useful function.
43There is insufficient analysis to provide any confidence in Dr. Wiesenthal’s rating for this sphere of function. Dr. Wiesenthal lists the subjective reports of the applicant, an excerpt from Ms. Wendt’s report and her rating. In this instance I also question the selection of excerpt and draw attention to the specific excerpt of Ms. Wendt report within Dr. Wiesenthal’s report “With respect to attendance and punctuality, Mr. Ebrahim participated in both assessments as scheduled.”; which seems at odds with Ms. Wendt’s report that states “Mr. Ebrahim’s spouse greeted the translator and I at the entrance to his home. The examinee was reportedly still asleep when we arrived.” In my mind, Dr. Wiesenthal’s report provides no analysis or examples that draw the evidence together to provide a sense that the assessor has concluded based on the evidence. Finally, it appears the applicant was not prepared for the assessment at his home, and I am not able to reconcile this with a general expectation of timely attendance in a workplace and how this did or did not factor into the analysis by Dr. Wiesenthal.
44For the reasons above, I find, on a balance of probabilities, that the applicant has suffered a marked impairment of his adaptation sphere
45For the reasons above, I find, on a balance of probabilities, that the applicant has suffered a catastrophic impairment according to criterion 8 in the Schedule.
Attendant Care Benefit
46Section 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”).
47The applicant submits that he requires attendant care benefits due to functional limitations he received as a result of the subject accident and relies on the Form 1 submitted by Remik Zakrzewski, OT on November 4, 2024.
48The respondent submits that the applicant’s Form 1 of November 4, 2024, is not reasonable or necessary, standing by their partial denial, and relies on the Form 1 and testimony by Ms. Kelly Wendt, OT.
49Part 1 of Form 1 explores needs for routine personal care. The Form 1 submitted by Remik Zakrzewski assesses that the applicant requires 280 minutes per week to support dressing and undressing, 175 minutes per week for grooming support, 630 minutes per week of support with feeding, 315 minutes per week in mobility assistance, and 60 minutes per week in extra laundering, for a total of 1,470 minutes per week. Part 2 of Form 1 explores needs for basic supervisory care. The Form 1 by Mr. Zakrzewski assesses that the applicant requires 2,520 minutes in hygiene support, 60 minutes per week to coordinate attendant care and 1,260 minutes per week in supervisory care in case of emergency. Part 3 of Form 1 explores the needs for more complex healthcare, hygiene, and care functions. The Form 1 submitted by Mr. Zakrzewski proposes 210 minutes per week of assistance with prescribed exercises, 140 minutes per week for skin care, 105 minutes per week in support for medication, monitoring and administration, 175 minutes per week in bathing support, and 70 minutes per week to monitor and maintain supplies and equipment. In sum the plan proposes $6,481.54 in monthly attendant care support.
50The Remik Zakrzewski OT’s Form 1 does not completely align with evidence before me. The Form 1 submitted by Remik Zakrzewski, OT assesses that the applicant requires 630 minutes of support with feeding, the applicant did not testify to any difficulty with or need for support in feeding and on August 1, 2024 the applicant reports to family physician Dr. Zghal that he requires help with his appetite, he feels hungry but has early satiety, it is unknown how feeding support would assist against early satiety. The applicant did not express any requirement for support with mobility, and most assessments express that the applicant departs regularly for cigarette breaks and while most note an antalgic gate the applicant did not express that his mobility required support. The need for extra laundering was not outlined by the applicant, Dr. Zghal’s clinical notes and records indicate that the applicant does not have any incontinence issues, and I was not pointed to any evidence that the applicant’s condition caused excessive spillage. Finally, the applicant has reported to Ali Habash that he is independent with his prescribed exercises. Mr. Zakrzewski’s assessment that the applicant requires 1,260 minutes of supervisory care each week is the only record I have been pointed to that expresses this need. The applicant did not testify to any need for supervisory care, and I have not been pointed to any other records which indicate that the applicant requires this level of observation and support. 140 minutes per week for skin care in not reasonable and the applicant testified that the skin disorder which requires care is not as a result of the subject accident. 105 minutes per week for medication monitoring and support is not reasonable; the applicant testified that he did have issues with his memory and specifically cited the medication as an issue and then also testified that this had been rectified with pre-packaged pills from the pharmacy that are timed and indicated in blister packs. 70 minutes for monitoring and maintenance of equipment and supplies is not supported with any evidence; I am unclear as to which equipment and supplies are being monitored or maintained.
51A Form 1 was also completed and submitted by Kelly Wendt, OT. In Part 1 of the Form 1 regarding routine personal care Ms. Wendt assesses that the applicant does not require any support. In Part 2 of the Form 1 Ms. Wendt assesses that 350 minutes per week are required for hygiene care, 280 minutes of basic supervisory care and 30 minutes per week for coordination of attendant care. Ms. Wendt does not assess that there are any needs for Part 3 of the Form 1. In summary, Kelly Wendt OT proposes a plan of $662.20 in monthly attendant care support.
52The evidence does not entirely align with Ms. Wendt’s Form 1. The applicant has reported to Dr. Jay McGrory, psychologist, in 2023 that he requires assistance with dressing, self-care, and bathing due to the inoperability of his left hand. Ms. Wendt testified that the applicant had the functional ability to dress and undress himself; Ms. Wendt also conceded that she did not see the applicant dress or undress himself and was making assumptions based on her observations. In contrast, the applicant was observed by Ali Habash, OT struggling greatly in an attempt to dress. The applicant testified that he changes his clothes every 10 to 20 days and requires assistance dressing and undressing due to pain, something he has also raised with family doctor, Dr. Zghal on May 8, 2023. The applicant is showering infrequently and substantially less than pre-accident; he has reported to Ali Habash that he showers every 14 to 20 days; Ms. Wendt assessed no need for shower support and Mr. Zakrzewski assessed that the applicant required 175 minutes per week in showering support. Neither of these assessments seems entirely reasonable, while the applicant requires bathing support for 30 minutes, every 2 days seems more reasonable and in line with requirements for someone staying home most days. The applicant reported to Ali Habash that he is unable to trim the nails on his right hand, Ms. Wendt also observed this. Finally, the applicant is capable in an emergency. The applicant responded to enquiries by Ali Habash, OT regarding options in an emergency and the applicant was able to identify that he should call 911 in an emergency, additionally the applicant reported that he is able to ambulate out of the house and off of the porch and therefore is capable of exiting the home should the need arise.
53Taken together and on a balance of probabilities, I find that the applicant requires 280 minutes per week to support dressing and undressing, 175 minutes per week for grooming support, 2,520 minutes in hygiene support, 60 minutes per week to coordinate attendant care and 105 minutes per week in bathing support. In sum, a plan of $3,233.31 a month in attendant care support.
Assistive Devices
54To 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.
55Several exhibits were entered that were noted to deal with the assistive devices dispute. Both entries are for the same letter, an entry from each of the applicant and respondent for a letter of clarification, in which the respondent corrects an error in earlier correspondence, that the attached assessment was not for the assistive devices treatment plan but was for a physiotherapy services plan. The respondents exhibit also includes the assessment by Dr. Stephen Bartol, orthopaedic surgeon who is quite explicitly reviewing an OCF-18 dated April 2, 2025, and prepared by Shivang Khamar, physical therapist.
56I have no further specific information regarding this disputed plan. The applicant did not point me to a plan, denial or reference these devices during his testimony, with the exception of a bath chair which he had and is noted to use.
57The applicant has not met his onus to prove, on a balance of probabilities, that he is entitled to this benefit.
One Occupational Therapy, Four Chiropractic, Two Physiotherapy, and Two Psychological Treatment Plans
58I have no specific information regarding these elements of the dispute. The applicant did not point me to any OCF-18s regarding treatment plans for Occupational Therapy, Chiropractic, Physiotherapy or Psychological treatment. The applicant did not testify regarding these disputed plans.
59I have not been pointed to persuasive evidence to support the applicant’s entitlement to these nine treatment plans.
60The applicant has not met his onus to prove, on a balance of probabilities, that he is entitled to these benefits.
Catastrophic Determination Assessment and Attendant Care Assessment Plans
61I have no specific information regarding these disputed plans. The applicant did not point me to a plan or denial. The applicant did not testify directly regarding either the catastrophic determination or attendant care assessment plans.
62I have not been pointed to persuasive evidence to support the applicant entitlement to these assessment plans.
63The applicant has not met his onus to prove, on a balance of probabilities, that he is entitled to these benefits.
Three Prescriptions (OCF-6)
64I have no specific information regarding these OCF-6 submissions or their denial. The applicant did not point me to any OCF-6s or denials. The applicant did not testify directly regarding these OCF-6s.
65I have not been pointed to any persuasive evidence in support of the applicant’s entitlement to these OCF-6s.
66The applicant has not met his onus to prove, on a balance of probabilities, that he is entitled to these reimbursements.
Interest
67Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Interest applies on all overdue payments.
Award
68The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
69The applicant did not point me to any evidence and did not testify regarding an award. I do not see any evidence that would warrant an award.
ORDER
70The applicant, on a balance of probabilities, is catastrophically impaired according to criterion 8.
71The applicant is entitled to $3,233.31 a month in attendant care costs from December 10, 2024, to date and ongoing.
72The applicant has not met his onus and is not entitled to the four chiropractic treatment plans.
73The applicant has not met his onus and is not entitled to the attendant care assessment plan.
74The applicant has not met his onus and is not entitled to the assistive devices’ treatment plan.
75The applicant has not met his onus and is not entitled to the physiotherapy treatment plan.
76The applicant has not met his onus and is not entitled to the two psychological treatment plans.
77The applicant has not met his onus and is not entitled to the three prescriptions submitted on OCF-6 forms.
78The applicant has not met his onus and is not entitled to the partially approved CAT determination assessment plan.
79The applicant has not met his onus and is not entitled to the occupational therapy treatment plan.
80Interest applies to all overdue payments.
81The applicant has not met his onus and is not entitled to an Award.
Released: March 5, 2026
__________________________
Timothy Porter
Adjudicator