Arora v. Security National Insurance Company, 2026 CanLII 21044

Citation: Arora v. Security National Insurance Company, 2026 ONLAT 24-013449/AABS

Licence Appeal Tribunal File Number: 24-013449/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:

Rahul Arora

Applicant

and

Security National Insurance Company

Respondent

DECISION

ADJUDICATOR: Ulana Pahuta

APPEARANCES:

For the Applicant: Sofia Katyshev, Paralegal

For the Respondent: Matthew Dugas, Counsel

HEARD: By way of written submissions

OVERVIEW

1Rahul Arora, the applicant, was involved in an automobile accident on February 7, 2023 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, Security National 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. Is the applicant entitled to $1,112.91 for physiotherapy services, proposed by Lifemark in a treatment plan dated April 20, 2023?

ii. Is the applicant entitled to $4,290.93 for psychological services, proposed by All Health Medical Centre in a treatment plan dated June 17, 2024?

iii. Is the applicant entitled to $2,520.00 for an orthopedic assessment, proposed by All Health Medical Centre in a treatment plan dated June 13, 2023?

iv. Is the applicant entitled to $2,200.00 for a functional cognitive assessment, proposed by All Health Medical Centre in a treatment plan dated September 29, 2023?

v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

RESULT

3The applicant is entitled to the treatment plan in the amount of $1,112.91 for physiotherapy services, plus interest.

4The applicant is not entitled to the remaining treatment plans in dispute, or an award.

ANALYSIS

5Sections 14 and 15 of the Schedule set out 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.

6The applicant has the onus of proving on a balance of probabilities that the treatment plans are reasonable and necessary because of the accident. To meet this burden, the applicant should identify the goals of the plan, how the goals are being met to a reasonable degree and whether the time and cost expended to achieve these goals is proportional to the benefit of treatment.

OCF-18 dated April 20, 2023 for $1,112.91 in physiotherapy services

7I find that the applicant has established that the OCF-18 for physiotherapy services is reasonable and necessary.

8The applicant submits that the treatment plan is reasonable and necessary, as he had been diagnosed soon after the accident with sprain and strain of the thoracic spine and WAD II injuries, both of which are conditions commonly treated through physiotherapy. The applicant further argues that his post-accident pain continued and that he was referred to a pain specialist clinic on September 26, 2023.

9The respondent submits that the treatment plan is not reasonable and necessary, and relies on its physiatry insurer’s examination report of Dr. Ko dated September 12, 2023. Dr. Ko noted that the applicant had reported that physiotherapy had only helped “on the day of the therapy”, and that the physical examination had revealed full range of motion. Dr. Ko concluded that the applicant had sustained only soft tissue injuries and that the physiotherapy treatment is not reasonable and necessary.

10I find that the applicant has established entitlement to the treatment plan for physiotherapy services.

11This treatment plan was dated April 20, 2023, only two months post-accident. It proposed six sessions of physiotherapy and six sessions of massage therapy, to address the stated goals of pain reduction, increased range of motion, increase in strength and return to activities of normal living.

12Around the time of the OCF-18 submission, the clinical notes and records (“CNRs”) of the applicant’s family physician Dr. Tahir reveal that the applicant was continuing to report accident-related neck pain. In CNR entries dated April 6, 2023, and April 20, 2023 Dr. Tahir noted that the applicant was attending physiotherapy, and recommended that the applicant continue with treatment. I note the respondent’s submissions that its assessor determined that the applicant had full range of motion, and that the physiotherapy treatment is not reasonable and necessary. However, I place greater weight on the CNRs of the applicant’s family physician who was treating the applicant post-accident, and specifically recommended additional physiotherapy treatment at the time the OCF-18 was submitted.

13I also note the respondent’s submissions that it has subsequently approved a number of treatment plans to address the applicant’s pain symptoms, including a chronic pain program, chiropractic treatment, Botox injections and pain injections. However, I note that all of these treatment plans were approved in 2024. In my view, the fact that other treatment plans were approved eight months to a year later, does not detract from the fact that the applicant required treatment in April 2023, at the time the OCF-18 was submitted.

OCF-18 dated June 13, 2023 for $2,500.00 for an orthopedic assessment

14I find that the applicant has not established entitlement to the orthopedic assessment.

15The applicant submits that the orthopedic assessment is reasonable and necessary given his persistent and worsening musculoskeletal pains post-accident. The applicant argues that his pain symptoms worsened despite attending physiotherapy treatment, which was suggestive of deeper orthopedic or structural pathology. The applicant argues that more than two years post-accident, Dr. Tahir continues to note ongoing pain, reduced range of motion and cervical radiculopathy.

16The respondent submits that the proposed orthopedic assessment is duplicative and not reasonable and necessary. It cites Tribunal decision Hassan v Wawanesa Mutual Insurance Company, 2023 CanLII 55977 (ONLAT), where the Tribunal found that a chronic pain assessment would be duplicative, as an orthopedic assessment had been approved. The respondent further argues that none of the findings in the applicant’s chronic pain report suggest that there would be a basis for an orthopedic assessment.

17I agree with the respondent that the applicant has not established that an orthopedic assessment is reasonable and necessary.

18Although the applicant submits that his chronic pain with radiating symptoms was suggestive of deeper orthopedic or structural pathology requiring further investigation, the applicant has not directed me to any evidence that any of his treating physicians felt that an orthopedic assessment was required or that there was an orthopedic cause of the applicant’s pain. The applicant does not direct me to any CNR entry where Dr. Tahir supported or queried the need for orthopedic investigation. The applicant points to his pain clinic records which on September 26, 2023 noted unresolved symptoms and made further referrals for pain management. However, none of the various pain assessors recommended an orthopedic assessment.

19In the September 22, 2023 reporting letter from Simcoe Medical Pain Clinic, the applicant’s pain symptoms were recorded, including radiating pain. A physical examination was conducted and the MRI of the cervical spine was reviewed. Dr. Nemer El-Batnigi made a number of treatment recommendations, but did not recommend an orthopedic assessment. It was expressly noted that “no referrals are suggested at this point.” Similarly, the applicant’s s. 25 chronic pain report dated February 8, 2024 noted the applicant’s pain complaints, including radiating pain, and diagnostic imaging results. Dr. Wildeman diagnosed the applicant with chronic pain syndrome and recommended a number of assessments, including a psychological chronic pain assessment and socio-emotional assessment, but did not recommend an orthopedic assessment.

20In the context of an assessment, while the applicant does not need to prove the condition exists, he must prove with persuasive evidence that there is some accident-related condition that warrants investigation via the proposed assessment. On the medical evidence submitted, I find that the applicant has not established that further orthopedic investigation was warranted.

OCF-18 dated September 29, 2023 for $2,500.00 for functional cognitive assessment

21I find that the applicant has not established entitlement to the functional cognitive assessment.

22The applicant submits that he has been experiencing cognitive dysfunction as a sequelae of psychological injury, which warrants a functional cognitive assessment. He points to Dr. Tahir’s CNR entry dated April 23, 2025 which referenced post-traumatic stress, poor sleep, memory issues and an inability to concentrate. The applicant also refers to his s. 25 psychological assessment report dated October 12, 2023 which noted the applicant’s reports of cognitive dysfunction like forgetfulness and difficulty concentrating.

23I do not find that the applicant has established that the proposed assessment is reasonable and necessary.

24Although the applicant cites the s. 25 psychological report of Dr. Kershner as evidence that a functional cognitive assessment is required, I note that such an assessment was not recommended in the report. Rather, the applicant’s psychological assessor Dr. Kershner recommended a psychiatric assessment. I further find that the subsequent s. 25 psychiatric assessment dated December 21, 2023 also did not recommend a further functional cognitive assessment. Rather, while Dr. Yaroshevsky noted the applicant’s physical and emotional/psychological symptoms and diagnosed him with Major Depressive Episode (Depression), Dr. Yaroshevsky also noted that the applicant’s “cognitive abilities were undisturbed”.

25The applicant further cites Dr. Tahir’s CNR entries from April 23, 2025 in support of the assessment. In these entries the applicant reported being unable to concentrate or function properly, that he had poor memory and concentration. However, I agree with the respondent that these complaints were first raised to Dr. Tahir more than two years post-accident. The applicant does not direct me to any CNR entry where he reported cognitive impairments to his treating medical practitioners in the first two years post-accident.

26Accordingly, I find that the applicant has not met his onus to prove that the proposed functional cognitive assessment is reasonable and necessary.

OCF-18 dated June 17, 2024 for $4,290.93 for psychological services

27I find that the applicant has not established entitlement to the proposed psychological services.

28The applicant relies on his s. 25 psychological report and his s. 25 psychiatric report to argue that he has sustained serious psychological injuries as a result of the accident, including: adjustment disorder with mixed anxiety and depressed mood, specific phobia – vehicular, insomnia disorder, somatic symptom disorder, major depressive disorder and post-traumatic stress symptoms. He argues that these ongoing psychological conditions establish that continued psychological services are needed.

29The respondent submits that the June 17, 2024 treatment plan is not reasonable and necessary, since it is duplicative. The respondent argues that it had approved a number of psychological treatment plans both before and after the treatment plan in dispute, but that the applicant had submitted a number of overlapping treatment plans, which rendered the June 17, 2024 OCF-18 duplicative.

30I agree with the respondent and find that the applicant has not established that the OCF-18 for psychological services is reasonable and necessary.

31The applicant submitted the OCF-18 on June 17, 2024 for eighteen sessions of mental health treatment/psychotherapy with a clinical social worker. However, the respondent has provided evidence that it had previously approved a chronic pain program in the amount of $6,421.11, which included social work intervention and psychotherapy. The respondent noted that as of June 28, 2024, the applicant had only incurred one of the approved social worker sessions and had not used any of the psychotherapy sessions. The applicant did not provide reply submissions to refute the respondent’s argument that he had not utilized previously approved mental health treatment.

32Further, the respondent provided evidence that it had also approved several additional treatment plans to address mental health and psychological concerns. A number of these treatment plans preceded the June 17, 2024 OCF-18. However, the respondent also approved an August 29, 2024 OCF-18 in the amount of $7,877.01 for driving therapy and fourteen sessions of individual psychotherapy. The applicant did not provide submissions to explain how the August 29, 2024 OCF-18s psychotherapy sessions, differed from those proposed in the June 17, 2024 OCF-18.

33Accordingly, I find that the respondent has established that a number of psychological treatment plans had already been approved. Some prior to the submission of the June 17, 2024 OCF-18, one of which had not been utilized. Further, soon after the June 17, 2024 OCF-18 was submitted, the respondent approved a different plan which also proposed individual psychotherapy sessions. Therefore, I find that the June 17 2024 treatment plan is not reasonable and necessary, as it is duplicative.

Interest

34Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. The applicant is entitled to interest on the OCF-18 dated April 20, 2023 for physiotherapy services.

Award

35The 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. I find that the applicant has not established that he is entitled to an award. Although I have found that the applicant is entitled to one of the treatment plans in dispute, it is well-settled that an award should not be ordered simply because an insurer made an incorrect decision. The applicant has not directed me to evidence that the respondent acted in bad faith nor that its actions rose to a level of being excessive, imprudent, stubborn, inflexible, unyielding, or immoderate. Accordingly, the respondent is not liable to pay an award.

ORDER

36The applicant is entitled to the treatment plan in the amount of $1,112.91 for physiotherapy services, plus interest.

37The applicant is not entitled to the remaining treatment plans in dispute, or an award.

Released: March 11, 2026

__________________________

Ulana Pahuta

Adjudicator