Licence Appeal Tribunal File Number: 18124/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:

Moustafa Makhmoud

Appellant

and

Registrar of Motor Vehicles

Respondent

DECISION

ADJUDICATOR: Dr. Isla McPherson, Member

APPEARANCES:

For the Appellant: Moustafa Makhmoud, Appellant

For the Respondent: Stephen Grootenboer, Agent

Held by teleconference: March 11, 2026

OVERVIEW

1Moustafa Makmoud (the “appellant”) appeals 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 report stating that the appellant suffers from a medical condition that may affect his ability to drive a motor vehicle 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 safely drive a motor vehicle of the applicable class safely. Under s. 14(2)(b) of the Regulation, the Minister of Transportation 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 a brain injury with residual cognitive impairment, 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 agrees that he suffered from a brain injury but argues that he has no residual cognitive impairment and 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.

6The Open Court Principle was reviewed at the outset of the hearing.

ISSUES

7The 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.

8To resolve that issue, I will address the following questions:

i. Does the appellant suffer from brain injury with residual cognitive impairment?

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

9The Registrar bears the burden of proving on a balance of probabilities that the answer to each of the above questions is “yes.”

RESULT

10Having 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.

ANALYSIS

Does the appellant suffer from a brain injury with residual cognitive impairment?

11The evidence presented at the hearing establishes that the appellant suffers from a medical condition, namely a brain injury with residual cognitive impairment.

12The Registrar’s position is supported by:

i. a Medical Condition Report (MCR) dated September 6, 2024, completed by physiatrist, Dr. G;

ii. a MCR dated September 27, 2024, completed by treating physician Dr. P;

iii. a Cerebrovascular Diseases, Traumatic Brain injury, Tumour or Other Neurological Disease Form (Cerebrovascular Diseases and TBI Form) dated April 24, 2025, completed by neurologist Dr. R;

iv. a Cognitive Disorder Form dated June 18, 2025, completed by specialist Dr. A;

v. a narrative letter dated March 9, 2026, completed by family physician, Dr. M.

13Physiatrist Dr. G completed a MCR dated September 6, 2024, documenting the appellant suffered from a disorder resulting in cognitive impairment that affects attention, judgement and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and results in substantial limitation of the person’s ability to perform activities of daily living due to a brain injury. Dr. G added the following narrative comments to the MCR, “suffered traumatic brain injury, with severe cognitive impairment”.

14Following receipt of the MCR, the Registrar suspended the appellant’s driver’s licence due to a brain injury and cognitive impairment and requested the completion of a Cerebrovascular Diseases and TBI Form and a Cognitive Disorder Form.

15The Registrar then received a second unsolicited MCR by treating physician Dr. P dated September 27, 2024, that also documented the appellant suffered from a disorder resulting in cognitive impairment that affects attention, judgement and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and results in substantial limitation of the person’s ability to perform activities of daily living due to a brain injury. Dr. P additionally documented the appellant suffered from a cerebrovascular accident that resulted in cognitive impairment. Dr. P added the following narrative comments to the MCR, “recent brain bleed with residual memory concerns, occasionally not oriented”.

16The Registrar highlighted that on the Cerebrovascular Diseases and TBI Form completed by neurologist Dr. B on April 24, 2025, it was documented that the appellant had suffered a traumatic intraventricular hemorrhage while on blood thinners that required neurosurgical intervention. The Registrar highlighted on the Cognitive Disorder Form completed by specialist Dr. A on June 18, 2025, that the appellant was diagnosed with mild cognitive impairment and a Functional Driving Assessment was recommended.

17The Registrar further relied on a narrative letter written by family physician Dr. M dated March 9, 2026. Dr. M documented that the appellant suffered an intraventricular hemorrhage due to a fall in July 2024 that required neurosurgical intervention. She documented the appellant had completed his recovery but was still demonstrating mild cognitive impairment as a result of the fall and hemorrhage.

18The appellant’s position is that he did experience a fall resulting in a brain injury, but he had made a full recovery and has no residual cognitive impairment.

19The appellant’s Notice of Appeal documents that he has gone through treatments and a rehabilitation process, and he is totally cured now. He further documents he has had many cognitive and other tests, and the results were good.

20The appellant testified that he had no doubts as to his cognitive function. He testified he holds a very responsible job, and every time he goes to court, he keeps in mind many things, and he has no doubt as to his cognitive power. He testified he currently works full time as an interpreter.

21Under cross-examination the appellant testified that he had suffered a fall that resulted in a head injury with hemorrhage that required surgery on his brain. He testified he attended rehabilitation for 2-3 months after his injury, but also that the rehabilitation finished in October or November 2025, which would be over a year since his injury. Upon seeking clarification as to the timeline, the same response was provided.

22Under cross-examination he explained that sometimes it takes him time to remember things. He was asked about his relationship with Dr. M, who had submitted the latest medical evidence, and he responded that Dr. M had been his family doctor for approximately 10 years, and he sees her regularly.

23The medical evidence before the Tribunal comprises multiple medical documents from multiple physicians confirming a brain injury with residual cognitive impairment. Recognizing the appellant has undergone a rehabilitation process where improvement could be expected, I give weight to the most contemporary medical evidence, which is the narrative letter from Dr. M, dated two days prior to the hearing. By the appellant’s testimony, Dr. M has been the appellant’s physician for almost a decade, and he attends appointments with her regularly. This longitudinal relationship would position Dr. M well to have had oversight of the appellant’s injury and recovery. For these reasons, I give weight to Dr. M's written submission that the appellant has completed his recovery from his brain injury, but that he continues to suffer from mild cognitive impairment.

24I find the medical evidence in this case relevant and persuasive. While the appellant argues the does not have any residual cognitive impairment, I give more weight to the medical opinion of Dr. M as a qualified physician, and a treating physician who would reasonably be expected to be familiar with the appellant’s medical history. Based on the information available, I find that the Registrar has established on a balance of probabilities that the appellant suffers from a brain injury with residual cognitive impairment.

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

25I 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.

26The Registrar argued that the appellant’s medical condition is likely to interfere with his ability to drive a vehicle safely and supported their position with the results of a Functional Driving Assessment completed by the appellant on July 9, 2025. The Registrar highlighted the results of this Assessment, including that the appellant scored 22/30 on a Montreal Cognitive Assessment (MoCA) which was classified as below normal limits. The Registrar also highlighted that the appellant was determined to not have the functional skills necessary for driving with respect to awareness of the driving environment, with comments provided that included, “inadequate processing and self regulation”. The occupational therapist’s on road assessment indicated that there was evidence of medical impairment and the appellant did not demonstrate the skills functional for driving, and the driving instructor’s assessment also demonstrated the appellant did not have the functional skills necessary for driving with a score of 17/33. The Registrar noted narrative comments provided on the Assessment, including that the drive was discontinued prior to being completed as a result of concerns such as the appellant not stopping on a red signal that required instructor intervention. The final result of the assessment was that there were deficits in functional driving skills and driving was not recommended.

27The Registrar further relies on the Canadian Council of Motor Transport Administrators Medical Standards for Drivers [2025] (the “CCMTA Standards”), Chapters 6 and 20. The Registrar stated that these Standards are written by physicians and experts across the country and used as guidelines to assess driver fitness as it pertains to medical conditions.

28Chapter 6 of the CCMTA Standards describes cognitive impairment, including cognitive impairment due to brain trauma.

29The Registrar stated that Standard 6.6.1 applies to the appellant’s medical condition, and it states that drivers who are diagnosed with cognitive impairment would be eligible for a licence if:

i. Complete medical assessment indicates cognitive functions necessary for driving are not impaired.

ii. Where required, functional driving assessment shows the condition does not affect ability to drive.

iii. Conditions for maintaining a licence are met.

30Chapter 20 of the CCMTA Standards describes traumatic brain injuries and possible cognitive impairments that may result. This Chapter further documents that research indicated that there are higher rates of crashes and traffic violations for those who have experienced a traumatic brain injury.

31The Registrar stated that Standard 20.6.1 applies to the appellant’s medical condition, and it states that drivers who have experienced a traumatic brain injury would be eligible for a licence if:

i. Movement and strength are sufficient to perform the functions necessary for driving.

ii. Cognitive and visual functions necessary for driving are not impaired.

iii. Any pain associated with the condition, and any treatment for the condition, do not impair the functional abilities necessary for driving.

iv. Where required, a functional assessment indicates that the driver is able to compensate for any loss of functional ability necessary for driving.

v. The conditions for maintaining a licence are met.

32The Registrar submits that both Standards recommend a Functional Driving Assessment, which the appellant has undergone and made critical errors during which resulted in the Assessment being discontinued. The Registrar submitted that they have no choice but to keep the appellant’s licence under suspension, and their decision is reasonable, prudent, and in keeping with the law and national medical standards.

33Section 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 is not bound by them.

34The appellant testified that he no longer has any problem with driving, and he wishes he could take the test again and go driving again.

35Under cross-examination the appellant testified as to the result of the Functional Driving Assessment. He testified that he was told the result at the end of the Assessment, but he did not understand why that was the result as he had driven ok. He testified that small mistakes happen to everyone when driving. He was asked about any recommendations from his physicians, and he testified that they had not told him anything about driving and that no one was concerned about his driving. He was asked if he had approached his doctors to request support for reinstatement, and he responded that he had asked Dr. M who had submitted the narrative letter dated March 9, 2026.

36I considered the appellant’s position that he has no residual cognitive impairment from his brain injury that will impact his ability to drive safely. However, this is weighed against the scientific research that those with a traumatic brain injury are at higher risk for adverse driving outcomes, as outlined in the CCMTA Standards, and that there was no medical opinion or evidence that otherwise explains the results of the Functional Driving Assessment that demonstrate deficits in functional driving skills sufficient enough that driving is not recommended. The Functional Driving Assessment is particularly persuasive because it evaluates real-world driving performance rather than theoretical capacity, and I assign substantial weight to the outcome of this Assessment.

37Although this Tribunal is not bound by the CCMTA Standards, they can be considered 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. My review of the evidence shows that none of the conditions recommended for relicensing outlined in the CCMTA Standards have been met.

38I acknowledge the burden that the lack of a driver’s licence is having on the appellant. However, the medical evidence is compelling in this case.

39As 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

40I find that the Registrar has discharged the onus of establishing on a balance of probabilities that the appellant suffers from a medical condition, namely a brain injury with residual cognitive impairment, and that condition is likely to significantly interfere with his ability to drive a motor vehicle safely.

ORDER

41For 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.

Released: April 1, 2026

__________________________

Isla McPherson MD

Adjudicator