Licence Appeal Tribunal File Number: 24-012016/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:
Princess Asieduaa
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Steven Glowinsky, Counsel
For the Respondent:
Nicole De Bartolo, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Princess Asieduaa, the applicant, was involved in an automobile accident on February 6, 2022, 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 $4,389.16 for psychological services, proposed by In Motion Rehabilitation and Wellness Center Inc. in a treatment plan/OCF-18 (“plan”) submitted June 3, 2024?
ii. Is the applicant entitled to $17,967.00 for catastrophic impairment (“CAT”) assessments, proposed by Deena Rogozinsky Therapy in a plan submitted July 2, 2024?
iii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
i. Is the applicant entitled to interest on any overdue payment of benefits?
3In submissions, the applicant refers to a related Tribunal decision released November 17, 2025: Asieduaa v TD General Insurance Company, 2025 CanLII 119944 (ON LAT) (“24-002324/AABS”). Upon the Tribunal’s request for a clarification by the parties, according to the applicant, the following issues in this application before me are duplicative in that they were already addressed by the Tribunal in 24-002324/AABS:
i. Is the applicant entitled to $11,821.05 for physical modalities, proposed by In Motion Rehabilitation and Wellness Center Inc. in a plan submitted May 28, 2024?
ii. Is the applicant entitled to $2,299.22 for a psychological assessment, proposed by TDI Chronic Pain and Medical Assessments Inc. in a plan submitted April 4, 2024?
4Therefore, I have removed these issues from the issues in dispute, as set out above.
RESULT
5The applicant is entitled to the treatment plan for psychological services, in part. The applicant is entitled to $2,103.58 of the $4,389.16 claimed for this treatment plan.
6The applicant is not entitled to the treatment plan for $17,967.00 for CAT assessments.
7The respondent is not liable to pay an award under s. 10 of Reg. 664.
8The applicant is entitled to interest.
PROCEDURAL ISSUES
9I deny the respondent’s request to exclude all portions of the applicant’s submissions beyond the 10-page limit, as well as two appended tabs in the applicant’s brief that are summaries of the applicant’s evidence and authorities.
10The respondent argues that repeated disregard for the Tribunal’s procedural directives significantly prejudices the respondent because it has to dedicate additional time and resources addressing the non-compliance. Beyond this, the respondent did not identify any prejudice it faced in responding to the applicant’s arguments on the merits of this case. I find that the respondent had an opportunity and did make fulsome submissions in response to the applicant.
11The applicant concedes that it did not follow the formatting requirements in the Case Conference Report and Order. The applicant argues that her submissions are within the 10-page limit when not double spaced, and at most they are half a page over the limit if double spaced. I find that this non-compliance is non-consequential to the hearing on the merits of this case and decline to disregard any of these initial submissions.
12As to the two tabs at issue, the applicant argues that she does not advance any argument in the “Summary of Pertinent Evidence” or “Summary of Pertinent Authorities” tabs. Further, that they were included with the intention to assist the hearing adjudicator with the reading and referencing of the materials “so that the entirety of evidence (i.e., over 1,000 pages of medical documentation) need not be reviewed when a summary would suffice.”
13I find that the applicant is describing precisely the purpose of submissions, and therefore the tabs are indeed an extension of her submissions. I am persuaded by the respondent that this Tribunal has previously found it is improper to attempt to extend the limits placed on submissions by attaching optional charts and documents. Further, that such appended documents, including summaries of evidence and authorities, are not excluded from the page limits applicable to submissions and that parties must bring a motion to extend page limits, if necessary.
14Despite the above, I find that, as argued by the applicant, she intended for all arguments to be contained within the 10 or so pages of her initial submissions and not in the tabs containing summaries of evidence and authorities otherwise appropriately filed. For the reasons reviewed above, I find that excluding the summaries from the record in this case is not warranted.
ANALYSIS
15I find that the applicant is partially entitled to the plan proposing $4,389.16 for psychological services and not entitled to the plan proposing $17,967.00 for CAT assessments.
16To 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.
17The purpose of an assessment is to determine whether a condition exists. For an insured, they bear the onus to demonstrate that there are grounds to suggest that some condition exists that would warrant investigation by way of an assessment.
18The applicant begins submissions with arguments in support of removal from the Minor Injury Guideline (“MIG”). The applicant submits that although the issue of removal from the MIG is not before me and she had not yet been removed from the MIG at the time of submissions, she was awaiting a decision from an active Tribunal file on the issue. The applicant referred me to 24-002324/AABS where the Tribunal subsequently found that the applicant’s injuries are not subject to the MIG, among other findings. I accept that the applicant has been removed from the MIG. Although the decision in 24-002324/AABS was subsequently reconsidered by the Tribunal, the MIG finding was not disturbed. Since the applicant is removed from the MIG, regardless the basis of that removal, the applicant has access to the enhanced benefits and limits as outlined in the Schedule.
$4,389.16 for psychological services
19I find that the applicant is partially entitled to this treatment plan, in the sum of $2,103.58, because treatment in that amount is reasonable and necessary.
20The plan proposed 16 counselling sessions for mental health and addictions, each session being 1.5 hours long for a total of $3,590.72 at an hourly rate of $149.61 per hour. The plan also proposed $149.61 for 1 hour of preparation service, 3 planning services proposed as a procedure at a rate of $149.61 per instance, and documentation support activity of $200.00 as a procedure. In the additional comments these line items are explained to be, in order, psychotherapy sessions, three psychological reassessments, a progress report, and completion of the OCF-18. Other than form completion, the proposed services are provided by Sandra Ramnaraine, registered psychotherapist.
21The rate of $149.61 is the Professional Services Guideline (“Guideline”) rate for services provided by a psychologist or psychological associate. The applicant did not address why a rate of $149.61 is reasonable and necessary. The proposed treatment provider is a psychotherapist, an unregulated provider under the Guideline rather than a psychologist or psychological associate. I find the rate of $58.19 appropriate for a psychotherapist, as it is the approved rate for unregulated providers, which includes psychometrists, and rehabilitation, family, and vocational counsellors. The 16 counselling sessions, 1.5 hours in length, at this rate result in a sum of $1,396.56. In addition, three reassessments at $149.61 per procedure, 1 hour for a progress report at $58.19 per hour, and $200.00 for form completion per procedure, bring the total to $2,103.58.
22The goals of the plan include pain reduction and return to activities of normal living. The plan refers to other goals identified in Dr. Gabidulina’s report. The report states that the goal of treatment includes recovery as well as helping the applicant find effective coping skills for her increasing symptoms of anxiety, depression, difficulty adjusting and interpersonal difficulties. A further goal is to restore the level of self-confidence she enjoyed prior to the accident.
23I note that the sole reason provided in the respondent’s July 9, 2024 notice denying the plan was that the applicant is subject to the MIG. The Schedule states that these notices require the respondent to include all of its reasons for denial, and the notice confirms that it has done so. The respondent did not refer me to any further denial notice that would provide any continuing reason supporting a denial of this plan after the applicant was removed from the MIG.
24In a Medical Legal Psychological Report of Dr. Svetlana Gabidulina Ph.D.,C. Psych, dated June 4, 2024, Dr. Gabidulina diagnosed the applicant with Depressive Episode, Somatic Symptom Disorder with Predominant Pain, and Situational (isolated) Phobias (automobile anxiety). The respondent makes a number of arguments and relies on a s. 44 psychology assessment report by Dr. Kelly McCutcheon, Ph.D., C. Psych., dated August 16, 2022 opining while the applicant has accident-related psychological symptoms, they are mild and subclinical and within the scope of the MIG.
25Dr. McCutcheon’s report states that the applicant indicated "My problem is pain, I don't have psychological problems". The respondent argues this supports a finding that treatment is not reasonable and necessary. However, I find that Dr. McCutcheon opined that the applicant has mild accident-related psychological symptoms which, in my view, calls into question the applicant’s ability to appreciate or self-identify whether she has any psychological symptoms.
26Dr. McCutcheon’s report also states that the applicant endorsed depression and anxiety symptoms on the Beck Depression Inventory-II and Beck Anxiety Inventory, opining that the results were in the mild ranges. Further, that the applicant did not display any obvious indication of manipulation, resistance, evasiveness or embellishment and that there is no concern of over reporting of pain and emotional concerns. Dr. McCutcheon concluded that as a result of the subject accident, the applicant appears to be experiencing some mild depressive and anxious symptomatology in the context of her ongoing pain and physical concerns, as well as some in-vehicle anxiety, and worries related to her finances, her safety, being able to work again, as well as the possibility of being involved in another accident. I find that this certainly does not support the respondent’s position that the applicant has no accident-related psychological symptoms requiring treatment, her symptoms are recorded in the evidence dating back to 2022.
27In this context, since the applicant is not subject to the MIG, I am persuaded by the applicant’s reference to Dr. Gabidulina’s opinion recommending evidence-based psychological treatment, and that this plan is partially reasonable and necessary. Dr. Gabidulina opines:
While Dr. McCutcheon notes that [the applicant’s] psychological symptoms fall within the limits of the MIG because the symptoms are “mild” or “subclinical,” depression and anxiety are valid clinical symptoms, that do not fall within the MIG, irrespective of severity. “Mild or subclinical” depression and anxiety are still depression and anxiety.
28For the reasons above, I find that, on a balance of probabilities, the applicant is partially entitled to this treatment plan, in the sum of $2,103.58, because it is reasonable and necessary.
$17,967.00 for catastrophic impairment
29I find that the applicant is not entitled to $17,967.00 for CAT assessments.
30The applicant submits that the relevant question before me is not whether it is likely that the applicant suffered a catastrophic impairment. Instead, the question is whether this outcome is possible and whether it is reasonable to explore that possibility under s. 3.1(1)(7) and s. 3.1(1)(8) of the Schedule commonly referred to as criterion 7 and criterion 8. The applicant cites 17-006956 v Guarantee Company of North America, 2018 CanLII 110952 (ON LAT), at para 37, where the Tribunal stated that “[t]here must be some suggestion that the specified condition exists, and that further investigation is reasonable and necessary.” Although not binding on me, I agree with this reasoning, and indeed, the entirety of paragraph 37 of that decision aligns with the applicant’s onus on the question of entitlement to assessments, as set out earlier in this decision.
31However, I find that the applicant has not established that there are grounds to suggest a CAT impairment exists such that further investigation is reasonable and necessary. In summary, the applicant’s submissions refer to the following grounds to suggest she has a catastrophic impairment under criteria 7 and 8 that warrants investigation:
i. The evidence confirms consistent and credible symptoms of anxiety, depression, insomnia, chronic pain, and other symptoms.
ii. The applicant has been diagnosed with Depressive Episode, Somatic Symptom Disorder with Predominant Pain, and Situational (isolated) Phobias (automobile anxiety).
iii. The evidence establishes the presence of psychological complaints.
iv. The evidence establishes that the applicant’s psychological injuries are a result of the subject accident.
v. The evidence establishes that the applicant has mild depressive and anxious symptomatology.
32The treatment plan proposing the CAT assessments lists the following injury and sequalae information; unhappiness, malaise and fatigue, sprain and strain of lumbar spine, limitation of activities due to disability, problems related to life-management difficulty, stress not elsewhere classified.
33Even if I was to accept all of the above submissions, on the applicant’s physical and psychological injuries, these are not grounds on the basis of which CAT assessments under criteria 7 or 8 are reasonable and necessary. The focus of these CAT criteria is whether the applicant has a catastrophic impairment and I have not been referred to a suggestion in the evidence that such an impairment exists.
34For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to $17,967.00 for CAT assessments.
Interest
35The applicant is entitled to interest because interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
Award
36The 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.
37In determining the type of conduct for which an award is appropriate, the adopted standard is set out in the Financial Services Commission of Ontario case: Wayne Allan Plowright v. Wellington Insurance Company, 1993 ONICDRG 66 (“Plowright”). According to Plowright, unreasonable conduct can include “excessive, imprudent, stubborn, inflexible, unyielding or immoderate” behaviour.
38The applicant submits that the respondent’s conduct amounted to willful blindness as its denials of the plans in dispute predominantly rely on the conclusions of the s. 44 assessment reports. The respondent submits that it relied on its s.44 assessors in good faith and that the applicant’s position that the respondent’s conduct amounts to wilful blindness is unfounded.
39The Tribunal has consistently held that an insurer is entitled to rely on the opinions of s. 44 assessors and that such reliance does not, without more, amount to unreasonable conduct attracting an award.
40For the reasons above, on a balance of probabilities, the respondent is not liable to pay an award.
ORDER
41For the reasons above, I make the following orders:
i. The applicant is entitled to the treatment plan for psychological services, in part. The applicant is entitled to $2,103.58 of the $4,389.16 claimed for this treatment plan.
ii. The applicant is not entitled to the treatment plan for $17,967.00 for CAT assessments.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664.
iv. The applicant is entitled to interest.
Released: May 13, 2026
Amar Mohammed
Adjudicator