Citation: Omokaro v. Allstate Insurance Company of Canada, 2026 ONLAT 25-005569/AABS

Licence Appeal Tribunal File Number: 25-005569/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:

Devin Omokaro

Applicant

and

Allstate Insurance Company of Canada

Respondent

DECISION

ADJUDICATORS:

Aric Bhargava

Rebecca Hines

APPEARANCES:

For the Applicant:

Matthew D Newton-Reid, Counsel

For the Respondent:

Victoria C Little, Counsel

HEARD: by Videoconference:

March 10, 11 and 12, 2026

OVERVIEW

1Devin Omokaro, the applicant, was involved in an automobile accident on September 2, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule — Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, Allstate Insurance Company of Canada, and applied to the Licence Appeal Tribunal — Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2The matter proceeded to a case conference, but the parties were unable to resolve the issues in dispute. As a result, the matter proceeded to a three-day videoconference hearing. For the applicant, we heard the testimony of the applicant, Dr. Zahida Meghji, psychologist, and Krista Cole, occupational therapist. On behalf of the respondent, we heard the testimony of Dr. Ahmed Jwely, psychiatrist, and Joseph Morgan, occupational therapist.

ISSUES

3The issues in dispute are:

a) Has the applicant sustained a catastrophic (“CAT”) impairment as defined by the Schedule?

4The applicant withdrew two disputed issues (issues ii and iii) listed in the Case Conference Report and Order (“CCRO”) The applicant also withdrew his entitlement to interest and an award. The parties agreed if the applicant is deemed to be CAT, then he is entitled to the two occupational therapy treatment plans in full.

RESULT

5After considering the parties’ submissions, the testimony of all witnesses and reviewing the evidence we find that the applicant did not sustain a CAT impairment.

ANALYSIS

Did the applicant sustain a CAT impairment as a result of the accident?

6For the reasons that follow, we find that the applicant has not sustained a CAT impairment pursuant to Criterion 8.

7On April 24, 2025 the applicant applied to the respondent for a determination that his accident-related impairments met the definition of CAT impairment under the Schedule. The current dispute involves whether he sustained a CAT impairment pursuant to section 3.1(1)(8) of the Schedule (known as Criterion 8). Criterion 8 which is assessed in accordance with Chapter 14 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4^th edition, 1993 (“Guides”),

8As the accident took place in 2015, to meet the Schedule’s threshold for a CAT impairment under Criterion 8, an individual must have one marked (class 4) or one extreme impairment (class 5) as a result of the accident due to a mental or behavioural disorder in any one of the four spheres of functioning outlined in Chapter 14 of the Guides. The applicant bears the onus to prove on a balance of probabilities that he is CAT impaired.

9The Guides sets out that mental and behavioural impairments are rated according to how seriously they affect a person’s useful daily functioning. Impairment levels are to be assessed in relation to four functional domains: (1) activities of daily living; (2) social functioning; (3) concentration, persistence, and pace; and (4) adaption (deterioration or decomposition in work or work-like settings). The spheres of functioning and the levels of impairment are outlined 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

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

Adaptation (Deterioration in a work-like setting)

10The applicant submits that he is CAT impaired and has a class 4 marked impairment under Criterion 8 in the sphere of social functioning. He relies on the section 25 catastrophic psychological assessment of Dr. Meghji, and occupational therapy assessments of Ms. Cole dated September 14, 2024, who opined the applicant has a class 4: marked impairment rating in the sphere of social functioning. Although neither parties’ assessor determined that the applicant had a marked impairment under adaptation, the applicant submits that it is within the Tribunal’s discretion to make that determination based on the totality of the evidence.

11The respondent submits the applicant’s injuries do not reach the level for a finding of a class 4 impairment in the domain of social functioning and relies on the reports and testimony of Dr. Jwely and Mr. Morgan. Dr. Jwely concluded that the applicant did not have any impairment ratings under the four spheres of function as a result of a mental health and behavioural disorder.

12The applicant provided the following testimony regarding his accident-related injuries and his pre- and post-accident functioning:

a) At the time of the accident in 2015 he was 12 years old and did not have any medical issues. During the accident, he hit the side of his head, neck and knee which has resulted in ongoing chronic pain.

b) During cross-examination the applicant acknowledged that he visited his family doctor two days after the accident and did not complain of body pain, other injuries, or any psychological or emotional injuries. The applicant also testified he has never attended a psychiatrist, psychologist, or counsellor’s office for therapy and he was not prescribed any medicine for emotional or psychological injuries.

c) Prior to the accident he was outgoing, worked well with others in team settings, spent time with his family and played various sports such as soccer and basketball.

d) The applicant is now 23 years old, and he does not go outside or play sports as much. He socializes less, watches movies and social media videos by himself at home where he lives with his mother and sister(s). His father resides outside of Canada, and his last visit with him was in 2019. He speaks to his father by phone a few times per week. His family is close with another family who live in Toronto and the families get together on special occasions and in the summer. During cross-examination he acknowledged that he volunteered with his church in 2023 where he was responsible for planning special events. He also independently takes the bus routinely for school and work.

e) Since the accident, he graduated from elementary and high school and attended full time in-person studies at Fanshawe College taking a business administration and accounting course. He stopped attending Fanshawe College in December 2025.

f) He is currently working at Cellular Magic, a mobile phone shop, 10 to 15 hours a week doing various non-customer facing duties. He previously worked at Tim Hortons in customer service for 20 to 25 hours a week in 2022 and 2025, and also at Peavy Mart in 2023. He was let go from Tim Hortons due to his physical limitations, notably his back injury.

g) The applicant testified that he recently had a gym membership and was attending two to three times a week. However, his gym membership was cancelled because he no longer has any funding.

13Dr. Meghji testified that she saw the applicant in September 2024 and diagnosed him with other specified depressive disorder; depressed mood. The doctor testified that he had diminished interest or pleasure in all or almost all activities, fatigue and a diminished ability to think or concentrate, and exhibited difficulty engaging and attending appointments. Dr. Meghji observed the applicant to be more introverted and quiet, although polite and forthcoming, he occasionally required prompting and was asked to elaborate on certain answers.

14Dr. Meghji testified that the applicant spends time alone, is a passive observer of social media, does not meaningfully engage with his mother or sister, has no friends and does not attend social events. Despite the diagnosis, Dr. Meghji notes the applicant reported no prior history of psychiatric issues and there was no previous history of therapy or counselling. During cross-examination the doctor also acknowledged that post-accident the applicant had no reported altercations, no convictions, was not fired from any jobs, was not considered uncooperative, there was no observation of hostility, and that he is able to attend school.

15Ms. Cole testified that she conducted a collateral interview with the applicant’s mother in February 2023, and an environmental assessment, and community-based situational assessment in 2022. Ms. Cole testified that the applicant has a flat affect and struggles with pain in his mid to low back and neck, light sensitivity, headaches, anxiety, low mood, apathy, motivation, disturbed sleep, concentration and memory. Ms. Cole testified these impairments significantly impede the applicant’s ability to participate meaningfully in social functioning.

16During cross-examination, Ms. Cole acknowledged that the applicant first complained of psychological symptoms three years after the accident. We find Ms. Cole’s report does not consider the applicant’s part-time work experience at Tim Hortons or his volunteer experience with his church; and her report only includes the applicant’s work at Peavy Mart in 2023.

17Dr. Jwely testified that the applicant has unspecified depression, anxiety which did not meet the criteria for a psychological diagnosis. The doctor found no impairment in the four spheres of function pursuant to Criterion 8. Dr. Jwely testified that he interviewed the applicant in December 2024 and states that the applicant’s personality has changed over the course of time from being a child to an adult. Dr. Jwely testified that the applicant is able to attend school, graduate, secure employment, he is able to socialize and does not require psychological treatment or psychotropic medication.

18Dr. Jwely testified the applicant’s self reporting is more severe, however, at the time of the doctor’s assessment the applicant was going to the gym, playing sports, playing online games with his friends, and attending his part time work at Tim Hortons. Dr. Jwely testified the applicant is doing more than the applicant believes he is able to do, such as graduating high school and finishing his college program. Further, he is able to communicate effectively, get along and interact with others, and that he does not display inappropriate behaviours.

19During cross-examination Dr. Jwely acknowledged the applicant has a restricted, or flat affect, and that he did not conduct collateral interviews as part of the assessment. Dr. Jwely testified that the applicant does not suffer a permanent impairment based on his review of the applicant’s medical history from the time of the accident to the date of the assessment. Dr. Jwely also testified that his job loss at Peavy Mart and Tim Hortons were due to a physical impairment, and not due to any psychological issues or limitations in social functioning.

20Mr. Morgan testified that he assessed the applicant in February 2025, and the applicant reported that he is connected to friends in person and online, he does not have a best friend, has low mood and does not enjoy being in close physical proximity to people. Mr. Morgan also testified that the applicant has challenges to find a full-time job, and that he declined to participate in the meal preparation task and terminated the community interaction test early. Mr. Morgan testified that the applicant has difficulty with emotional functioning and decreased motivation. However, he has adequate social functioning and is connected to his friends and family.

21During cross-examination Mr. Morgan testified that the applicant does not have someone to confide in, however, he meets his friends and can communicate through video game chats. Mr. Morgan testified that the applicant has a depressed affect, misses deadlines, and has issues with complex decision making, with the lowest end score for self-reported anxiety.

22We find that in both occupational therapist’s assessments that the applicant presents as someone who has significant limitations, which we find is inconsistent with the medical evidence and academic records, as well as his self-reports regarding his day-to-day functioning. For example, in Mr. Morgan’s assessment, the applicant reported he was able to attend for scheduled work, he routinely takes the bus to and from work, and he stopped playing sports due to his sports related injuries. The applicant also reported to Mr. Morgan that he speaks with his father by phone frequently, and he connects with his extended family during holidays. Mr. Morgan testified that the applicant has set goals to move out of the family home and pursue additional academic qualifications.

23We find the applicant’s presentation during both assessments unreliable when compared to the rest of the evidence before us and is not an accurate reflection of his social functioning which will be discussed further below.

24For the reasons below, we find the applicant does not have marked impairment of his social sphere.

25With respect to social functioning, the Guides state, social functioning refers to an individual’s capacity to interact appropriately and communicate effectively with other individuals. Social functioning includes the ability to get along with others, such as family members, friends, neighbours, grocery clerks, landlords, or bus drivers. It is not only the number of aspects in which social functioning is impaired that is significant, but also the overall degree of interference with a particular aspect or combination of aspects that is significant.

26We find the applicant’s testimony is inconsistent with the school records shortly following the accident and the medical evidence. For example, the applicant testified that prior to the accident he was an extrovert, he was social and enjoyed participating in various sports. Post-accident he testified that he is an introvert, does not play sports and is socially withdrawn. However, we find this is inconsistent with his teacher’s description of him in the post-accident Grade 7 and 8 report cards. For example, his Grade 7 report card notes that he was always cooperative and is accepted by others. He is respectful towards others and is not verbally or physically aggressive. His Grade 8 report card notes that he had an aptitude for sports activities through participation in athletic activities that require teamwork and strategy and demonstrates excellent sportsmanship. We assign more weight regarding any impact the accident had on the applicant’s function to these records because they were in the first two years post-accident.

27In addition, two CNRs from the hospital emergency room visits confirm that he fractured his wrist playing soccer in 2016 and injured his elbow playing basketball in 2023. Moreover, an occupational therapy note from 2019 indicates that he played basketball with his siblings at the YMCA where he laughed, and he joined another group of kids afterwards to continue playing. We find that the applicant continued to play sports post-accident and if he has stopped playing it is not as a result of the accident. We find this is demonstrative of the applicant’s sociability and functioning within shared social norms, such as engaging and communicating effectively with others for the purposes of team sports.

28We also find the applicant’s testimony about his post-accident socializing with friends to be inconsistent. For example, he reported to his assessors that he is socially withdrawn and rarely sees friends. Of note, Ms. Cole’s assessment took place during the height of the COVID 19 pandemic where social distancing policies were in effect. We find that given the timing of her assessment the causal link between the accident and his social isolation is not clear. In contrast he reported to Mr. Morgan that he has five friends and that he would get together with them at home or meet up with at the college.

29The applicant submits that he prefers to sit in the dark by himself; however, he testified that he was employed at various times and that his employment requires travelling to and from work using public transportation and engaging with customers and staff in work settings. We find this is demonstrative of social functioning, in that he has been able to engage in the process of applying, interviewing and securing employment and he engages with staff and customers which requires social interaction.

30The applicant submits he was reporting to an accommodating supervisor during his employment at Tim Hortons; however, we were not directed to evidence in support of any accommodation at his place of employment or from his academic pursuits. During cross-examination the applicant testified that he was let go from his job at Tim Hortons due to back pain, not a psychological impairment, and that he does not have a psychological or emotional problem.

31In addition to this, there is a significant gap in the medical records where no psychological symptoms are reported. During cross-examination Dr. Meghji acknowledged that the first mention of any psychological complaints in the CNRs was in 2018, which is three years post accident. In fact, despite reminding the parties several times that relevant records should be entered into evidence, the only record referred to prior to the CAT assessments was the section 25 medical report of Dr. Nadia Brown, physician, dated November 3, 2020 who diagnosed the applicant with adjustment disorder with depressed mood. This evidence is five years after the date of the accident, and the applicant did not address the reason for the prolonged gap in the medical records.

32We are not persuaded by Dr. Meghji’s report and testimony with regards to the domain of social function because she relied heavily on the applicant’s self-reporting, and for the reasons noted above we find his self-reports, unreliable. The doctor acknowledged during her testimony that no psychometric tests were administered because the applicant failed to complete them. As we find the applicant’s testimony to be unreliable, we find psychometric tests would have assisted in supporting the doctor’s opinions, psychological diagnosis, and CAT impairment ratings.

33Further, during cross-examination the doctor acknowledged that she did not ask the applicant about his job duties, and that the applicant’s part time work at Tim Hortons demonstrates that he is able to be collaborative, follow social norms, work in teams, demonstrate social functioning, and that he has the ability to tolerate social spaces.

34Also, in our view, the doctor does not adequately account for the applicant’s academic and job-related history. For example, she notes that almost ten years after the accident, the applicant was attending school, setting additional academic and professional goals, such as the desire to pursue a degree in business or accounting, and the applicant was able to find, secure, and attend part time work. In our view this demonstrates social engagement with others.

35For the above-noted reasons we assign little weight to Dr. Meghji’s report and opinion.

36We acknowledge the shortcomings in Dr. Jwely’s assessment. For example, Dr. Jwely’s report contains errors such as the incorrect age of the applicant at the time of the accident, and the report does not consider the applicant’s social or community interactions; however, it relies on his work at various places including Tim Hortons. We also find it unclear whether the report was finalized prior to reviewing the final occupational therapy report; and the report does not include collateral interviews.

37The applicant relies on the Tribunal’s decision in Rattan v. TD General Insurance Company, 2024 CanLII 126980 (ON LAT) where the adjudicator did not find Dr. Jwely’s CAT assessment persuasive because the doctor copied and pasted from the occupational therapist’s report and did not provide any rationale for his rating. While we are not bound by other decisions of the Tribunal, we find that Rattan is not applicable in this case because Dr. Jwely testified in his cross-examination that he reviewed and considered the applicant’s history, including his medical records, he also considers examples from the applicant’s past and current circumstances, as well the applicant’s behaviours in the context of the events happening in his life, in order to reach his conclusions.

38However, even if we gave Dr. Jwely’s opinion no weight we find the applicant has not met his onus in proving that he has a marked impairment in social functioning for the reasons discussed above. Now we will address the sphere of adaptation.

Adaptation

39We do not find that the applicant has a marked impairment in the sphere of adaptation for the reasons outlined below.

40The Guides define impairment in adaptation as the repeated failure to adapt to stressful circumstances, in the face of which the individual may withdraw from the situation or experience exacerbation of signs and symptoms of a mental disorder; that is, decompensate or having difficulty maintaining activities of daily living, continuing social relationships, and completing tasks. By definition, impairment in adaptation affects the ability to function across all activity areas. Regarding activities of daily living, their quality is judged by their independence, appropriateness, effectiveness, and sustainability.

41As a starting point neither parties’ assessors determined that the applicant has a marked impairment in adaptation. Based on the totality of the evidence before us we find that there is little which establishes that the applicant has had a repeated failure to adapt to stressful circumstances because of a mental or behavioural disorder. The evidence before us demonstrates that the applicant is independent in carrying out his activities of daily living such as self-care, that he is able to communicate by using his phone and through social media, and that he has the ability to socialize as he has five close friends. He independently accesses the community by taking public transit to school and to his part-time work. He also has a driver’s licence and accesses the community sometimes by car. Finally, he was able to graduate from both elementary school, high school, obtain a college certificate, and he has sought out and held various part-time jobs. We find the applicant’s inability to maintain steady part-time work post-accident to be related to physical complaints as opposed to a mental or behavioural disorder. We find that when we consider the applicant’s function across the four spheres, he does not have a marked or extreme impairment in adaptation.

42Although we acknowledge that the applicant was involved in an accident as a minor and sustained injuries as a result, we do not find that he meets the threshold for a CAT impairment under Criterion 8.

ORDER

43For the above reasons, it is ordered that the applicant does not have a catastrophic impairment under Criterion 8.