Citation: Cetin v. Definity Insurance Company, 2026 ONLAT 25-006515/AABS

Licence Appeal Tribunal File Number: 25-006515/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:

Dogan Cetin

Applicant

and

Definity Insurance Company

Respondent

DECISION

ADJUDICATOR:

Tami Cogan

APPEARANCES:

For the Applicant:

Sema Cetin, Applicant’s Spouse

For the Respondent:

Stephen Whibbs, Counsel

Interpreters:

Muberra Sydi, Turkish Language

Ozlem Arac, Turkish Language

Court Reporter:

Abhishek Pawar

HEARD by Videoconference:

March 9, 10, 11, 12, 13, 16, 17, 2026

OVERVIEW

1Dogan Cetin, the applicant, was involved in an automobile accident on May 26, 2019, 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, Definity 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. Has the applicant sustained a catastrophic impairment (“CAT”) as defined by the Schedule under criterion 8?

ii. Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $400.00 per week from November 28, 2023, to present?

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?

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

RESULT

3I have considered the parties’ submissions, the testimony of the witnesses and the documents entered into evidence, and I find the following:

i. The applicant has not sustained a catastrophic impairment as a result of the accident, as defined by the Schedule.

ii. The applicant is not entitled to post-104-week income replacement benefit, from November 28, 2023, to present.

iii. The applicant is not entitled to an award under s.10 of Reg. 664.

iv. No interest is owed.

PROCEDURAL ISSUES

Self-represented Applicant

4The applicant does not have counsel and the applicant’s wife is requesting to assist him throughout this hearing. Mrs. Cetin is also listed as a witness who will testify.

5The respondent does not oppose Mrs. Cetin appearing on the applicant’s behalf for the purposes of questioning the witnesses, so long as she does not testify.

6I allowed the applicant and Mrs. Cetin to decide in which capacity she would be of greatest assistance to the applicant; as a witness, or as his representative. The applicant and Mrs. Cetin elected for her to act as his representative, and she did not testify.

Witnesses

7At the start of the hearing, the respondent brought a motion seeking to bar the applicant’s lay witnesses from testifying because notice of their attendance was not provided, nor were any particulars of their anticipated evidence. The respondent further raised concern that the applicant’s former lawyer, Ivor Levstein is listed as a lay witness. Mr. Levstein was present and on the record at the case conference. The respondent seeks to limit the witness’ testimony to preclude any evidence regarding his involvement as a representative in this matter and the case conference.

8Mrs. Cetin submitted that she is not trained as a representative and was unaware of the requirement to inform the respondent of the witnesses’ evidence. The respondent was informed late last week of who will be appearing to testify. The lay witnesses include, Muharrem Genc, a friend who has worked for the applicant. He will testify to the applicant’s abilities pre and post accident. Yasemin Aygun, bookkeeper who has worked for the applicant and prepared a report on which the applicant intends to rely. She will testify to the loss of anticipated income as a result of the accident. Yasha Ifraimov, property manager for the applicant’s AirBnB. He will testify to his involvement with the rental of Reiner Road and management of same.

9The respondent submits that the accounting report was sent the day before the hearing. It appears to be in the format of an expert’s report. No curriculum vitae has been provided for the report’s author and proposed witness. The applicant’s witnesses were named in an email last week, with one sentence each indicating the content of their evidence. The respondent submits that to allow the witnesses is procedurally unfair and should not be allowed.

10I ordered that Mr. Levstein’s testimony may not address the case conference, and must be limited to his personal knowledge of the applicant’s functional abilities and activities.

11I also ordered that Ms. Aygun’s will not be qualified as an expert, and therefore, may not provide opinion evidence.

12I ordered that the three proposed lay witnesses may testify. To mitigate procedural unfairness, the respondent will be provided time to prepare for cross-examination after hearing the witnesses’ testimony in direct examination, if requested.

Applicant’s Documentary Evidence

13The applicant has not filed a document brief. Over the course of seven months Mrs. Cetin has been sending documents to the Tribunal. The applicant submits that these documents were provided to the respondent either in one of two banker boxes that were delivered to counsel, or via email. I note that the documents sent to the Tribunal were not labelled and in such quantities that receipt of each document is not reasonable to confirm at this stage of the proceeding.

14Mrs. Cetin was ordered to re-file only the documents on which the applicant intends to rely. A naming convention was provided for ease of identification of each document. These documents were served and filed via email throughout the hearing. I note that throughout the proceeding the applicant attempted to introduce additional documents that had not been received by either the respondent or the Tribunal. I heard submissions from both parties on each document. Documents that I deemed to have probative value that outweighed the prejudice to the respondent were admitted into evidence. The parties were invited to make submissions as to weight of the evidence in their closing submissions.

ANALYSIS

Catastrophic Impairment

15On December 13, 2021, the applicant applied to the respondent for a determination that his accident-related impairments meet the definition of CAT under the Schedule pursuant to Criterion 8.

Criterion 8

16I find that the accident was not a necessary cause of the psychological impairments the applicant puts forth in support of his application for a CAT determination, which is discussed in further detail below.

17In order to prove their case, the applicant must demonstrate that they have suffered accident-related impairments that result in a marked (class 4) impairment in three or more areas of function, or an extreme (class 5) impairment in one area of function according to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (the “Guides”) 4th Edition due to a mental or behavioural disorder.

18Mental and behavioural impairments are rated according to how seriously they affect a person’s useful daily functioning. The Guides set out the four areas or “spheres” of functioning and the relative levels of impairment. The test to determine whether the applicant has sustained a catastrophic impairment is a legal one and not a medical one. See: Liu v. 1226071 Ontario Inc. (Canadian Zhorong Trading Ltd.), 2009 ONCA 571 at paras. 29-30.

19The four spheres of functioning are set out in the Guides as follows:

Area or Sphere 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)

20The applicant relies on the psychological catastrophic impairment assessments conducted on June 3, 4, 14, and 21, 2021 by Dr. Jeremy Frank, psychologist and Dr. Karen Gordon, psychologist whose report is dated August 26, 2021; and the occupational therapy in-home and situational therapy assessments conducted on June 8 and 10, 2021 by Ms. Erin Sesel, occupational therapist report dated August 1, 2021.

21The respondent relies on the psychiatric catastrophic impairment assessments conducted on June 14, 2022, by Dr. Velan Sivasubramanian, psychiatrist, report dated February 24, 2023; and the occupational therapy in-home and situational assessments conducted on January 4 and 11, 2023, by Ms. Susan Javasky, occupational therapist, reports dated February 24, 2023.

22The chart below is a summary of the applicant’s and respondent’s assessed ratings for each sphere of function.

Area or Sphere 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)		Respondent		Applicant
Social Functioning		Respondent		Applicant
Concentration, Persistence, and Pace (CPP)		Respondent		Applicant
Adaptation (Deterioration in a work-like setting)			Respondent / Applicant	Applicant

Causation

23The applicant’s claim is complicated by his pre-existing medical conditions resulting from a slip and fall on February 16, 2019. His injuries, conditions, and symptoms from the slip and fall included: Right hand injury; right shoulder injury; right side neck pain; numbness in right arm; limited use of right hand/arm; post-traumatic headaches; difficulty sleeping/insomnia; urinary incontinence; anxiety; low mood; Complex Regional Pain Syndrome (CRPS). Treatment included spinal cord stimulation implant surgery.

24In making my determination, I must consider the level of the applicant’s functional abilities before the accident as well as after the accident.

25The respondent submits that any mental behavioural functional limitations under criterion 8, are the direct result of the applicant’s physical functional limitations caused by the slip and fall.

26The applicant did not address causation in his submissions or evidence.

27In order to determine if the applicant suffered an impairment as a result of the accident, I must first determine if the accident was a necessary cause of the injuries the applicant puts forth as the basis for his CAT application and his claim for IRBs.

28It is well established law that the appropriate test to determine causation in accident benefit cases is the “but for” test, which was confirmed by the Divisional Court in Sabadash v. State Farm et al., 2019 ONSC 1121 (Sabadash). To satisfy this test, the applicant must prove on a balance of probabilities that “but for” the accident he would not have suffered the impairments which form the basis for his application for CAT status. In Sabadash, the Court sets out that pre-existing medical issues do not negate an insurer’s liability. Further, that the accident need not be the only cause of the impairment but a necessary cause. The Court further instructs the decision maker to conduct a robust analysis given the unique circumstances of the case at hand.

29The applicant attended his family physician, Dr. Geleff many times after the slip and fall. I note that these records are not before me, however, Dr. Geleff’s post slip and fall records were reviewed and referred to in the document summaries of several assessors. I find the summaries of Dr. Geleff’s records are highly consistent in the assessors’ reports and therefore accept them as an accurate record. The applicant reported to Dr. Geleff on February 28, March 13, 19, April 5, 12, May 7, 17, 2019, that he had difficulty sleeping due to pain, numbness, worry, anxiety, and low mood. The applicant also reported to Dr. Geleff that his concentration was poor. I find this supports that the applicant’s sleep disorder, and the onset of his psychological symptoms pre-existed the accident.

30In her pain management consultation notes, Dr. Cindy Chan documented on April 18, 2019, “… reports increased symptoms of depression since the onset of pain and I have advised him to F/U with GP or be referred to a psychiatrist.” I find that this also supports that the onset of his psychological conditions was pre-accident.

31The family physician’s clinical notes and records post accident are in evidence, and indicate that the applicant’s reporting to his family physician did not change after the accident and treatment was focused on the pre-accident injuries, including CRPS.

32Due to complaints of nocturnal incontinence after the slip and fall, Dr. Geleff referred the applicant to a urologist. On August 13, 2019, Dr. Livia Lee, Urologist opined in a consultation letter that the applicant’s enuresis may be related to deep sleep due to Elavil/Pregabalin and overactive bladder.” I note these are pain medications prescribed to the applicant due to the injury to his right arm, sustained in the slip and fall. The applicant submitted that his enuresis contributes to his mental behavioural function after the accident. I find Dr. Lee’s letter supports that the applicant’s enuresis was a pre-existing condition.

33I heard testimony from the applicant that before the ‘accident’ he would get up at 6:00am, go to the coffee shop, then go to work. He would chat with friends, go to wedding ceremonies, hang out in clubs and bars, go to the gym, go out to eat with his family, and celebrate birthdays and anniversaries. He did the yard maintenance, cooked, played with his kids, and was working. However, the applicant reported to all of his assessors, that he had stopped all of these activities after the slip and fall accident on February 16, 2019. I note that the applicant, does not make any further differentiation between the slip and fall and the motor vehicle accident when describing his injuries and symptoms, he only uses the term “accident”. I find the applicant’s reporting to the assessors was consistent over several years. I accept that before the slip and fall the applicant had a full life without restrictions, and the slip and fall incident resulted in injuries and functional limitations. However, this determination of a catastrophic impairment is separate from the slip and fall, and is specific to the applicant’s limitations because of mental and behavioural disorders, as a result of the motor vehicle accident.

34I was directed to the report of Dr. Raymond Zabieliauskas, physiatrist, who assessed the applicant on behalf of the respondent on July 8, 2020. I am persuaded by Dr. Zabieliauskas, who opined that “[w]hile I do not discount the fact that the motor vehicle accident would have caused a temporary flare-up of his complex regional pain syndrome, this would have dissipated within 2 to 3 months of the time of the motor vehicle accident. His current voiced complaints are attributable to the slip and fall of February 16, 2019. The motor vehicle accident would have caused only a temporary condition but within three months of the motor vehicle accident he would be back to his pre-accident level, which is to say his challenges are with the complex regional pain syndrome that is currently being addressed by pain specialists.” I prefer Dr. Zabieliauskas’ evidence because he considered causation. Whereas the s. 25 assessors appear to have co-mingled the applicant’s physical injuries from the accident with the psychological sequelae from the slip and fall, which I will discuss below.

35In order for assessors to make an informed opinion as to causation and his functional limitations, the applicant must provide full disclosure of his activities and circumstances. I find that the applicant was not forthcoming with information that is relevant for this purpose because I heard testimony that the applicant continued as a general contractor on his personal construction projects until approximately 2022, which was not disclosed to the assessors.

36I find that the applicant having omitted telling the assessors very relevant details of his activities after the accident, has substantially weakened the opinions of assessors, such as Dr. Z. Waisman, psychiatrist who completed a psychiatric assessment, and who opined in the report that the accident played a material role in the applicant’s current psychiatric impairments. I also note that the report of Dr. Waisman is an incomplete copy, and is undated, and therefore give his report, and his opinion little weight.

37I give little weight to the conclusions of Dr. Frank and Dr. Gordon because in the psychological assessment report of Dr. Frank and Dr. Gordon dated August 26, 2021, there were significant validity concerns in on the Personality Assessment Inventory and the Minnesota Multiphasic Personality Inventory - 3, both of which they opined the profiles to be invalid and uninterpretable. In spite of significant validity concerns, Dr. Frank and Dr. Gordon diagnosed Somatic Symptom Disorder, Post Traumatic Stress Disorder, and Major Depressive Disorder. However, the presence of pre-existing psychological symptoms was given little weight, and the diagnoses are attributed to the accident.

38Further, Dr. Frank and Dr. Gordon assign a rating of moderate-to-marked impairment in adaptation (as noted in the rating chart above), however the AMA Guides do not allow for a split rating. Further, I note that the Psychiatric Impairment Rating Scale (PIRS) score for their criterion 7 assessment is moderate-to-no-impairment in five of the six domains, which is not consistent with a marked impairment in the criterion 8 rating. Also, they rate the applicant as severely impaired in the domain of resilience and employability, however they too were unaware of the applicant’s real estate dealings, or his involvement with the construction project at Reiner Road, which was on-going at the time of their assessment.

39I prefer the evidence of Dr. Sivasubramanian, who in his assessment noted that the applicant did not display any significant anxiety when describing his motor vehicle accident. There was no indication of psychosis or acute suicidal ideation. Dr. Sivasubramanian opined that the applicant had been struggling with signs and symptoms consistent with Somatic Symptom Disorder with predominant pain and Major Depressive Disorder with anxious distress leading up to the accident. He further opined that the applicant was already significantly impaired prior to the accident and although both diagnosed conditions were exacerbated by the accident, it is very difficult to discern any further significant impairment following the subject accident.

40I give Dr. Sivasubramanian’s testimony and report more weight than Dr. Frank and Dr. Gordon’s report. Dr. Sivasubramanian testified, and his evidence was available for cross-examination. I find that Dr. Sivasubramanian provided a thorough and thoughtful analysis of the causation of the applicant’s psychological condition. I accept the ratings Dr. Sivasubramanian assigned in the four spheres of functional ability: mild impairments in ADLs, Social Functioning, CPP, and a moderate rating in Adaptation.

41I will further consider causation of the applicant’s functional limitations within my analysis of each sphere of function, as well as the applicant’s credibility, below.

i. Activities of Daily Living (ADLs)

42I find the applicant does not have a marked impairment in the sphere of activities of daily living.

43The activities of daily living are defined in the Guides:

Activities of daily living include 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 of 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.

44I have been directed to numerous reports in which the applicant reports limited abilities for his own personal care, grooming, household chores, cooking and family activities. He testified that he is only able to walk, stand, or sit for short periods of time and requires a cane when he is outdoors. Due to the injury to his right hand and shoulder he is limited in tasks that require two hands, or reaching overhead. However, these limitations are related to the applicant’s physical injuries he sustained in the slip and fall. After the slip and fall the applicant’s nephew was providing him with support. I heard testimony from the applicant that after the start of COVID restrictions, Personal Support Workers (PSW) would no longer attend, so his ex-wife moved in with their children to provide support. Again, a criterion 8 CAT determination is based on mental behavioural disorders and does not include limitations strictly due to physical injuries.

45The applicant did report to Dr. Frank and Dr. Gordon that his motivation for personal grooming has declined. He does not shower as often and has let his hair and beard grow. He testified that he showers every 2 -3 days. During the occupational therapy assessments, both Ms. Sesel and Ms. Javasky noted the applicant’s limited effort in the assessments, and that he declined to participate in many tasks, citing fatigue and pain as the reasons.

46The applicant reported to Dr. Frank, Dr. Gordon, and Dr. Sivasubramanian that he travelled to Turkey in 2021. The applicant testified that he travelled to Turkey for three weeks to visit his mother after an earthquake had struck the region in which she lived. His eldest son travelled with him. He testified that his son was his caregiver during their travels. I find that although an 8-year-old child may be capable of assisting with some tasks during the journey, I do not accept that the child was the applicant’s caregiver, but rather I find the applicant demonstrated the ability to independently travel while providing care to a minor child.

47I heard testimony from Mr. Drinkwater, physiotherapist who undertook a Functional Abilities Evaluation with the applicant on September 3, 2020. He expressed concerns with the significant lack of effort put forth by the applicant during each assessment.

48Mr. Drinkwater testified that the outcome of the assessment on September 3, 2020, was a null set because the applicant had declined almost all of the tasks, and therefore his abilities had not in fact been evaluated. Mr. Drinkwater expressed that the applicant’s demonstrated functional abilities were so low, that an assessment may have been inappropriate. For example, the applicant was asked to complete a task that assesses the person’s ability to use their fingers and hands for fine motor skills. The person is to move a peg that weighs less than one ounce, and each peg takes less than ten seconds to move. After moving four pegs using his left hand, the applicant declined to continue due to low back pain. The applicant refused to attempt the task with his right hand. Mr. Drinkwater testified that there was no orthopaedic consistency with the applicant’s documented injuries.

49Mr. Drinkwater reassessed the applicant on February 16, 2022. He described the applicant as using a cane and walking with a significant limp, and that he “barely made it into the examination room”. Other than walking into the examination room, the applicant declined all other tasks except the grip strength test for his left hand. The results were 1.3lbs, which would equate to the inability to open a door, which is below the level of a quadriplegic. Mr. Drinkwater described the applicant as being completely consumed by pain, and compatible with someone who is bedridden. Further, Mr. Drinkwater testified that “if I had taken his presentation as accurate, I would want to call an ambulance.” The applicant had exceedingly low function in the first assessment, and was worse in the second assessment. He stated that there is no organic explanation for the demonstrated decline between the assessments.

50During his testimony, Mr. Drinkwater was shown a surveillance video from November 4, 2021, which is between the two assessments. Mr. Drinkwater was aghast at the functional ability of the person in the video (who had been previously confirmed to be the applicant). He spontaneously uttered “I feel like I have been duped.” Mr. Drinkwater re-composed himself and stated that there is “no organic explanation for the miraculous recovery from the first assessment” to the date of the video. Further, when he was shown a surveillance video taken on May 11, 2023, Mr. Drinkwater questioned if the person in the video was in fact the same person, because what he was viewing was completely inconsistent with the person who appeared at the second assessment. He stated that he does not know of a medical explanation for the improvement in function. Mr. Drinkwater opined that people talk about good days and bad days of pain, and the use of medication, but that does not explain the discrepancy in the applicant’s functional abilities. I find that the significant inconsistencies in ability and effort put forth by the applicant brings into question whether his reporting of his symptoms can be relied on.

51The respondent relies on surveillance videos taken of the applicant on November 26, 2021, and May 15, 2023. I have taken into consideration that the surveillance is a “snapshot in time” and may not represent the applicant’s function on a consistent basis. However, these videos depicted a man who was dressed in a suit; was groomed; ambulated with ease; traversed stairs; walked across grass; stepped down a sidewalk curb; manipulated a cellphone with his dominant right hand. He drove a vehicle to the gas station and to Tim Hortons. He was alone and did not receive assistance from anyone, nor did he use any mobility devices. I find that the applicant’s presentation in the videos was not consistent with how he describes his abilities.

52I have not heard persuasive evidence that the applicant is incapable of ADLs without direction or supervision. I have heard that his limitations in ADLs are primarily due to physical restrictions as a result of the injuries sustained in the slip and fall, and the psychological sequelae that followed the slip and fall. I find the evidence does not support that the accident was a necessary cause of the applicant’s functional limitations and therefore, the applicant has not proven on a balance of probabilities that he has a marked impairment in the sphere of ADLs as a result of the accident.

ii. Social Functioning

53I find the applicant does not have a marked impairment in the sphere of social functioning.

54Social functioning is defined in the Guides:

An individual’s capacity to interact appropriately and communicate effectively with other individuals. It 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 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 with others and interact and actively participate in group activities, cooperative behaviour, consideration for others, awareness of others’ sensitivities and social maturity also need to be considered.

55The applicant reported to Dr. Frank and Dr. Gordon on June 3 and 14, 2021 that he separated from his wife in 2015, and at the time of the assessment he was single and not dating. He has two children then ages 6 and 10. He has consistently reported these facts to all other assessors, and testified to same. Initially, after the slip and fall, the applicant’s nephew, with whom he was living, provided assistance. Also, his wife, although separated, moved in with the children, to provide assistance. They remained cohabitating and eventually he and his wife reconciled in 2024. I find the applicant’s reconciliation with his former spouse is not consistent with a marked impairment in social functioning.

56I also heard testimony from the applicant that he brought his mother from Turkey to live with his family. It was unclear when this occurred, except that it was sometime after the earthquake in 2021, however, I find it supports that the applicant has the ability to maintain familial relationships. The applicant did testify that he does not speak as often with his brother who lives in Turkey. However, I also heard testimony from the applicant that there was tension between the brothers due to the applicant seeking financial support from the brother, who eventually sent approximately $100,000 after the sale of property in Turkey. The applicant testified that he is embarrassed that he needs financial support.

57The applicant testified that due to his pain and depression, he no longer participates in leisure or recreational activities. He does not participate with his children as he used to. The assessors have attributed the applicant’s psychological condition to his physical injuries and limitations. However, I have not heard persuasive evidence that the injuries that are causing the applicant’s pain, and therefore psychological conditions, are attributable to the accident.

58The applicant testified that before the slip and fall, he was a person of status in his community. His business was successful with a good reputation and was growing. It is evident that this is very important to the applicant and was a source of pride. He reported to assessors that after the slip and fall he cancelled contracts, and people were not happy. He reported that people were threatening legal action. He stopped answering phone calls. He testified that he did not want people to see him with his injury, in pain, and he socially withdrew. Again, I find the cause of this social stress was the slip and fall incident, and not the subject accident.

59An analysis of the sphere of Social Function includes social conflicts. Dr. Shade Miller, Psychiatrist noted the applicant’s involvement with three legal actions involving insurance companies and the applicant’s level of stress and anxiety associated with them. These included a tort action stemming from the slip and fall in 2019, a tort action resulting from the accident in 2019; and the Tribunal applications. However, I find these are not social conflicts.

60I was directed to evidence that the applicant was sued on a construction lien in 2021 as a result of not paying a contractor for work on a construction build; and he was audited by the CRA in 2023, which resulted in a demand for repayment of over one million dollars as a result of not paying HST on the sale of properties. While I accept that these actions would cause the applicant stress and anxiety, I find that they are not a result of the accident.

61The applicant’s credibility is also called into question because of reporting to assessor such things as “he had built his business and was making millions”, which Dr. Frank and Dr. Gordon documented in their August 26, 2021, report. I was directed to the applicant’s corporate and personal income tax records which strongly support the applicant drew a modest salary each year up until 2018, which placed the corporation in a deficit every year except 2018, when a modest gross profit was earned.

62I heard testimony from the applicant, as well as Mr. Levstein that the applicant purchased, demolished, and reconstructed several properties between 2018 and 2022. The earlier projects were through the applicant’s business. The projects involved the applicant contracting with the real estate agents for the viewing of the properties and negotiations of the purchase/sale prices. He was also dealing with financial institutions or private lenders for the mortgages and signing financing contracts. I find that each of these requires significant social and communication skills. While the applicant testified that he “just signed the papers”, I am not persuaded that transactions of this nature would be completed without the signatory being actively involved in the process.

63I find the applicant has not established that as a result of the accident, he has a marked impairment in the sphere of Social Functioning.

iii. Concentration, Persistence, and Pace (CPP)

64I find the applicant does not have a marked impairment in the sphere of CPP.

65CPP is defined in the Guides:

Concentration, persistence and pace 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 work settings… 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.

66I note that much of the applicant’s evidence was focused on his financial stressors. When speaking with Dr. Frank and Dr. Gordon he reported that he “has lost his own house, and he lost all of his money”. The applicant reported to Dr. Geleff and all assessors that he was unable to work after the slip and fall. He testified that he has not returned to work since then.

67The applicant lead evidence of his mental health crisis and suicidality in support of his lack of functional ability. I note that Dr. Miller, at the Centre for Addictions and Mental Health (CAMH) opined in the clinical notes and records dated January 17 – 20, 2026, “[h]is symptoms are in keeping of a major depressive episode precipitated by financial stress in the community. [A]ll of his suicidality appears to be impulsive and directly tied to his legal and financial issues. Often emailing or telling lawyers or the CRA he will kill himself in response to their questions or requests for money. Given the direct connection of his symptoms to his financial and pain related stressors, I have diagnosed this as Adjustment Disorder with mixed disturbance of emotion and conduct.” The applicant was discharged on the same day of his admission assessment. I find this opinion is helpful to place perspective and causation to the applicant’s psychological condition. I find that the applicant’s financial stress is attributable to the slip and fall, not the accident.

68Mr. Levstein testified that while retained by the applicant for many of his business transactions and legal dealings, up until his recent retirement, at no time was Mr. Levstein concerned about the applicant’s ability to make decisions or instruct counsel. At no time was there a Power of Attorney, other substitute decisionmaker, or litigation guardian involved in his business or private affairs. I heard evidence from the applicant, Mr. Levstein, Mr. Muharren Genc, and Mr. Yasha Ifraimov that the applicant’s wife was at times involved with decisions. I note that they were living separately until sometime in 2020. I did not hear persuasive evidence that Mrs. Cetin was at anytime the primary decision maker.

69The applicant testified that in February 2018 he sold his home at 127 Searle Avenue for $2,235,000.00. This was a house he had reconstructed and then sold. In 2018 the applicant purchased 106 King High Avenue for $1,075,000. The applicant demolished the existing home and built a new custom home. At the time of the accident the applicant was living at 106 King High Avenue. In March 2019, after the slip and fall, but before the accident, the applicant obtained a second mortgage financed against 106 King High Avenue for $1,850,000.

70The applicant testified that he also had a second house on Clifton, which he renovated and sold. I note I did not hear any details regarding this property.

71The applicant testified that on December 21, 2020, he sold 106 King High Avenue for $2,435,000.00. On January 4, 2021, the applicant closed on the purchase of 98 Reiner Road for $1,280,000.00. This purchase included financing the mortgage for $1,600,000.00.

72I note that it is the sale of 106 King High Avenue and 98 Reiner Road that the applicant was reporting to Dr. Geleff, family doctor; Dr. Cheng, physiatrist who conducted an assessment on September 15, 2023; Ms. Sesel; Ms. Melissa Paniccia, occupation therapist during an assessment on March 27, 2023; and Dr. Miller that he was unable to pay his mortgage, that he needed to sell his house. He also reported when he had sold his house, he had to purchase a much smaller home, but that he could not pay that mortgage and moved into a rental property.

73However, the applicant testified that after he purchased 98 Reiner Road, he did not live there because he demolished the house in April 2021 and began building a new custom home, while he lived in a rental property on 123 McAllister Avenue.

74I heard testimony from Mr. Levstein that although the applicant was unable to physically participate in the construction work, he continued as the general contractor to manage the sub-contractors. He was responsible for finding, scheduling, and paying the subcontractors and keeping projects on schedule.

75On July 21, 2021, the applicant secured a second mortgage on 98 Reiner Road for $700,000.00. Then on December 9, 2021, the applicant secured a third mortgage against 98 Reiner Road for $1,250,000.00.

76Mr. Genc testified that in December 2021 he volunteered to help the applicant. He stated that the applicant needed help because he could not walk. I note that this is shortly after the applicant’s spinal surgery for the treatment of his arm injury and Complex Regional Pain Syndrome, resulting from the slip and fall. He was involved for approximately three months. Mr. Genc attended on the work site and spoke with the subcontractors. However, it was the applicant who was making the decisions. Mr. Genc testified that their friendship continues. I find that this evidence supports the applicant’s ability to maintain relationships, not only with friends, but also with the people he has contracted and corroborates his level of social function.

77The applicant testified that in January 2022 he and his family moved into 98 Reiner Road. He testified that construction was not complete, however I did not hear what work was left outstanding. On June 10, 2022, the applicant secured a consolidation mortgage in the amount of $2,300,000.00. Again, on September 16, 2022, he secured a second mortgage against 98 Reiner Road in the amount of $125,000.00.

78I find that the applicant does not have an impairment that significantly impedes useful functioning because managing the demolition and reconstruction of 98 Reiner Road, as well as the financial transactions of obtaining mortgages, and negotiating the purchases and sales of the properties supports that the applicant is able to manage complex tasks that require concentration, and attention to detail over a period of time.

iv. Adaptation

79I find the applicant does not have a marked impairment in the sphere of Adaptation.

80Adaptation is defined in the Guides:

Deterioration or decompensation 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.

81I heard evidence from the applicant that during the construction of his house at 98 Reiner Road, he had confrontations with the concrete foundation contractor. He submits that he was being threatened and was fearful. He testified that it was a very stressful situation. I heard testimony from Mr. Amir Javady who works for his father, the owner of that concrete foundation company. Mr. Javady testified that they dealt directly with the applicant, and they began the concrete work at 98 Reiner Road in May 2021, while the excavation work was being completed. They were the second contractor on site of the new project. He testified that when the work was complete in July 2021, the applicant refused to pay the invoice for the work completed, claiming he did not have any money to pay the bill. A construction lien was obtained, and legal action ensued. Eventually, the matter was settled out of court, directly between the parties. The applicant testified that he had retained a lawyer for the lawsuit. I find that the ability to retain and instruct counsel, as well as resolve the dispute without counsel, supports the applicant is capable of complex decisions and communication that involve social interactions and does not support a marked impairment in Adaptation.

82Further, I find this legal action is unrelated to the accident, and any psychological sequelae as a result of the lawsuit is not caused by the accident.

83I do note, that Dr. Sivasubramanian testified that he was unaware of the applicant’s real estate and financial dealings, or his involvement with the construction project at 98 Reiner Road, and that information would have influenced his rating to be lower than a moderate impairment in the sphere of Adaptation.

84I find that the applicant does not have an impairment that significantly impedes useful functioning in the sphere of Adaptation.

85I find that the accident is not a necessary cause of the applicant’s mental behavioural impairments.

86I find that as a result of the accident, the applicant does not have a marked impairment in ADLs, Social Functioning, CPP, or Adaptation, and thus, has not met the definition of a catastrophic impairment as defined by the Schedule.

Income Replacement Benefit (IRB), Post-104 Week

87I find the applicant has not established that as a result of the accident, he is entitled to post-104-week IRB from November 28, 2023 to present.

88To receive payment for a post-104-week IRB under s. 6 of the Schedule, the applicant must demonstrate on a balance of probabilities that he suffers from a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience.

89I find that since the accident occurred on May 26, 2019, the post-104-week IRB period begins on May 23, 2021. The parties agree the applicant was paid IRB until November 27, 2023. I heard testimony from the applicant that his IRB was stopped because he did not attend an MRI required by the respondent.

90The applicant spent little time at the hearing addressing the post-104 IRB test that he has a complete inability to engage in any employment or self-employment for which he is reasonably suited by education, training, or experience. This is the disability test which must be met in order to prove entitlement to the benefit.

91I heard that he has a high school education and has on the job training. The applicant did not lead evidence of his work experience, except that he was a general contractor and the owner of his own company. He testified that as a result of the accident, he is unable to work.

92I find the totality of the medical evidence supports that the accident was not a necessary cause of the applicant’s inability to work because he reported consistently that he had stopped working due to his injury sustained in the slip and fall. However, I also heard testimony from Mr. Levstein and Mr. Genc that the applicant continued to work as a general contractor building custom homes until at least 2022.

93In addition to the issue of causation, the applicant has also not established on a balance of probabilities that he suffers from a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience.

Award

94An award under s. 10 of Reg. 664 is listed as an issue in dispute in the case conference report and order and was confirmed by the parties at the start of the hearing. 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.

95The applicant did not make submissions on the issue of an award.

96The respondent submits that no particulars of an award were provided. The benefits were not unreasonably withheld, and payments were not delayed. Therefore, the issue should be dismissed.

97I find the applicant has not met his burden of proof that an award under s. 10 of Reg. 664 should be granted because I have not heard evidence to support payments were delayed or that benefits were unreasonably withheld.

Interest

98Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.

99As there are no overdue benefits, no interest is owing.

ORDER

100For the reasons above, I find:

i. The applicant has not established that as a result of the accident, he has sustained a catastrophic impairment as defined by the Schedule.

ii. The applicant has not established that as a result of the accident, he suffers from a complete inability to engage in any employment or self-employment for which he is reasonably suited by education, training or experience.

iii. The applicant is not entitled to an award under s. 10 of Reg. 664.

iv. No interest is owing.