Citation: Ghabour v. Belair Insurance Company Inc., 2026 ONLAT 24-015366/AABS

Licence Appeal Tribunal File Number: 24-015366/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:

Safwat Ghabour

Applicant

and

Belair Insurance Company Inc.

Respondent

DECISION

VICE-CHAIR: Robert Maich

APPEARANCES:

For the Applicant:

Mireille Dahab, Counsel Avneet Kaur, Counsel

For the Respondent:

Joy Kohli, Counsel

HEARD: In Writing

OVERVIEW

1Safwat Ghabour, the applicant, was involved in an automobile accident on August 25, 2024, 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, Belair Insurance Company Inc., and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUES

2In his submissions, the applicant withdrew issues in dispute using the following language:

“He has streamlined the issues before the Tribunal. He withdraws his claim regarding the quantum of income replacement benefits as well as the partial denial of chiropractic treatment. The only treatment issues advanced are:

a. A concussion assessment in the amount of $2,200.00 (OCF-18 dated December 6, 2024); and

b. A concussion treatment program in the amount of $5,883.98 (OCF-18 dated January 14, 2025). which was inadvertently noted in the Case Conference Order as “physiotherapy treatment”.

3The applicant made no further submissions in respect to either income replacement benefits (“IRB”) or the partial denial of chiropractic treatment in either his written submissions or reply.

4The respondent submitted that the applicant withdrew quantum of IRB in his submissions and did not make any submissions on entitlement to IRB. The respondent submitted the applicant has failed to meet his onus to establish entitlement. Further, the respondent submitted the applicant is prohibited from making additional submissions in reply on entitlement as it would be highly prejudicial to the respondent.

5I note that the applicant made no submissions on IRB in his reply.

6I find from the applicant’s conduct in both written submissions and reply that his intention was to withdraw the IRB issue in its entirety, as IRB was not raised in either of the applicant’s submissions.

7I also find the issue of the partially approved chiropractic treatment plan dated October 24, 2024 in dispute is withdrawn.

ISSUES

8The issues in dispute are:

1. Is the applicant entitled to $5,883.98 for physiotherapy services, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025?

2. Is the applicant entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024?

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

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

RESULT

9The applicant is entitled to $5,883.98 for physiotherapy treatment, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025.

10The applicant is entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024.

11The respondent is not liable to pay an award under s. 10 of Reg. 664.

12The applicant is entitled to interest on any overdue payment of benefits.

ANALYSIS

Legal Test for Assessments and Treatment Plans

13To 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.

Applicant’s Medical Evidence

14The applicant submits that, as a result of the accident, he sustained a C6 cervical fracture, was treated with an Aspen collar, lost consciousness and developed persistent post-concussion symptoms including dizziness, headaches, blurred vision, cognitive impairment, and sleep disturbance.

15The applicant relies upon the clinical notes and records (“CNR”) of Harwood Health between March through August 2025, the CNR of Dr. Girgis, physician, the CNR of Lakeside Health, the CNR of St. Michaels Hospital, the psychological assessment by Dr. Sharifzadeh, psychologist, dated June 23, 2025 (“Sharifzadeh report”), the chronic pain assessment by Dr. Al-Jazrawi, physician, dated July 29, 2025 (“Jazrawi report”), and the concussion assessment of Mr. Abdelkader, physiotherapist and certified provider for concussion management, dated January 8, 2025 (“Abdelkader report”).

16The applicant submits both disputed OCF-18s identify the impairments outlined above in Part 6 of the forms. The December 6, 2024 OCF-18 lists post-concussion syndrome, syncope and collapse, subjective visual disturbances, sleep disorder, anxiety, nervousness, irritability, and cervical and shoulder injuries. The January 14, 2025 OCF-18 repeats these sequelae, further highlighting the persistence of post-concussion and musculoskeletal impairments. The applicant submits the medical documentation establishes a causal connection between the accident and the impairments and so, the treatment plans in dispute are reasonable and necessary.

17The applicant submits at the Emergency Department at Lakeside Health on August 25, 2024, the applicant reported dizziness and was observed with an unsteady gait. Nursing records documented the presence of headache and described dizziness and light-headedness lasting from minutes to hours. The applicant submits that these early records capture both vestibular and head-related complaints immediately after the motor vehicle accident. I have reviewed the CNR of Lakeside Health and find the submissions of the applicant accurately reflects the CNR of Lakeside Health.

18The applicant further submits the CNR of Dr. Girgis, his family physician, dated October 10, 2024, documented that the applicant had lost consciousness at the time of the accident and was experiencing flashes of light in his left eye causing his referral to an ophthalmologist. Dr. Girgis also confirmed that the applicant had not returned to work since the accident, indicating a significant functional impact from his ongoing symptoms. I have reviewed the CNR of Dr. Girgis and find the applicant’s submission to be accurate.

19The applicant submits the Abdelkader report findings included an applicant score of 109 on the Graded Symptom Checklist, reflecting a severe symptom burden; objective testing revealed impaired balance on the BESS test, an abnormal vestibular ocular reflex, and visual deficits affecting convergence, saccades, and smooth pursuit. Further, the applicant submits he reported severe headaches, dizziness, disrupted sleep, and cognitive fatigue limiting concentration to fifteen minutes. The Abdelkader report concluded that the applicant was suffering from persistent post-concussion syndrome and required a structured rehabilitation program. I have reviewed the Abdelkader report and find the submissions of the applicant to be accurate.

20The applicant submits the CNR of Core Physical and CNR of Harwood Health from February to August 2025, both consistently document cervico-vestibular dysfunction, headaches, persistent left shoulder pain rated six to nine out of ten, restricted range of motion, and poor sleep. Further, despite manual therapy, IFC, heat, and home exercises, the applicant showed minimal improvement. I have reviewed the CNR from Harwood Health and find the applicant’s submissions to be accurate; no review of the CNR for Core Physical was completed as the materials could not be located within the applicant’s brief of documents.

21The applicant submits the Sharifzadeh report diagnosed post-traumatic stress disorder, severe anxiety, and moderate depression; further the applicant reported nightmares, flashbacks, irritability, social withdrawal, and poor concentration. Dr. Sharifzadeh confirmed that these psychological impairments were exacerbating the applicant’s recovery from concussion and further supported the need for multidisciplinary treatment. I have reviewed the Sharifzadeh report and find the applicant’s submissions to be accurate. I find the Sharifzadeh report included a clinical interview of the applicant, review of his medical and personal history and objective psychometric testing; accordingly, I give his report significant weight.

22The applicant submits the Jazrawi report diagnosed chronic pain syndrome with severe depression and anxiety, confirmed persistent pain at level of five to six out of ten and peaking at eight out of ten, and documented substantial interference with sitting, standing, lifting, dressing, and sleep. Dr. Al-Jazrawi concluded that the applicant’s impairments were permanent and required a multidisciplinary treatment approach, including physiotherapy and psychological treatment. I have reviewed the Jazrawi report and find the applicant’s submissions to be accurate. I find the Jazrawi report included a clinical examination of the applicant and a review of his medical history including diagnostic imaging; accordingly, I give his report significant weight.

23The respondent submits the applicant has not been diagnosed with a concussion nor was he diagnosed at St. Michael’s Hospital after the accident. The respondent submits the applicant did not report loss of consciousness until he visited his family physician, Dr. Girgis on October 10, 2024, nor did Dr. Girgis diagnose the applicant with a concussion. The respondent submits the applicant did not return to Dr. Girgis with accident-related complaints until February 24, 2025; further he had no concussion/vestibular complaints at this visit nor was he referred for imaging for his head or brain, nor was he referred to a neurologist, brain injury clinic or concussion clinic.

Is the applicant entitled to $5,883.98 for physiotherapy services, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025?

24The applicant is entitled to $5,883.98 for physiotherapy services, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025.

25The applicant submitted the goals of the physiotherapy treatment plan are pain reduction, increased range of motion, and increased strength with the functional goals to return the applicant to activities of daily living, to enable him to return to pre-accident or modified work, and to improve posture and restore his pre-accident functional abilities so he could lead a healthy, independent, and active lifestyle. The proposed physiotherapy services includes twenty-four sessions of concussion-focused therapy for the head and neck, provider travel to facilitate home-based rehabilitation, and a concussion management kit including a wobble board, BlazePod reaction trainer, balance pad, laser headlamp, and neck massager. Further, any future progress and/or changes will be evaluated during follow-up evaluations, testing, NPRS, palpation tests, and evaluations of posture and functional abilities.

26The applicant relies upon medical evidence as reviewed previously in paragraphs [17] through [22].

27The respondent submits that the onus is on the applicant to demonstrate the treatment plans in dispute are reasonable and necessary and has failed to discharge this burden. The respondent submits that a treatment plan without supportive medical evidence is not enough to establish the treatment plan is reasonable and necessary; the respondent relies upon Blas v. Aviva Insurance Canada, 2021 CanLII 127471 (ON LAT).

28The respondent denied this treatment plan pursuant to the s. 44 general practitioner report of Dr. Sawh, physician, dated March 31, 2025 (“Sawh report”). Dr. Sawh reviewed Dr. Girgis’ records, Ajax Pickering Hospital Records, diagnostic images from the date of loss and records from St. Michael’s Hospital. Dr. Sawh noted inconsistencies between the functional limitations described by the applicant and the objective findings that did not fully support the severe functional limitations reported.

29I have reviewed the Sawh report and am satisfied it included a physical examination and review of the applicant’s records; accordingly I assign it significant weight. However, I find the Sawh report to be an outlier as the CNR of Dr Girgis, CNR from Harwood Health, Abdelkader report and Jazrawi report all contain evidence of the applicant’s physical limitations that the support the treatment plan; in particular I assign greater weight to the CNR’s of Dr Girgis and Harwood Health as the notes were made for the most part contemporaneously as the symptoms arose.

30I find the applicant’s submissions to be persuasive, the need for the treatment plan is supported by the CNR of Dr Girgis, CNR from Harwood Health, the Abdelkader report and the Jazrawi report and am satisfied the stated goals are well defined and reasonable with a sufficient plan to monitor progress.

31The applicant is entitled to $5,883.98 for physiotherapy services, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025.

Is the applicant entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024?

32The applicant is entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024.

33The applicant submitted the goals of the assessment are pain reduction, increased range of motion, and increased strength with the functional goals to return the applicant to activities of daily living, to enable him to return to pre-accident or modified work, and to improve posture and restore his pre-accident functional abilities so he could lead a healthy, independent, and active lifestyle.

34Further, the applicant submits the cost of the assessment was reasonable at $2,000.00 with $200.00 documentation support fee, and the costs are proportionate to the purpose of providing diagnostic clarity and establish baselines for rehabilitation.

35The applicant relies upon medical evidence as reviewed previously in paragraphs [17] through [22].

36The respondent submits that the onus is on the applicant to demonstrate the treatment plans in dispute are reasonable and necessary and has failed to discharge this burden. The respondent submits that a treatment plan without supportive medical evidence is not enough to establish the treatment plan is reasonable and necessary; the respondent relies upon Blas v. Aviva Insurance Canada, 2021 CanLII 127471 (ON LAT).

37The respondent denied this treatment plan pursuant to the s. 44 general practitioner report of Dr. Sawh. Dr. Sawh reviewed Dr. Girgis’ records, Ajax Pickering Hospital Records, diagnostic images from the date of loss and records from St. Michael’s hospital. Dr. Sawh noted inconsistencies between the functional limitations described by the applicant and the objective findings that did not fully support the severe functional limitations reported. Dr. Sawh opined that there was insufficient evidence to support the need for concussion assessment and treatment as proposed in the treatment plans. I have reviewed the Sawh report and note the assessor included a physical examination and review of the applicant’s records, accordingly I assign it significant weight. However, I do note Dr. Sawh did not perform vestibular, ocular, or cognitive testing, nor applied any concussion protocols. I contrast it with the CNR of Lakeside Health and Dr. Girgis, the Sharifzadeh report and the Jazrawi report, when read together address vestibular, ocular and cognitive testing, as well as applied concussion protocols; accordingly, I assign greater weight to the Sharifzadeh report, the Jazrawi report, CNR of Lakeside Health and CNR of Dr. Girgis.

38The respondent submits the Tribunal should assign greater weight to the Sawh report over the Abdelkader report as the latter is not a physician and not able to diagnose a concussion. I find the respondent’s submission to be flawed as it is not necessary to diagnose a concussion to demonstrate a need for a concussion assessment. Rather, the evidence should establish that there are grounds on which to believe that a condition exists that would warrant further investigation by way of an assessment. I find no reason to prefer Dr. Sawh’s evidence over the Abdelkader report as it stays within its scope and documented concussion symptoms.

39I find the applicant’s submissions to be persuasive, the need for the treatment plan is supported by the Abdelkader report, the Sharifzadeh report and the Jazrawi report as well as symptoms documented in the CNR of Dr Girgis and CNR of Hardwood Health; the preponderance of this evidence outweighs the Sawh report which stands as an outlier in evidence.

40The applicant is entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024.

Interest

41Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. The applicant is entitled to interest on the payment of overdue benefits.

Award

42The applicant sought an award under s. 10 of Reg. 664.

43Pursuant to section 10 of Reg. 664, an award of up to 50% of the amounts withheld may be payable by the respondent if it is determined that it unreasonably withheld or delayed payment of a benefit. Awards are determined on an individual basis and generally depend on a finding that the respondent’s withholding or delay was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.

44The applicant submits the respondent relied upon faulty reports and disregarded medical evidence that favoured the applicant’s position. Further, the applicant submits the respondent failed to revisit its denials when provided with overwhelming new medical evidence supporting the applicant’s treatment plans; given the additional medical evidence it cannot be said to reflect a bona fide disagreement about the evidence and constitutes a wilful withholding of benefits compelling the applicant to litigate and incur delay and additional costs.

45The respondent submits its adjusting of the claim is not to be held to a standard of perfection. The respondent submits it complied with the procedures under the Schedule and evaluated the evidence before it in a reasonable manner and should only be held to the standard of reasonableness. The respondent submits it should be held to the standard of reasonableness as it made its decisions based on the best available evidence, made honest efforts to investigate the proposed goods and services by reviewing medical documentation, requesting additional medical documentation and arranging s.44 examinations; its decision to deny benefits was not arbitrary. Further, the respondent submits its conduct does not amount to unreasonably delaying or withholding benefits and a special award is not warranted on the facts.

46I find the submissions of the respondent to be persuasive; it relied upon s.44 reports to support its position and did not act in an arbitrary manner. I find the respondent is not held to a standard of perfection and may be found to be wrong without acting in a manner that would substantiate an award; this also includes continuing to disagree after a review of the applicant’s evolving evidence if it is not found to be convincing. I find the respondent’s conduct did not amount to withholding or delay that was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.

47I find the respondent is not liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant.

ORDER

48The Tribunal’s final Orders:

i. The applicant is entitled to $5,883.98 for physiotherapy treatment, proposed by Ismail Rehab Ltd. in a treatment plan dated January 14, 2025.

ii. The applicant is entitled to $2,200.00 for a concussion assessment, proposed by Core Physical Care in a treatment plan dated December 6, 2024.

iii. The respondent is not liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant.

iv.

v. The applicant is entitled to interest on any overdue payment of benefits.