Licence Appeal Tribunal File Number: 25-000585/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:
Zaina Kassim
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Kathleen Wells
APPEARANCES:
For the Applicant:
Rebecca Coughlan, Counsel
For the Respondent:
Michael Rattray, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Zaina Kassim, the applicant, was involved in an automobile accident on October 18, 2020, 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:
Is the applicant entitled to $1,602.05 for medication, submitted on a claim form (OCF-6) dated July 12, 2023?
Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
Is the applicant entitled to interest on any overdue payment of benefits?
3The applicant advised the Tribunal by way of email dated October 31, 2025, after both parties’ submissions had been filed with the Tribunal, that she wished to withdraw issue #1 as set out in the Case Conference Report and Order, with respect to her entitlement to an Income Replacement Benefit (“IRB”). As a result, I have removed the IRB as an issue in dispute.
RESULT
4I find that:
The applicant is not entitled to the OCF-6 dated July 12, 2023.
As no payments are owing, no interest is due.
The applicant is not entitled to an award.
5The application is dismissed.
PROCEDURAL ISSUE
6In her submissions, the applicant refers to multiple medical records, including the clinical notes and records (“CNRs”) of the applicant’s family doctor, Dr. Joanne Grevler, her treating neurologist, Dr. Roy Baskind, and the August 15, 2024 insurer’s examination (“IE”) report of Dr. David Berbrayer, physiatrist. These records appear to be attached to her submissions by an external link, which cannot be accessed by the Tribunal.
7However, the respondent has submitted Dr. Grevler and Dr. Baskind’s CNRs as well as Dr. Berbrayer’s August 15, 2024 IE report, and as such, I have considered the evidence referred to by the applicant and contained in the respondent’s submissions.
ANALYSIS
Is the applicant entitled to $1,602.05 for medication submitted on a claim form (OCF-6) dated July 12, 2023?
8I find that the applicant has not established on a balance of probabilities that she is entitled to the OCF-6 dated July 12, 2023.
9To receive payment for medical and rehabilitation benefits under s. 15 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.
10I note that neither party has submitted the OCF-6 into evidence. In her submissions, the applicant referred to 6 medications for which she sought reimbursement including five medications which were prescribed to treat her seizures and related symptoms (lamotrigine, levetiracetam, auro-levetiracetam, lacosamide, and naproxen), in addition to sertraline, which was prescribed to treat the applicant’s psychological symptoms.
11The respondent’s July 17, 2023 denial letter reveals that the prescriptions were dated between September 23, 2020 and May 4, 2023, and that the OCF-6 also sought reimbursement for two other medications, pantoprazole, which is used to treat heartburn, and tetracycline, which is used to treat bacterial infections, which are not related to the accident.
12The applicant submits that she is entitled to the OCF-6 for $1,602.05 for reimbursement of expenses to treat seizures and psychological symptoms resulting from the accident. The applicant relies on the CNRs of Dr. Grevler and Dr. Baskind, and Dr. Berbrayer’s August 15, 2024 IE physiatry report.
13The respondent argues that the applicant has not met her onus to prove that the medication expenses were accident-related and relies on the IE report of Dr. Nagib Yahmad, neurologist, dated August 15, 2024.
14I find that the evidence does not establish on a balance of probabilities that the applicant’s seizures are a result of the accident, in part because Dr. Baskind’s CNRs contradict the applicant’s submissions. While the applicant refers to Dr. Baskind’s comment on November 26, 2020, that after a long seizure-free period, the applicant had experienced two seizures after the accident, Dr. Baskind’s CNRs reveal that he opined on three separate occasions that there was no connection between her seizures and the accident. For example, on November 8, 2023, Dr. Baskind opined that the applicant “has a history of epilepsy and there is no mechanism whereby the minor motor vehicle collision would cause a seizure.”
15Further, the applicant submits that in his August 15, 2024 IE physiatry report, Dr. Berbrayer diagnosed the applicant with “exacerbation of pre-existing seizures” as a result of the accident. However, as the applicant notes, Dr. Berbrayer also deferred to the neurologist (Dr. Yahmad) who conducted a neurological IE for further comment.
16Dr. Yahmad did not confirm Dr. Berbrayer’s diagnosis in his August 15, 2024 neurological IE report. He deferred his own diagnosis until he had an opportunity to review further medical evidence. In his subsequent IE addendum report, dated October 29, 2024, after reviewing additional medical documents including the emergency department records from the date of the accident and subsequent brain imaging, Dr. Yahmad opined that “nothing in the medical brief review revealed any acute traumatic based neurological injury that would explain the re-emergence of her pre-existing seizures after the index accident.” Given Dr, Berbrayer’s deference to Dr. Yahmad, I assign Dr. Yahmad’s opinion more weight.
17I further find that the applicant has not established on a balance of probabilities that the prescription for sertraline is related to the accident. Dr. Grevler’s CNRs reveal that the applicant complained of psychological symptoms after the accident, including symptoms of vehicular anxiety and depression. However, the respondent argues that the applicant last complained of psychological symptoms related to the accident on June 14, 2021. Dr. Grevler’s CNRs reveal that the applicant’s subsequent reports of low mood and sleeplessness are related to her seizures, which I have found, as set out above, are not accident-related, as well as stress from school, work, and other life events.
18Further, Dr. Grevler’s CNRs reveal that the applicant repeatedly declined medication for her depression for more than two years after the accident, and the applicant has not made submissions with respect to the date or circumstances of the prescription for sertraline.
19For these reasons, I find that the applicant has not met her onus to prove on a balance of probabilities that the medications sought in the OCF-6 are reasonable and necessary to treat her accident-related injuries.
20As such, the applicant is not entitled to the OCF-6 dated July 12, 2023.
Interest
21Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no payments are owing, no interest is due.
Award
22The 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. Provide the basis for the award. Identify the response. The Tribunal has determined that an award is justified where the delay or withholding of benefits by the insurer is unreasonable conduct, meaning “behaviour which is excessive, imprudent, stubborn, inflexible, unyielding or immoderate.” The onus is on the applicant to prove, on a balance of probabilities, that the respondent’s conduct meets these criteria.
23The applicant submits that she is entitled to an award because the respondent denied the OCF-6 in dispute. The respondent counters that the applicant has not provided the particulars of the award, as required by the CCRO. As the applicant has not made submissions or directed me to evidence that the respondent’s conduct met the bar of unreasonable conduct as set out above, and I have found that the applicant is not entitled to the OCF-6 in dispute, I find that the applicant has not met her onus to prove on a balance of probabilities that she is entitled to an award.
ORDER
24I find that:
The applicant is not entitled to the OCF-6 dated July 12, 2023.
As no payments are owing, no interest is due.
The applicant is not entitled to an award.
25The application is dismissed.
Released: June 4, 2026
Kathleen Wells
Adjudicator