Licence Appeal Tribunal File Number: 25-000106/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:
Nola Nikols
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Tony Lafazanis, Counsel
For the Respondent:
Nicole De Bartolo, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Nola Nikols, the applicant, was involved in an automobile accident on October 26, 2016, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Security National Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to the services proposed by Bill Nikols, chiropractor, at Back Pain and Joint Treatment Centre, as follows:
(a) $8,040.00 for chiropractic services, in a treatment plan submitted on December 16, 2022;
(b) $2,580.00 for chiropractic services, in a treatment plan submitted on January 16, 2024;
(c) $2,600.00 for chiropractic services, in a treatment plan submitted on June 1, 2024;
(d) $2,600.00 for chiropractic services, in a treatment plan submitted on October 5, 2024?
RESULT
3I find that the applicant is not entitled to the treatment plans in dispute, interest or an award.
PROCEDURAL ISSUES
Page Limits
4The respondent submits that the applicant has failed to comply with the submissions page limits set out in the Case Conference Report and Order (“CCRO”) dated May 8, 2025. The CCRO indicates that the written submissions of the applicant and the respondent are limited to 10 pages in length.
5The respondent argues that the Tribunal should disregard all portions of the applicant’s submissions beyond the 10-page limit set out in the CCRO, as well as the Tabs that improperly present argument as evidence.
6The respondent submits that the CCRO requires submissions to be 10 pages, double spaced, while the applicant’s submissions are 24 pages single-spaced, which would equal roughly 45 pages if properly formatted. Additionally, the applicant includes a “Tab” with extra arguments disguised as supporting material, specifically at Tab 2, Chronology and Summary of Evidence, which adds 24 pages. The respondent relies upon the Tribunal decisions in J.M. v. Aviva General Insurance, 2019 CanLII 51309 (ON LAT) (“J.M.”) and Mann v. Intact Insurance Company, 2025 CanLII 23472 (ON LAT) (“Mann”), where similar attempts to expand submissions were found improper by the Tribunal.
7The respondent further submits that non-compliance with page limits undermines the integrity of the hearing process. It further argues that arguments embedded in appendices or tabs are not excluded from page counts, and that parties must bring a motion to extend page limits if necessary. The respondent argues that allowing this conduct causes it significant prejudice because it had to address non-compliance issues in their submissions. In addition, responding to excessive submissions requires additional time and resources, placing an undue burden on the respondent. The respondent relies upon the Tribunal decision in Black v. Aviva General Insurance Company, 2024 CanLII 15893 (ON LAT) (“Black”).
8The applicant in her Reply submissions submits that the CCRO provides the standard language for page limits as, “The page limits are exclusive of evidence and authorities”. She claims that once those exclusions are made from the applicant’s submissions, and the general background information is excluded, the 10-page limit is complied with. The applicant submits that she regrets the submissions were not double spaced. The applicant further argues that there is no prejudice demonstrated to the respondent based on the Tribunal decisions in Mann.
9I find that the applicant initially submitted her submissions that were single spaced and 23 pages in length. At Tab 2 of the applicant’s submissions, she attached a “Chronology and Summary of Evidence” which is 48 pages in length. At Tab 3 of the applicant’s submissions, she attached “Caselaw” where she summarized multiple cases, which is 15 pages in length.
10The respondent initially submitted its submissions which were 12 pages in length.
11By correspondence dated May 11, 2026, the Tribunal wrote to both parties advising them that their submissions are in non-compliance with the Tribunal’s CCRO because they exceed the page limits. The Tribunal further advised the applicant that her submissions were not double spaced.
12On May 12, 2026, the respondent filed its resubmissions in compliance with the 10 pages ordered by the Tribunal.
13On May 15, 2026, the applicant filed its resubmissions. Counsel for the applicant notes in its correspondence to the Tribunal that the “within submissions are about 15 pages of evidence and authorities. Aside from those pages are an additional seven pages, double spaced”.
14On May 20, 2026, the Tribunal again wrote to the applicant and advised that her resubmissions still exceed the page limits, and the document is not-double spaced as required. No response was received from the applicant to this correspondence.
15I find that the applicant is in non-compliance with the CCRO which ordered her submissions to be 10 pages in length including submissions, evidence and authorities. Despite the Tribunal’s second request for her submissions to be resubmitted in accordance with the CCRO, her submissions include eight pages of submissions and a Schedule A which is 15 pages in length, single spaced, summarizing the medical documentation. In addition, I find that the applicant’s inclusions of Tab 2, providing a Chronology and Summary of Evidence and Tab 3 Summarizing Case Law, is contrary to the CCRO.
16I find that the applicant’s summary of the medical evidence at Schedule A and the evidence at Tab A and B, should have been included within the applicant’s submissions totalling 10 pages.
17The CCRO sets out that the hearing adjudicator may choose not to consider submissions which exceed the page limits and that it is subject to my discretion. Pursuant to s. 23(1) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S. 22, it is within my discretion to strike any submissions in excess of the ten-page limit set out in the CCRO.
18In this case, I agree to consider the applicant’s eight pages of substantive submissions which are double spaced and compliant with the CCRO. The applicant’s Schedule A and Tab 2 and 3 will not be considered, as these medical summaries and case law summary, are not compliant with the CCRO. All submissions on the medical evidence and case law should have been included within the applicant’s substantive submissions. What will be considered are the medical reports and evidence attached to the applicant’s submissions and the case law referred to within her substantive submissions. I remind the applicant that non-compliance with Tribunal Orders is strongly discouraged, and in the future the appropriate course of action is to file a timely Notice of Motion if they seek to vary submission page limits.
Conflict of Interest
19The respondent argues that the central question in this dispute is whether the overlapping roles of Dr. Bill Nikols, chiropractor, who is the applicant’s husband, the applicant’s treating chiropractor, and a policyholder, compromises the independence, reliability and evidentiary weight of the treatment recommendations, especially in view of established professional standards for chiropractors and the legal requirement of impartiality. The respondent argues that Dr. Nikols has a direct financial and familial interest in the outcome of the insurance claim and in the treatment recommendations themselves. Treating immediate family members, particularly with the possibility of financial benefit, is a high-risk scenario that requires careful management or avoidance altogether.
20The respondent relies upon s. 46 of the Schedule which addressed conflicts of interest in insurance claims and prohibits health care providers from acting in ways that create a conflict between their duties to the insured and their own interests. The respondent argues that while the language in s. 46 refers to the insurer, the applicant’s treatment providers should be held to the same standard which the Tribunal made clear in V.K. v. Allstate Insurance Company, 2018 CanLII 61172 (ON LAT).
21The respondent argues that while Dr. Nikols is not giving expert assessments or testimony, he is the sole author of every single treatment plan in dispute and stands to benefit from the treatment recommendations. The weight of professional standards, legal authorities, and regulatory policies strongly supports the inference that such relationships pose unacceptable risks to independence and reliability. The respondent relies upon the Supreme Court of Canada decision in White Burgess Langille Inman v. Abbott and Haliburton C., 2015 SCC 23, which established that independence and impartiality of expert witnesses is a threshold requirement for admissibility; if a witness has a personal or financial interest in the outcome, the reliability and weight of their evidence may be significantly diminished. The respondent further relies upon the Court of Appeal decision in Bruff-Murphy v. Gunawardena, 2017 ONCA 502, which clarified that actual or perceived bias can undermine the credibility of expert evidence, and that a close familial relationship such as a spousal connection presents an obvious risk to independence.
22The respondent argues that as there are concerns about the independence and reliability of the treatment plan submissions, the Tribunal should rely more on the independent assessments by practitioners with no vested interest. The respondent further argues that the Tribunal should deny the applicant’s claims in their entirety and find that Dr. Nikols’ role in the claim constitutes a clear conflict of interest.
23The applicant submits that there is no conflict of interest and their relationship was never hidden. The applicant argues that Dr. Nikols is not providing a medical opinion or report. She submits that Dr. Nikols’ recommendations are anchored in the specialist opinions of the applicant’s condition. The applicant further submits that Dr. Nikols checked with his College and was told that there was no problem with him treating the applicant.
24The applicant in her Reply submissions submits that her interests are aligned with the interests of Dr. Nikols, her spouse, and there is no conflict. The applicant argues that Dr. Nikols has been her treating chiropractor since 1990, and it would be a surprise if she did not obtain treatment from him. The applicant further submits that the respondent has approved and paid for previous treatment provided by Dr. Nikols. She argues that there is nothing in the Schedule or the Regulations for chiropractors that prevents her husband from treating her. Any perception that his judgment may be clouded by financial gain, is more than offset by the easy access to treatment and the results of the treatment.
25I find that the respondent has not pointed the Tribunal to any case law or authority which has specifically dealt with the conflict between an insured and a spouse providing her with treatment. While I do agree that there is a potential conflict of interest to medically treat a family member, the respondent has not directed the Tribunal to any Regulation from the College of Chiropractors of Ontario which prohibits this.
I find upon my review of the Regulation that the College generally advises against treating family members and friends because maintaining clinical objectivity and professional boundaries can be difficult. However, family treatment is not explicitly named as a prohibited conflict of interest.
26I further agree with the applicant that the respondent did not raise this conflict when assessing the claim or advise the applicant that it would not approve any treatment provided by her spouse. I find that the respondent has not directed the Tribunal to any correspondence or evidence that this was previously communicated to the applicant.
27I do not agree to dismiss the applicant’s claims based on a finding that her spouse authored the subject treatment plans. I do agree however with the respondent that the fact the applicant’s spouse has authored all of the treatment plans in dispute should be considered in weighing the evidence of both Dr. Nikols and other medical assessors. I find that this will be addressed in my decision below in determining whether the treatment plans in dispute are reasonable and necessary.
Exclusion of Dr. Gofeld’s rebuttal report dated April 21, 2025
28The respondent submits that the Rebuttal report of Dr. Gofeld was authored on September 24, 2025, well after the disclosure deadline for responsive items. The respondent further submits that the report was never served on the respondent prior to receiving their written submissions and should not be considered by the Tribunal.
29The applicant in her Reply submissions states that the respondent’s IE report is dated April 21, 2025. It requested that Dr. Gofeld review and comment on this report on July 17, 2025. However, the report was only received on October 3, 2025. The applicant requests that the Tribunal extend the timeline for production of this report and claims that there is no indication of prejudice as the purpose of the report was a rebuttal and the respondent would not have done anything different had they received the report earlier.
30I accept the applicant’s submission that it only received the Rebuttal report of Dr. Gofeld on October 6, 2025. It then included the report in its submissions which were filed on October 9, 2025. However, I find that the proper procedural step had the applicant wanted to rely upon this report would be to bring a Motion, rather than just submit it with its written submissions.
I agree with the respondent that it was prejudiced because it was not provided the opportunity to have the Rebuttal report reviewed by its own experts in response, due to the late production of the report.
31However, I do find that the Rebuttal report is pertinent to the issues in dispute and one of the arguments made by the respondent is that the applicant did not have a rebuttal report to its IE opinions. Therefore, in the interest of consumer protection and procedural fairness, I do not agree to omit this report from the evidence. I will consider the weight to be given to this report due to its late submissions within my analysis of the issues in dispute.
ANALYSIS
Entitlement to Medical and Rehabilitation Benefits
32To receive payment for a treatment and assessment plan under ss. 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 that the goals of treatment are reasonable, how the goals would be met to a reasonable degree, and that the overall costs of achieving them are reasonable.
33The applicant is not entitled to the Expense Form (“OCF-6), for chiropractic services, dated December 16, 2022.
34The applicant claims entitlement to $8,040.00 for chiropractic services, proposed by Dr. Bill Nikols, chiropractor, at Back Pain and Joint Treatment Centre, in a treatment plan dated December 16, 2022.
35The respondent submits that the proposed treatment was not submitted on a treatment plan as claimed by the applicant but rather was submitted on an OCF-6, dated November 2, 2022. The OCF-6 claims chiropractic treatment from April 23, 2021 to November 4, 2022 and attaches a printout of the dates, treatment provided and value of the services. The respondent submits that this OCF-6 was never properly submitted to HCAI and was denied by letter dated January 5, 2023.
36The respondent submits that the applicant has made no submissions as to why this treatment should be considered by the Tribunal based on her procedural non-compliance with s. 38(2) of the Schedule. The respondent relies upon the Tribunal decision in K.R. v. Certas Direct, 2020 CanLII 40341 (ON LAT) (“K.R. v. Certas”), which confirms that claims which fail to comply with the requirements stipulated within s. 38(2) of the Schedule should be dismissed.
37The applicant in her Reply submissions submits that the respondent’s January 5, 2023, letter does not indicate that the OCF-6 was improperly submitted. The letter includes in its reasons for denial, that MR coverage ended October 26, 2021 (5 years post-accident). The applicant submits that the respondent’s subsequent letter dated January 13, 2025, corrects the letter of January 5, 2023 and states that the applicant’s “claim remains open as per your policy limits of 1 million for medical/rehabilitation and attendant care”. A copy of the letter dated January 5, 2023 was not provided by the applicant in her submissions.
38Section 38(2) of the Schedule provides that, “an insurer is not liable to pay an expense in respect of a medical and rehabilitation benefit or an assessment or examination that was incurred before the insured person submits a treatment and assessment plan that satisfies the requirements of subsection (3)”. There are four exceptions noted within s. 38(2).
39I agree with the respondent that the applicant did not comply with s. 38(2) of the Schedule and that none of the exceptions are applicable to this case.
40I find that the applicant has not provided any submissions as to why the expenses were not submitted on a treatment plan for pre-approval by the respondent and were instead submitted on an OCF-6.
41I find that the language of s. 38(2) is clear. I find that where an insured incurs a medical/rehabilitation or an assessment/examination expense prior to submitting a treatment plan to the insurer requesting specific treatment, s. 38(2) is automatically invoked. The insurer is then not liable for paying for the expense.
42I agree with the Tribunal decision in K.R. v. Certas, relied upon by the respondent, where the Tribunal held that, “I find the operation of s. 38(2) of the Schedule relieves an insurer from being liable to pay for a medical/rehabilitation or cost of examination expense prior to having an opportunity to review the expenses and then determine whether they agree to pay for it.” Therefore, I find that the requirements as set out within s. 38(2) are the law and I do not have the discretion to waive them.
43I find that the facts are clear in this case. The applicant does not dispute incurring the medical benefit prior to submitting her OCF-6. It is clear that no treatment plan was ever submitted by the applicant for the claimed treatment. The parties agree that the OCF-6 was denied by the respondent in its letter dated January 5, 2023. The applicant has not provided any submissions as to why these expenses were not first submitted on a treatment plan or any reasonable explanation for failure to comply with s. 38(2) of the Schedule or how they may fit into one of the exceptions under s. 38(2). Therefore, due to the applicant’s non-compliance with s. 38(2), the OCF-6 is not payable. I have made no finding on whether the expenses are reasonable and necessary.
Entitlement to the treatment plans for chiropractic services, dated January 16, 2024, June 1, 2024 and October 5, 2024
44The applicant is not entitled to the disputed treatment plans for chiropractic services.
45The applicant claims entitlement to $2,580.00 for chiropractic services, in a treatment plan proposed by Dr. Bill Nikols, chiropractor, dated January 16, 2024. The treatment plan recommends the following:
Assessment (examination), total body: $ 180.00 20 therapy, multiple body sites: $1,300.00 20 therapy, multiple body sites: $1,100.00
46The applicant claims entitlement to $2,600.00 for chiropractic services, in a treatment plan proposed by Dr. Nikols, dated June 1, 2024. The treatment plan recommends the following:
Assessment (examination), total body: $ 200.00 20 therapy, multiple body sites: $1,300.00 20 therapy, multiple body sites: $1,100.00
47The applicant claims entitlement to $2,600.00 for chiropractic services, in a treatment plan proposed by Dr. Nikols, dated October 5, 2024. The treatment plan recommends the following:
Assessment (examination), total body: $ 180.00 20 therapy, multiple body sites: $1,300.00 20 therapy, multiple body sites: $1,100.00
48The goals of the treatment plans listed at Part 9 of the treatment plans are pain reduction, increase range of motion, increase strength and return to activities of normal living.
49The applicant submits that the treatment plans in dispute are reasonable and necessary due to her neck injury/chronic; lower back injury/chronic pain; right shoulder injury/chronic pain; and headaches post-traumatic tension and cervicogenic. She argues that she continues to have symptoms in various parts of her body and continues to have functional impairment in virtually all aspects of her life and activities. She further argues that now, more than eight and a half years later, they can fairly be considered chronic. The applicant submits that the medical evidence supports the need and value of treatment for pain and functional management.
50The applicant submits that pain management is a valid basis for treatment approval. She relies upon the decision in Hoskins v. Co-Operators, 2023 CanLII 3344 (ON LAT), where it was held that:
There is no dispute among the parties that chiropractic treatment gives short term pain relief and maintains the applicant’s level of function. The cases provided by the applicant show that short term pain relief and maintaining function, on their own, are reasonable medical and rehabilitative goals.
51The applicant submits that pain is best assessed by a doctor who specializes in chronic pain and relies upon the Chronic Pain Assessment report by Dr. Michael Gofeld, dated November 21, 2024 and the Independent Medicolegal Physiatry Assessment report of Dr. Michael Lang, physiatrist, dated November 15, 2023. The applicant argues that the Insurer Examination (“IE”) assessors do not consider the value of pain and function management in their reports.
52The respondent denies that the applicant is entitled to the treatment plans in dispute because the applicant has not proved that they are reasonable and necessary based on any objective evidence. The respondent submits that no independent clinical records or expert reports have been provided to support the treatment recommendations. The respondent submits that the only person recommending these treatments is Dr. Nikols, the applicant’s husband, who is not only the treating chiropractor, but also the applicant’s spouse and co-insured under the policy. The respondent submits that there are no recommendations from any other qualified or impartial healthcare provider.
53The respondent submits that the applicant supports her claim by referencing reports from Dr. Gofeld, a pain specialist, and Dr. Lang, a physiatry expert. The applicant argues that the disputed treatment plans are grounded in these medical opinions. However the respondent argues that given the timelines of their reports, it would be impossible for Dr. Nikols to have relied on them when recommending treatment. Dr. Gofeld’s first report is dated November 21, 2024, a month after the most recent treatment plan was submitted and was not available when the treatment plans were submitted. With respect to Dr. Lang’s report, the report was prepared as an expert opinion for tort litigation, and not for evaluating the reasonableness or necessity of continued treatment. The respondent also argues that the findings of Dr. Gofeld and Dr. Lang are contradictory with respect to the causation of the applicant’s shoulder injury, which casts doubt on their reliability.
54The respondent relies upon numerous s. 44 IE reports which are consistent in their findings. Specifically, the respondent relies upon the Neurological IE report of Dr. Moddal, dated May 10, 2024 and the General Practitioner IE report of Dr. Lee, dated May 10, 2024, which both conclude that no further treatment is warranted.
55I find that the initial treatment plan in dispute was submitted on January 16, 2024, and the subsequent treatment plans were submitted on June 1, 2024 and October 5, 2024. I find that the applicant has not submitted contemporaneous medical records from a treating practitioner during this period of time. Upon review of the CNRs of Dr. Jesse Teital, family physician, the last CNR provided in the medical evidence is dated May 9, 2023. The CNR notes that the applicant was last seen over a year ago and states: “neck now is good though lower back forever”. He notes that she has mid lower back pain and no degeneration. There are no treatment recommendations made. The applicant underwent an MRI of her lumbar spine on September 14, 2023, where the impression was “mild to moderate multilevel neural foramina stenosis as described, no significant spinal cord stenosis”. The applicant has not provided any CNRs from Dr. Teital that discuss the results of the MRI or provide any further recommendations.
56I find that the applicant has not provided the complete CNRs from Dr. Nikols. She has provided a copy of the initial examination on October 27, 2016, a reassessment on October 16, 2017 and a reassessment on October 3, 2020. I find that there are no CNRs provided thereafter to support the need for further treatment as recommended in the disputed treatment plans. I find that while Dr. Nikols has authored the treatment plans in dispute, a treatment plan in itself is not sufficient to support that the treatment recommended is reasonable and necessary. Objective evidence to support the recommendations is required.
57I further agree with the respondent that the applicant has not provided persuasive evidence to show that the proposed treatments would yield further benefit or measurable progression. The applicant reported to Dr. Lang that, following the accident, she received chiropractic treatment at her home, noting that her husband is a chiropractor. She reported that initially she received treatment two to three times weekly, and current receives treatment once weekly. She reported that her symptoms improved 50-60% from a physical point of view since the accident. As noted above, I find that the applicant has not provided any CNRs to support the ongoing treatment she reported receiving from her husband post-accident or the benefit of that treatment. In addition, the applicant has not provided any rationale as to why the treatment plans for chiropractic treatment were submitted in January 2024, seven years post accident, when she reported receiving the same treatment since the accident. I find that while pain management is a recognized and accepted goal of treatment, the applicant has not provided persuasive evidence to support that continued treatment as recommended in the treatment plans would achieve the proposed goals of pain management. While the applicant in her Reply submissions states that her submissions describe the pain reduction she receives from treatment, submissions are not evidence. Based on the lack of medical evidence detailing the treatment she has already received or how additional chiropractic treatment will meet the goal of pain management, I do not find that she has provided compelling evidence demonstrating that continued treatment would achieve its intended goals, particularly with respect to pain reduction.
58I find that there are competing medical opinions of Dr. Lang, Dr. Gofeld and Dr. Lee, as to whether the applicant continues to suffer physical impairments as a result of the accident. Each assessor has provided an assessment of the applicant’s impairments, and each reached opposite conclusions. I find that all of the assessors focused on the applicant’s self-reports because there was a lack of objective treatment records provided. I find that where there are competing opinions, the records of the treating practitioners should be given the most weight. As there are limited records documenting the applicant’s improvement or lack thereof, I find that the applicant has not proved on a balance of probabilities that the treatment plans for chiropractic services are reasonable and necessary.
59For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to the treatment plans in dispute.
Interest
60Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no overdue benefits payable, no interest is payable.
Award
61The 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.
62As I have found that the applicant is not entitled to the disputed treatment plans, I find that there is no evidence that the respondent unreasonably withheld or delayed the payment of benefits.
63For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to an award.
ORDER
64For the reasons outlined above, I find that the applicant is not entitled to the treatment plans in dispute, interest or an award. The application is dismissed.
Released: June 8, 2026
Melanie Malach
Adjudicator