Licence Appeal Tribunal File Number: 24-005800/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:
Alexander Bakos
Applicant
and
Definity Insurance Company
Respondent
DECISION
ADJUDICATOR:
Nadia Mauro
SUBMISSIONS BY:
For the Applicant:
Alexander Bakos, Self-Represented
For the Respondent:
Kayly Machado, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Alexander Bakos, the applicant, was involved in an automobile accident on June 16, 2022, 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.
2In the case conference report and order (“CCRO”) released on November 28, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for August 8, 2025. Notice of the written hearing was e-mailed to the parties on December 3, 2024.
3On June 24, 2025, the applicant filed a Notice of Motion requesting that the Tribunal make an order:
Permitting the applicant to rely on an OCF-3 dated June 9, 2025; and
Adding the following issue to the dispute: Treatment plan (OCF-18) in the amount of $1,880.00 for chiropractic services recommended by Dr. Curtis Seeley, dated May 15, 2025.
4The applicant’s motion was partially granted on July 9, 2025, permitting the use of the OCF-3, but denying the request to add the issue to the dispute.
5The applicant’s submissions were due on June 27, 2025. On August 5, 2025, the applicant filed a letter from Dr. William Parkinson, dated August 1, 2025, titled “Submission: Response to Recent Submission from Kayla Machado”. On August 8, 2025, the applicant filed a number of additional documents.
6The applicant filed an accommodation request on February 13, 2026.
7On February 25, 2026, I issued an Order allowing the parties additional time to file submissions.
ISSUES
[8] The issues in dispute are:
1. Is the applicant entitled to an income replacement benefit in the amount of $1,000.00 per week from July 13, 2022, to date and ongoing?
2. Is the applicant entitled to $2,094.54 for rehabilitation benefits, proposed by Dr. William Parkinson in a treatment plan (“OCF-18”) submitted December 15, 2022?
3. Is the applicant entitled to $3,772.88 for rehabilitation benefits, proposed by Dr. William Parkinson in an OCF-18 submitted January 16, 2023?
4. Is the applicant entitled to $3,962.49 for rehabilitation benefits, proposed by Dr. William Parkinson in an OCF-18 submitted June 2, 2023?
5. Is the applicant entitled to $3,881.49 for rehabilitation benefits, proposed by Dr. William Parkinson in an OCF-18 submitted October 25, 2023?
6. Is the applicant entitled to $4,389.00 for rehabilitation benefits, proposed by Mohannad Bakri in an OCF-18 submitted October 19, 2022?
7. Is the applicant entitled to $4,589.00 for rehabilitation benefits, proposed by Mohannad Bakri in an OCF-18 submitted December 14, 2022?
8. Is the applicant entitled to $2,172.00 for rehabilitation benefits, proposed by Laura Bristol in an OCF-18 submitted December 15, 2022?
9. Is the applicant entitled to $2,005.00 for rehabilitation benefits, proposed by Anthony Adams in an OCF-18 submitted November 16, 2022?
10. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
11. Is the applicant entitled to interest on any overdue payment of benefits?
9The applicant confirms in his submissions that he withdraws issue 3 as listed on the CCRO, dated November 28, 2024.
10The OCF-18 listed under issue 5 is incorrectly dated in the CCRO, I find that the evidence supports that its correct date is October 25, 2023, and have adjusted the issue accordingly.
RESULT
11The applicant is not entitled to an IRB in the amount of $1000.00 per week from July 13, 2022 and ongoing.
12The applicant is not entitled to the OCF-18 for neuropsychological testing, proposed by Dr. Parkinson, dated December 15, 2022.
13The applicant is entitled to the unapproved portions of the treatment plans for rehabilitation services proposed by Dr. William Parkinson dated January 16, 2023, June 2, 2023, and October 25, 2023, plus interest.
14The applicant is entitled to the treatment plans for rehabilitation services proposed by Mohannad Bakri, dated October 19, 2022, and December 14, 2022, plus interest.
15The applicant is entitled to the rehabilitation services proposed by Anthony Adams, date November 16, 2022, plus interest.
16The applicant is not entitled to the rehabilitation services proposed by Laura Bristol, dated December 15, 2022.
17The applicant is not entitled to an award.
ANALYSIS
Income Replacement Benefits (“IRB”)
18I find that the applicant has not demonstrated entitlement to an IRB in the amount of $1,000.00 per week from July 13, 2022 and ongoing.
19To receive payment for an IRB under s. 5(1) of the Schedule, the applicant must be employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffer a substantial inability to perform the essential tasks of that employment. The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them. The applicant bears the burden of proving, on a balance of probabilities, that they meet the test.
20The applicant submits he was employed at the time of the accident with a construction material company (“the company”) until he was terminated in the fall of 2022.The applicant relies on the medical opinion of neuropsychologist, Dr. William Parkinson to support that he could not work because he was injured and disabled by the car accident.
21The respondent submits that the applicant did not return to work after May 30, 2022. The respondent relies on the Divisional Court decision in Kawa Arab v. Unica Insurance, 2022 ONSC 5761 (“Arab”) wherein it was held that the Schedule requires more than simply a contractual relationship with one’s employer. The respondent submits that the applicant was not receiving wages from the company, nor was he receiving a Loss of Earning benefit from WSIB, and as such, was not eligible for an IRB as he had no income to replace. The respondent further submits that the records provided confirm that the applicant did not work in 2021, and at most for six weeks in 2022. The respondent takes the position that the applicant does not meet any of the eligibility requirements for an IRB.
The applicant was not employed at the time of the accident
22I find that the applicant was not “employed” prior to the accident pursuant to s. 5(1)(1) of the Schedule.
23In order for an insured person to be eligible to receive an IRB, s. 5(1)(1) of the Schedule specifies that they must have been employed at the time of the accident, or for at least 26 of the 52 weeks prior.
24The applicant submits that he was terminated by his employer on October 26, 2022, by way of letter correspondence. The applicant submits that, although he was not paid by his employer after the last pay period of June 18, 2022, he was still “employed” at the time of the accident.
25In Arab, the Divisional Court interprets the definition of “employed” as being “connected to income-earning and receiving wages in exchange for services being rendered.” The Court further clarified at paragraph 29:
Although the legislation does not define the term “employed”, when the term is read in its ordinary grammatical sense and considered within the context of Part II of the Schedule it is clear and unambiguous that section 5(1) is not just about the existence of a formal employment relationship. Its purpose is to determine the eligibility to income replacement benefits with reference to the exchange of wages, salary, or other remuneration for services, over a defined period.
26I have reviewed the evidence and find that the applicant’s Record of Employment (“ROE”) indicates that the applicant began working on May 2, 2022, and ceased working as a truck driver before the accident, on June 7, 2022. The applicant’s ROE confirms that his last day for which he was paid was June 7, 2022, which is 9 days prior to the subject accident. I agree with the applicant, that there was an employment relationship with the company that formally ended by way of letter of termination on October 26, 2022. However, Arab makes it clear that this is not enough to satisfy the overall parameters of the Schedule. There must have been an income-earning situation.
27The evidence indicates that the applicant worked at the company for a total of 5 weeks. The applicant has not pointed me to evidence of any other employment relationship during the 52-week period prior to the accident that would satisfy the 26-week minimum requirement under s. 5(1). While the respondent submits that the applicant was employed at Green Collar Inc. at some point in 2022, the T4 provided indicates the applicant worked a maximum of 20 hours. Even if liberally calculated, this would equate to a total of 6 weeks of employment out of the 52-week period, which I find is not sufficient to meet the minimum 26 of the 52-week period pursuant to s. 5(1)(1) of the Schedule.
28Moreover, a WSIB file dated February 23, 2023, indicates that prior to the accident, the applicant suffered a right wrist sprain on May 9, 2022 and was paid Loss of Earning benefits until June 13, 2022. The OCF-3 completed by Dr. William Parkinson, dated July 9, 2024, and the OCF-3 completed by physiotherapist, Christina Christian, dated June 22, 2022, confirms the applicant did not work, nor received Employment Insurance, in the 26 of the previous 52 weeks preceding the accident.
29The termination letter from the company, dated October 26, 2022, indicates that the applicant was terminated on the basis of “job abandonment/voluntary resignation”. The applicant submits that he did not “abandon” his job, rather he was unable to return to work because of his disability. I find that the evidence indicates that prior to the accident, on June 10, 2022, Kyle Parker of the company sent email correspondence to the applicant offering a modified work arrangement. The evidence also indicates that around July 15, 2022, the applicant had still not responded to the company’s modified work offer. It is not clear from the parties’ submissions or evidence if the applicant responded to the company’s modified work offer thereafter. It is also not clear from the applicant’s submissions whether the applicant notified the company of his accident or his accident-related injuries.
30I acknowledge that the applicant’s individual circumstances must be taken into account when considering the context of the specific application. After considering the circumstances of this case, I find that the legislation is clear. To be employed, the applicant must have been receiving wages in exchange for services provided during the period in question. The evidence shows the applicant was “employed” for approximately 6 weeks, falling short of the required minimum 26-weeks. On this point, I find that the applicant was not “employed” pursuant to s. 5(1)(1) of the Schedule.
The Treatment Plans
31To 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.
32The applicant submits that as a result of the accident, he sustained a brain injury and a low back injury.
The neuropsychological testing proposed by Dr. Parkinson
33I find that the applicant has not proven, on a balance of probabilities, that the proposed treatment plan for neuropsychological testing is reasonable and necessary.
34The applicant submits that the OCF-18 for neuropsychological testing proposed by Dr. Parkinson submitted December 15, 2022, was denied on first submission. The applicant submits that a subsequent OCF-18 for neuropsychological testing proposed by Dr. Parkinson was submitted with respect to his second accident that occurred on October 4, 2022. The applicant submits that this testing was done after both accidents and Dr. Parkinson addressed the contribution of both accidents in this report. Given this, the applicant submits that this issue can be withdrawn from the dispute “provided the insurer pay Dr. Parkinson’s recently submitted OCF-21 for that approved testing.”
35Despite the applicant indicating that he would withdraw this issue, it is not clear from the evidence and submissions of the applicant what recent OCF-21 was submitted.
In any event, based on the submissions of the applicant, the neuropsychological testing was ultimately completed in a report (date unknown) for the subsequent accident on October 4, 2022, of which Dr. Parkison addressed both accidents.
36As such, I find that the OCF-18 dated December 15, 2022 would be duplicative of the report conducted under the October 4, 2022 accident, and therefore not reasonable and necessary.
The Rehabilitation benefits proposed by Dr. Parkinson
37I find that the applicant has proven, on a balance of probabilities, that the unapproved portions of the proposed treatment plans are reasonable and necessary.
38The applicant relied upon the same evidence and arguments to establish that these treatment plans are reasonable and necessary.
39The OCF-18s were completed by psychologist, Dr. William Parkinson and identified goals of reducing pain, improving mood, stress, coping and cognitive compensation, pain coping, and to improve activity tolerance. The treatment plan also sought to achieve a return to activities of normal living, and pre-accident work activities. The OCF-18s sought funding for the following:
The OCF-18 dated January 16, 2023, in the amount of $3,772.88
Line
Provider
Quantity
Total
Therapy, mental health and addictions
Dr. William Parkinson, psychologist
5
$748.05
Training, cognition and learning (skills)
Mr. Brian D’Arcy, social worker
18
$2,376.00
Documentation support activity
Dr. William Parkinson, psychologist
3
$448.83
Documentation support activity for claim form
Dr. William Parkinson, psychologist
1
$200.00
The OCF-18 dated June 2, 2023, in the amount of $3,962.49
Line
Provider
Quantity
Total
Therapy, mental health and addictions
Dr. William Parkinson, psychologist
6
$897.66
Training, cognition and learning (skills)
Mr. Brian D’Arcy, social worker
18
$2,376.00
Documentation support activity
Dr. William Parkinson, psychologist
3
$448.83
Documentation support activity for claim form
Dr. William Parkinson, psychologist
1
$200.00
Educational Material
Dr. William Parkinson, psychologist
2
$40.00
The OCF-18 dated October 25, 2023, in the amount of $3,881.49
Line
Provider
Quantity
Total
Therapy, mental health and addictions
Dr. William Parkinson, psychologist
6
$897.66
Training, cognition and learning (skills)
Mr. Brian D’Arcy, social worker
17
$2,295.00
Documentation support activity
Dr. William Parkinson, psychologist
3
$448.83
Documentation support activity for claim form
Dr. William Parkinson, psychologist
1
$200.00
Educational Material
Dr. William Parkinson, psychologist
2
$40.00
40The applicant submits that the evidence of Dr. Parkinson supports the treatment to be reasonable and necessary by virtue of showing evidence of brain and emotional impairments. The applicant relies on the s. 25 psychological assessment report of psychologist, Dr. Jacqueline Brunshaw dated May 31, 2023, and s. 44 psychological assessment report of neuropsychologist Dr. Cheryl Bradbury, dated September 26, 2024, to support he required psychological treatment.
41The respondent submits that the treatment plans were partially approved with the remainder being denied on the basis of Dr. Bradbury’s opinion that the treatment was duplicative and not required. The OCF-18’s were partially approved on November 20, 2024, as follows:
The OCF-18 dated January 16, 2023, in the amount of $1,396.88;
The OCF-18 dated June 2, 2023, in the amount of $1,586.49; and
The OCF-18 dated October 25, 2023, in the amount of $1,586.49
42I am unpersuaded by the respondent’s reliance on the opinion of Dr. Bradbury that social work support is not required at this later stage. Dr. Bradbury’s report was conducted in September 2024, a year after the proposed treatment was submitted to the respondent for consideration. In my view, the reasonableness and necessity of the proposed treatment plans are to be considered at the time they were submitted to the respondent for consideration. While I agree with the respondent that the applicant does not make independent submissions with respect to “social work treatment”, the overall evidence supports that the proposed treatment is reasonable and necessary.
43The report of Dr. Parkinson, dated December 28, 2022, indicates that the applicant requires intervention to help with habit formation, and gradual learning of simple coping responses. Dr. Parkinson further opines that “these strategies all apply in an integrated, overlapping way to a program aimed at generating physical, emotional, and cognitive adjustment.” Although this report does not specify social work, I find that the recommendations made by Dr. Parkinson align with the goals of the treatment plans, that being to improve mood, coping and cognitive compensation. This is further supported by the report of psychologist, Dr. Brunshaw, who also recommended counselling sessions in addition to various relaxation and exposure techniques.
44As such, I find that the applicant has proven, on a balance of probabilities, that the unapproved portions of the proposed treatment plans for rehabilitation services dated January 16, 2023, June 2, 2023, and October 25, 2023, are reasonable and necessary.
The Rehabilitation benefits proposed by Mr. Mohannad Bakri and Dr. Anthony Adams
45I find that the applicant has proven, on a balance of probabilities, that the proposed treatment plans are reasonable and necessary.
46The OCF-18s completed by physiotherapist, Mr. Mohannad Bakri, identify goals of pain reduction, increase range of motion and strength, and a return to activities of normal living. The OCF-18s sought funding for the following:
The OCF-18 dated October 19, 2022 sought funding for 24 sessions of physical rehabilitation; 18 sessions of therapy, back NEC, assessment and documentation support activity in the amount of $4,389.50; and
The OCF-18 dated December 14, 2022 sought funding for 24 sessions of physical rehabilitation; 20 sessions of therapy, back NEC, assessment and documentation support activity in the amount of $4,589.50
47The OCF-18 completed by chiropractor Dr. Anthony Adams, dated November 16, 2022, sought funding for 30 sessions of chiropractic treatment. The treatment plan identifies goals of pain reduction, increased range of motion, increase in strength, and to return to activities of normal living, pre-accident work activities, and modified work activities.
48The applicant submits that the treatment plans are reasonable and necessary relying on the independent orthopaedic assessment report of Dr. Tajedin Getahun, orthopaedic surgeon, dated June 2, 2023. Dr. Getahun opined that as a result of the accident, the applicant sustained myofascial strain of the cervical and lumbosacral spine and aggravation of pre-existing degenerative changes; myofascial strain of the thoracic spine; and bilateral hip strains and aggravations of pre-existing underlying osteoarthritis.
49The respondent submits that the OCF-18 completed by Mr. Bakri dated October 19, 2022, was partially approved on November 2, 2022, in the amount of $1,100.00, up to the Minor Injury Guideline limit. The respondent submits that the balance of the treatment plan, along with the OCF-18 completed by Mr. Bakri, dated December 14, 2022, and the OCF-18 dated November 16, 2022 completed by Dr. Adams, were denied on January 17, 2025, based on the s. 44 orthopaedic assessment report of orthopaedic surgeon, Dr. Gilbert Yu Ming Lee, dated January 7, 2025, who opined the proposed treatment was for injuries flowing from the applicant’s second accident.
50In his report dated January 7, 2025, Dr. Lee opined that “given the time elapsed post-injury and treatment rendered to date I do not feel any further facility-based rehabilitation treatment is clinically indicated.” However, as I have indicated prior, the reasonableness and necessity of the proposed treatment plans are to be considered at the time they were submitted to the respondent for consideration. I am unpersuaded by the opinion of Dr. Lee that the proposed treatment is not reasonable and necessary given that this report was conducted more than two years after the proposed treatment was submitted in 2022. While I accept that the time elapsed may have changed the physical circumstance of the applicant, the treatment proposed should be considered based on the circumstances of the applicant at the time the plans were submitted to the respondent for consideration.
51As such, I prefer the report of Dr. Getahun given that this report was conducted in closer proximity to the proposed treatment plans. Based on clinical examination at the time and review of medical documentation, Dr. Getahun ultimately recommended physiotherapy and chiropractic treatment “in a multidisciplinary supervised setting to optimize [the applicant’s] outcome.” I also note that a CNR of the applicant’s family practitioner, Dr. Enas Abuelalaa, dated November 10, 2022 indicates the applicant was referred for physiotherapy regarding back pain following two recent accidents.
52Therefore, I find that on a balance of probabilities proposed treatment plans are reasonable and necessary.
Rehabilitation benefits proposed by Ms. Laura Bristol dated December 15, 2022
53I find that the applicant has not proven, on a balance of probabilities, that the proposed treatment plans are reasonable and necessary.
54The OCF-18, completed by massage therapist Ms. Laura Bristol, dated December 15, 2022, sought funding for 30 sessions of massage therapy. The goals of the treatment seek to reduce pain, increase range of motion, increase strength, and to return to activities of normal living.
55The applicant submits that the treatment is reasonable and necessary because it was intended to be administered alongside physiotherapy services to enable greater effectiveness of the physiotherapy.
56While I appreciate the applicant’s submission, submissions are not evidence. The onus is on the applicant to establish that, on a balance of probabilities, the proposed treatment is reasonable and necessary. In the present case, I am not satisfied that the applicant has met his burden.
57The applicant has not directed me to a medical opinion or evidence that recommends massage therapy. The OCF-18 is also silent with respect to “greater effectiveness” if administered alongside other treatment modalities.
58Given this, I find that the applicant has not established, on a balance of probabilities, that the proposed treatment plan is reasonable and necessary.
Interest
59The applicant is entitled to interest on any overdue benefits pursuant to s. 51 of the Schedule.
Award
60I find that the applicant is not entitled to an award pursuant to s. 10 of Reg. 664.
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.
62The applicant submits that the withholding of benefits has caused him great stress, aggravating his impairments.
63The respondent submits that the applicant has not established that the insurer has engaged in conduct that is excessive, imprudent, stubborn, inflexible, unyielding or immoderate behaviour and has not unreasonably withheld or delayed any benefits payable to the applicant.
64After considering the evidence before me, I do not find that the respondent acted in bad faith or unreasonably withheld or delayed benefits. I am not pointed to evidence that would support same.
65As such, I find that the respondent is not liable to pay an award.
ORDER
66I find that:
The applicant is not entitled to IRBs in the amount of $1000.00 per week from July 13, 2022 and ongoing;
The applicant has not established entitlement to the OCF-18 for neuropsychological testing, proposed by Dr. Parkinson, dated December 15, 2022;
The applicant is entitled to the unapproved portions of the treatment plan for rehabilitation services proposed by Dr. Parkinson dated January 16, 2023, plus interest;
The applicant is entitled to the unapproved portions of the treatment plan for rehabilitation services proposed by Dr. Parkinson dated June 2, 2023, plus interest;
The applicant is entitled to the unapproved portions of the treatment plan for rehabilitation services proposed by Dr. Parkinson dated October 25, 2023, plus interest;
The applicant is entitled to the treatment plan for rehabilitation services proposed by Mohannad Bakri, dated October 19, 2022, plus interest;
The applicant is entitled to the treatment plan for rehabilitation services proposed by Mohannad Bakri, dated December 14, 2022, plus interest;
The applicant is entitled to the rehabilitation services proposed by Anthony Adams, date November 16, 2022, plus interest;
The applicant is not entitled to the rehabilitation services proposed by Laura Bristol, dated December 15, 2022; and
The respondent is not liable to pay an award.
Released: June 15, 2026
Nadia Mauro
Adjudicator
