Applicant entitled to various medical benefits and a special award for insurer's unreasonable denials.
The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.
The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.
The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.
The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.
OLATOntario Licence Appeal TribunalJul 29, 2025
