(Re) 1801-00152, 2019 ONCICB 78

CRIMINAL INJURIES COMPENSATION BOARD

Adjudicator: Louise Charette and Veda Rangan

Date: April 25, 2019

Indexed as: (Re) 1801-00152

REVIEW DECISION

Introduction

1This application is the subject of a request for a review of a decision by a single Board Member, heard by the Criminal Injuries Compensation Board (CICB) on September 20, 2018. This application is being considered pursuant to section 10(1) of the Compensation for Victims of Crime Act, RSO 1990, c. C24, as amended (CVCA).

2Section 10 provides:

(1) Where an application is heard by a single member of the CICB under section 9, the Applicant or the Minister may, within fifteen days after service of the decision of the member, require a hearing and review by the CICB and the CICB shall fix a notice thereof to be served upon the parties to the proceeding.

(3) The Hearing shall be conducted and the jurisdiction of the CICB shall be exercised by at least two members of the CICB and the member whose decision is being reviewed shall not sit on the review.

(4) After a hearing and review by the CICB under this section, the CICB shall make its order in accordance with this Act and its order supersedes the order of a single member made under section 9 that is the subject of the hearing and review.

3Rule 19.2 of CICB’s Rules states:

An Applicant may request a review of the decision of a single member on the grounds that the decision contains a serious error of law or an unreasonable exercise of discretion.

Issue

4The issue before the panel is whether the CICB decision dated September 20, 2018 denying the Applicant’s request for reimbursement of counselling expenses contains an error of law or a significant error in facts and/or there has been an unreasonable exercise in discretion.

Applicant’s Grounds for Review

5In his request for review dated October 15, 2018 the Applicant asked the CICB to review the Single Member’s decision because the conclusion that he had failed to provide receipts to support his claim was “unreasonable as it fundamentally misapprehends the evidence”.

6The Applicant submitted that the therapy expenses information was provided in the therapy report dated May 2018. He further noted that the CICB forms did not ask him to attach receipts and because his therapist had provided the documentation, he was under the impression that further documentation was not required.

7The Applicant acknowledged that much of the therapy sessions he had attended were in connection with his marital difficulties. Nevertheless, he estimated that two sessions between November 2016 and January of 2018 had been devoted exclusively to addressing his injuries in connection with the crime of violence.

8With respect to the amounts being claimed, the Applicant submitted that the expenses related to this specific therapy amounted to a total of $340 (2 sessions at $250 per session minus $80 per session which is the amount covered by his insurance).

9In addition, the Applicant noted that as the incident continued to affect him, 10 additional sessions were recommended by the therapist. He indicated that this was noted in the therapy report submitted to the CICB prior to the hearing however it was not considered in the original decision.

10The CICB also reviewed an email from the Applicant dated April 3, 2019 summarizing his request for review.

Summary of the previous decision

11The Applicant originally submitted a claim to the CICB seeking compensation for his injuries as a result of a single assault. The decision dated September 20, 2018 found the Applicant to be a victim of a crime of violence pursuant to section 5(a) of the CVCA and as a result, he was awarded compensation for pain and suffering in the amount of $5,000.00.

12The Applicant’s claim for therapy expenses was denied as it was stated “he did not produce receipts or proof of payment despite being asked to do so by the CICB in their letter dated January 26, 2018. Therefore, the amount of $340 requested by the Applicant is denied”. It was further noted that “the Applicant, who was employed full time, had insurance that appeared to have covered a portion of his expenses”.

Analysis and Decision

13The purpose of this section 10 Review is to review the sufficiency of the decision dated September 20, 2018. The Decision will not be interfered with unless the Applicant demonstrates a failure of the Single Member to properly exercise discretion or an error in law or significant error in facts.

14The panel reviewed and considered all of the documents in the Applicant’s CICB’s file, including the information which the Single Member referred to and which she relied on in denying the claim for therapy expenses.

15Although no receipts were submitted to the CICB as requested prior to the hearing, the therapy report that was originally before the Single Member confirmed the Applicant attended 35 sessions and paid a total amount of $8,750.00 in therapy fees. The report indicates that the main focus of the therapy was dealing with his relationship however, the therapist also mentions addressing the injuries associated with the crime of violence. Although the report does not specifically indicate how many sessions were dedicated to dealing with the impact of the assault, the Applicant had submitted that he was seeking reimbursement for two counselling sessions.

16Although the therapy report confirmed the total costs incurred by the Applicant as well as the amount charged per session, the CICB also required proof of insurance coverage as the Application made mention of it. Although the Application noted the insurance company covered $80.00 per session, without proper documentation, the member could not properly assess the exact expenses incurred.

17The Applicant submitted proof of insurance coverage following the hearing. The insurance company confirmed the amount covered is $80.00 per session. The Applicant maintains that he attended two sessions dedicated to the crime of violence which seems reasonable under the circumstances.

18While the proof of payment (i.e. receipts) were not provided to the CICB, given that the therapy report provides information regarding the fees incurred, the CICB unreasonably exercised its discretion not to award expenses for therapy. We are satisfied that two sessions was a reasonable estimation on how much time was used specific to the crime of violence.

19In addition, the Therapy Report noted that 10 additional sessions was required to address the impact of the assault on him. This again did not appear to be considered in the Original Decision and therefore was an unreasonable exercise of discretion not to award future therapy expenses.

20Therefore, CICB grants the review.

21The CICB’s usual practice is to award up a maximum of $125.00 per session for registered psychologist. The expense for the two sessions is therefore calculated at $125.00 per session as the CICB’s approved rate for two sessions (total of $250.00) minus $160.00 for insurance coverage per session. The Board therefore awards $90.00 towards this expense.

22With respect to the 10 additional sessions, the CICB awards $55.00 per session ($125.00 minus $80.00 of insurance coverage) for ten sessions for a total of $550.00.

Award

23The CICB orders compensation as follows:

Subsection 7(1)(a) expenses

$640.00

Payment

24The CICB orders the following be paid directly to:

The Applicant: $640.00