Licence Appeal Tribunal File Number: 24-000986/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:
Jane Berberich
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Jeff Chatterton
APPEARANCES:
For the Applicant:
Turel Hufriz, Paralegal
For the Respondent:
Jessica Rogers, Counsel
HEARD:
In Writing
OVERVIEW
1Jane Berberich, the applicant, was involved in an automobile accident on August 15, 2021, 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, Aviva Insurance Company of Canada, 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 following amounts for psychological services proposed by Downsview Healthcare:
i. $1,937.92 ($6,050.08 less $4,102.16 approved) in a treatment plan dated January 25, 2022;
ii. $1,416.42 ($3,697.14 less $2,280.72 approved) in a treatment plan dated September 13, 2023;
iii. $1,909.64 ($4,204.32 less $2,294.68 approved) in a treatment plan dated January 9, 2024?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
1The application is dismissed. The applicant has not met the onus to establish entitlement to the disputed amount on the treatment plans in dispute. No interest is payable.
ANALYSIS
Psychological Treatment Plan – Professional Rates
2The applicant has not met the onus to establish entitlement to the unapproved amount in the psychological treatment plans.
3To 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.
4The dispute for all three disputed treatment plans lies in the professional rate paid to the treatment provider. Neither party disputes the necessity of the treatment plans in general. The applicant is claiming $149.62, the rate for a psychologist. Meanwhile, the respondent is claiming that the services are being conducted by a psychotherapist, versus a psychologist. The respondent has agreed to pay $99.75 per hour for all sessions.
5The applicant submits the that the work is being conducted by a psychotherapist, which is a highly regulated profession. To support their argument that a psychotherapist should be paid the same as a psychologist, the applicant cites J.V. and Intact Insurance Company, 2019 CanLII 76995 (ON LAT). J.V. established that a psychotherapist doing essentially similar work to a psychologist was entitled to be paid at the same rate as a psychologist.
6The applicant also cites A.S and Aviva Insurance Company, 2019 CANLII 51335 (ON LAT), which determined that if psychotherapists and psychologists are doing the same behaviour therapy, they should be paid the same hourly rate.
7The respondent submits that unregulated psychological providers are entitled to $58.19 per hour, but that it has agreed to pay a higher rate of $99.75 per hour.
8To support its position, the respondent refers to the Professional Services Guideline No.03/14 (“Guideline”) from the Financial Services Commission of Ontario, submitting that the Guideline establishes the maximum hourly rate payable by automobile insurers under the Schedule related to services provided by health care professions, or health care providers listed within the Guideline. Insurers are not prohibited from paying above any maximum amount or hourly rate established in the Guideline.
9It is also noted within the Guideline that services provided by health care professionals/providers, unregulated providers and other occupations not listed within the Guideline are not covered by the Guideline. For services not covered by the Guideline, the amounts payable by an insurer are to be determined by the parties involved. The Guideline further notes that automobile insurers are not liable to pay expenses for services rendered to an insured person which exceed the maximum hourly rates set out in the Guideline’s Appendix.
10Furthermore, the respondent states that the psychotherapist in question, Corraddo Recchiuti, was registered with the College of Registered Psychotherapists of Ontario (‘CPRO’), but as a ‘qualifying’ psychotherapist, and he was not qualified or not yet qualified to provide Cognitive Behavioural Therapy, unlike a psychologist. The respondent submits that therefore, the therapy being conducted is inherently different and does not require a psychologist’s expertise.
11I have reviewed the Clinical Notes and Records from Mr. Recchiuti and note that the (Qualifying) addendum appears in every signature block. According to the CPRO, a Registered Psychotherapist (Qualifying is a therapist who has completed their academic training but is currently practicing under the supervision of a fully registered therapist to meet the requirements for full registration. This status means they have completed a Master's degree, are practicing psychotherapy to gain supervised clinical experience and hours, and must also pass a registration examination before they can practice as a psychotherapist independently.
12Finally, the respondent cites the precedent established in Hawes v Aviva, 2022 CANLII 70525 (ON LAT) where the adjudicator states “A psychotherapist is not akin to a psychologist, that is precisely why a psychotherapist is not entitled to a psychologist's rate.”
13While the applicant argues the respondent should approve the psychologist’s rate, I have not been directed to any evidence that the work being done by Mr Recchiuti was essentially the same as a psychologist, or that he is entitled to a higher rate by virtue of his expertise, experience or credentials. The applicant has not submitted the OCF-18s which would outline the scope of therapy conducted, or how it is essentially the same or different than what could be conducted by a psychotherapist.
14I was not led to evidence which indicates the therapy work conducted was essentially the same as a psychologist, or that Mr Rechiuti was under constant supervision from a psychologist. Such indications could lend weight to the argument that the work should be paid at a psychologists rate.
15In my view, the $99.75 rate approved by the respondent is reasonable. While I am alive to the argument that a psychotherapist should be paid the same amount as a psychologist if they are essentially doing the same work, I have not been led to evidence that the work, in fact, was essentially the same. Furthermore, I note that Mr. Rechiuti is in ‘qualifying’ status, and is not a psychologist, nor has the applicant provided evidence that Mr. Rechiuti is qualified to provide Cognitive Behavioural Therapy, similar to a psychologist.
16For these reasons, I find the applicant has not, on a balance of probabilities, met the onus to establish that the disputed amounts related to professional rates in the psychological treatment plans are reasonable and necessary.
Interest
17Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are overdue, no interest is payable.
ORDER
18The application is dismissed.
19The applicant is not entitled to the disputed amount of the treatment plans in question.
20No interest is payable.
Released: October 17, 2025
Jeff Chatterton
Adjudicator