Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 24-003763/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:
Melissa Burgoin Applicant
and
CAA Insurance Company Respondent
DECISION
ADJUDICATOR: Melanie Malach
APPEARANCES:
For the Applicant: Brent McQuestion, Counsel
For the Respondent: Robert P. Bowman, Counsel
HEARD: By way of written submissions
OVERVIEW
1Melissa Burgoin, the applicant, was involved in an automobile accident on January 31, 2015, 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, CAA Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2On May 3, 2022, the respondent accepted that the applicant had sustained a catastrophic (“CAT”) impairment under the mental/behavioural category of Criterion 8 of the Schedule. The applicant was accepted as meeting the CAT designation having one marked impairment in the sphere of Adaptation (which is the relevant minimum for this accident date).
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $4,802.50 for rehabilitation therapy, proposed by Justine McKay in a treatment plan, dated August 20, 2022?
ii. Is the applicant entitled to attendant care benefits in the amount of $3,155.86 per month from March 23, 2024 to ongoing?
iii. Is the applicant entitled to $133,758.24 for home modifications proposed by Deborah Prestwood (Ross Rehabilitation) in a treatment plan, dated May 10, 2023?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4I find that the applicant is not entitled to $4,802.50 for tutoring sessions for her daughter, in the treatment plan dated August 20, 2022.
5I find that the applicant is entitled to attendant care benefits in the amount of $3,155.86 per month from March 23, 2024 and ongoing. However, I find that she has not proven that additional attendant care services have been incurred for the time period in dispute pursuant to s. 3(7)(e) of the Schedule.
6I find that the applicant is not entitled to $133,758.24 for home modifications proposed in the treatment plan dated May 10, 2023.
7I find that the applicant is not entitled to interest.
PROCEDURAL ISSUES
8The applicant’s request to strike the respondent’s submissions due to the respondent filing its submissions late is denied and the respondent’s motion to extend the time to allow it to file its submissions is granted.
9The applicant in her reply submissions, dated May 13, 2025, submits that the respondent’s written submissions were due on May 9, 2025, however as they were not submitted by email until 6:03 p.m. on May 9, 2025, they were deemed received on May 12, 2025 and were therefore late. The applicant requests that the Tribunal strike the respondent’s submissions pursuant to Rule 9.3 of the Licence Appeal Tribunal Rules (“Rules”).
10In response, on May 23, 2025, the respondent brought a motion requesting an order pursuant to Rule 3.1 and 3.2 of the Rules, extending the time to allow the respondent’s late filed submissions on May 9, 2025 at 6:07 p.m. to the deemed delivery date of May 12, 2025.
11The respondent submits that its submissions and evidence were sent on Friday, May 9, 2025 at 6:02 p.m., which is 62 minutes past the deemed close of business hours as described by Rule 6.2(e) of the Rules, and then were uploaded to the Tribunal at 6:07 p.m. on May 9, 2025. The respondent submits its counsel’s office encountered technical difficulties with linking the several surveillance videos in a format which permitted them to be filed with the Tribunal.
12The respondent submits that the applicant has not pointed to any prejudice which she sustained on account of this 62-minute delay. It notes that although the applicant was afforded up to May 16, 2025, to deliver her reply submissions, she delivered her reply submissions on May 13, 2025. This suggests that she did not require additional time to complete her reply submissions for the Tribunal and she did not suffer any prejudice by the delay.
13The respondent’s motion request is granted, and I agree to extend the time to allow the respondent’s late filed submissions. I find that the respondent’s submissions were only 62 minutes late due to technical difficulties experienced in filing its submissions. I do not find that the applicant suffered any prejudice from the late submissions as she had sufficient time to file her reply submissions, which she submitted prior to the due date.
ANALYSIS
Entitlement to the treatment plan for tutoring support
14I find on a balance of probabilities that the applicant has not proven that the treatment plan for tutoring support for her daughter is reasonable and necessary.
15Pursuant to s. 16(1) of the Schedule, rehabilitation benefits shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person in undertaking activities and measures that are reasonable and necessary for the purpose of reducing or eliminating the effects of any disability resulting from the impairment or to facilitate the person’s reintegration into his or her family, the rest of society, and the labour market.
16The applicant claims entitlement to $4,802.50 for tutoring support for her 13-year-old daughter, proposed by Deborah Prestwood, occupational therapist, of Justine McKay, in a treatment plan dated August 20, 2022. The treatment plan recommends the following:
Documentation, support activity for claim form: $ 50.00
24 half hour sessions of “Planning, service”: $ 600.00
24 one-hour “provider travel time, provider to treatment”: $1,200.00
24 one and a half hour “instruction, support activity”: $1,800.00
24 half hour “documentation support, activity”: $ 600.00
17The applicant submits that the primary goal of the subject treatment plan is to provide tutoring support to her 13-year-old daughter, to relieve her of the responsibility that exceeds her capabilities. She relies on the activity limitations noted in the treatment plan which state that, “She is not able to plan, prepare and execute an appropriate level of educational guidance for her daughter, understanding the material for the Grade 8 academic year, or how best to teach them to her daughter. She will also struggle to reliably maintain a schedule for tutoring due to low energy, mood, and chronic pain.”
18The applicant further relies upon the letter from Darlene Humphrey, case manager, to the respondent, dated January 18, 2024, which provided a summary of her contact with the applicant, her observations of the applicant’s struggles and vulnerabilities, and the applicant’s deterioration when not provided vital supports. She provides the reasons why the services recommended in the subject treatment plan are essential to the applicant’s rehabilitation.
19The applicant also submits that the respondent failed to comply with s. 38(8) of the Schedule, as it did not respond to the treatment plan within 10 business days. The respondent denied the treatment plan by letter dated September 21, 2022. The applicant relies upon the Tribunal reconsideration decision in T.F. v. Peel Mutual Insurance Company, 2018 CanLII 39373 (ON LAT), where it was found that as a consequence of the s. 38(8) breach, the benefits in question were payable by the insurer pursuant to s. 38(11) and the Tribunal did not even need to determine whether the said benefits in dispute were reasonable and necessary.
20The respondent submits that the fact the tutoring is for the applicant’s daughter is an important distinction, as the applicant must establish that funding this treatment plan, is a reasonable and necessary expense as well as serving some medical/rehabilitation purpose for the applicant.
21The respondent submits that the goal of the subject treatment plan is “to provide tutoring support to Ms. Burgoin’s 13-year-old daughter, to relieve the client of the responsibility that exceeds her capabilities.” The respondent submits that no information has been provided about how the goals of the treatment plan might reasonably be met. No school records have been provided, nor is there any evidence provided to support the applicant’s daughter’s tutoring needs. The respondent submits that the proposed tutoring services do not focus on the needs of the applicant who sustained the injury, which is implicit in the definition of a medical and rehabilitation expense.
22The respondent relies upon the Ontario Insurance Commission’s decision of Arbitrator K. Julaine Palmer, in Carlos Ferreyra and Blanca Ferreyra and Royal Insurance Company of Canada, 1992 ONICDRG 24, where it was held:
The principal focus of the No-Fault Benefits Schedule is on the needs of the insured person who sustained injury, not generally on replacement of the services formerly provided by the insured person who sustained the injury.
23The respondent argues that the proposed tutoring services appear to be replacement services formerly provided by the applicant who is the person who sustained the injury. The respondent submits that these are not expenses which in themselves provide any medical or rehabilitation benefit for the applicant.
24With respect to the applicant’s s. 38(8) argument, the respondent acknowledges that more than ten business days had passed between the submission of the treatment plan on August 20, 2022, until the time of the September 21, 2022 denial letter. However, the respondent submits that the applicant did not incur any tutoring expenses between August 30, 2022 and September 21, 2022. The respondent submits that the delay in providing its denial does not mean that the applicant is entitled to the treatment plan.
25In reply, the applicant submits that the Ferreyra decision relied upon by the respondent is distinguishable from the present case on the basis that the decision was decided by a historical tribunal no longer in existence, which applied sections of the Schedule since repealed, and which considered a set of facts dissimilar to those in the present case.
26I agree with the respondent that the applicant has not provided any evidence to support that her daughter requires the services of a tutor to support that the services are reasonable and necessary. She has not provided any evidence of her daughter’s academic issues or why a tutor was required for grade 8. I find that simply because the applicant’s daughter is in grade 8 does not mean that she requires a tutor. Further evidence to support her needs is required to prove that the services requested are reasonable and necessary.
27While Ms. Prestwood sets out that the goal of the treatment plan is to relieve the applicant of the responsibility of providing her daughter with assistance with her homework, and Ms. Humphrey supports this, the evidence does not support that there is a need for tutoring sessions in the first place. Without this supporting evidence, I do not find that the treatment plan in dispute is reasonable and necessary.
28I agree with the applicant that the respondent failed to comply with s. 38(8) of the Schedule as it did not respond to the treatment plan in dispute within ten business days and provided its denial letter on September 21, 2022. However, I do not agree that T.F. v. Peel stands for the proposition that due to the non-compliance, the treatment plan is then payable without determining whether it is reasonable and necessary. I find that s. 38(11) of the Schedule provides that the treatment plan is payable starting on the 11th business day after the insurer received the treatment plan and ending on the day the insurer gives a notice in s. 38(8). The applicant therefore would be entitled to any benefits incurred from the 11th business day after the respondent received the treatment plan until the respondent provided its denial letter, which was on September 21, 2022. I agree with the respondent that the applicant has not provided any evidence that any services were received during this period. Once the respondent provided its denial letter, the test then became whether the treatment plan is reasonable and necessary for the services incurred outside of the shall-pay period.
29For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to the treatment plan for tutoring sessions for her daughter.
Entitlement to attendant care benefits
30I find that the applicant has proven on a balance of probabilities that she is entitled to attendant care benefits in the amount of $3,155.86 per month from March 23, 2024. However, I find that she has not proven that these services have been incurred for the time period in dispute pursuant to s. 3(7)(e) of the Schedule.
31Section 19 of the Schedule provides that an insurer shall pay for all reasonable and necessary expenses incurred by or on behalf of an insured person as a result of an accident for attendant care services provided by an aide or attendant. A Form 1 prepared by an occupational therapist sets out the services and amount of care an individual requires as well as the monthly amount payable.
32Section 3(7)(e) provides that expenses are not incurred by an insured person unless:
i. They have received the goods and services to which the expense relates;
ii. They have paid the expense, have promised to pay the expense, or are otherwise legally obligated to pay the expense; and
iii. The person who provided the goods or services,
(a) Did so in the course of the employment, occupation or profession in which he or she would ordinarily have been engaged, but for the accident; or
(b) Sustained an economical loss as a result of providing the goods or services to the insured person.
33Both parties agree that the applicant requires attendant care benefits; however, there is a disagreement regarding the amount. The applicant relies upon the Form 1 prepared by Ms. Prestwood, dated March 24, 2023 which determined that she needs $3,155.68 per month in attendant care benefits. The Form 1 recommends assistance with dressing, grooming, feeding, mobility, hygiene, basic supervisory care, co-ordination of attendant care, exercise, medication, and bathing. The respondent relies upon the Form 1 prepared by Vinita Tandon, occupational therapist, dated September 5, 2023, which recommended $387.82 per month in attendant care benefits. Specifically, Ms. Tandon opined that the applicant only required assistance with hair care (60 minutes per week) and ensuring comfort, safety and security in the bedroom (420 minutes per week).
34The applicant argues that she requires attendant care due to her physical impairments caused by the accident, which include chronic pain, and are significantly compounded due to her psychological emotional and cognitive issues, and their impact on her motivation and energy levels.
35The applicant relies upon the Occupational Therapy Attendant Care Reassessment report of Ms. Prestwood, dated March 29, 2023, where the recommendations for attendant care benefits were based on an assessment of her compromised functioning and took into account her cognitive and emotional impairments that are impacting her ability to complete the aspects of her care. Regarding Level 1, Routine Personal Care, Ms. Prestwood considered the applicant’s functioning which is compromised by her episodes of dizziness, chronic pain, reduced physical tolerances, low motivation, poor stamina, severe fatigue, anxiety and low mood. With respect to Level 2, Basic Supervisory Function, Ms. Prestwood considered the applicant’s functioning which is compromised by chronic pain, mood problems, poor physical tolerances, balance impairments, inadequate sleep, emotional impairments, reduced ability to manage stairs in her home, chronic fatigue, tendency to be overwhelmed, requirement for verbal cueing, patterns of forgetting appointments, and lack of resources to follow through with recommendations. Finally when assessing her Level 3, Basic Supervisory Function, Ms. Prestwood considered her functioning which is compromised by her fatigue, pain, low mood, dizziness, cognitive difficulties and emotional difficulties.
36The applicant further relies upon the letter of Ms. Humphrey, dated January 18, 2024 to the respondent, where Ms. Humphrey expresses concern that the applicant’s mental and behavioural impairments had not been properly accounted for by Ms. Tandon in her assessment. She states that there is grave concern over the attendant care services being removed.
37The respondent submits that the applicant has confirmed in correspondence dated November 22, 2024 from her counsel that there are no outstanding incurred expenses on account of attendant care and therefore she has not proven that additional attendant care benefits were incurred pursuant to s.3(7)(e) of the Schedule.
38The respondent relies upon the Form 1, dated September 5, 2023, prepared by Ms. Tandon, which recommended $387.82 per month in attendant care services. The respondent notes that during the assessment, the applicant acknowledged that she was “independent with her personal care tasks for the most part”. The respondent further submits that Ms. Tandon supported that the applicant required intermittent support for encouraging activity as required.
39The respondent further relies upon the IE psychological report of Dr. Kerry Lawson, dated November 29, 2023. Dr. Lawson concluded that while the applicant has not reached maximum medical recovery from a psychological perspective, her level of psychological distress does not necessitate the services of an aide or attendant to assist with personal care activities. The respondent also relies upon the IE Attendant Care report dated November 29, 2023, in which he concluded that the applicant’s physical injuries were uncomplicated soft tissue injuries, without any neurological abnormalities. He concluded that the applicant was safe to resume all aspects of life that she was engaged in prior to the accident without restrictions.
40The respondent submits that in response to the letter from Ms. Humphrey, an Addendum report was prepared by Ms. Tandon, dated April 23, 2024. She notes that a total of eight hours per week or $387.82 in monthly attendant care was recommended. Assistance with household and heavier aspects of linen changes and bathroom cleaning were recommended within the housekeeping/home maintenance benefit and as such was not duplicated in the attendant care needs area.
41In reply, the applicant submits that Ms. Tandon failed to consider her permanent impairment to her left upper extremity in her assessment of the applicant’s attendant care needs. She further submits that Ms. Tandon’s assessment of her attendant care needs disproportionately assessed, on a cursory basis, her physical symptoms but at the expense of neglecting her attendant care needs from a mental/behavioural perspective.
42I find that neither party provided submissions on the individual recommendations for attendant care in the Form 1’s submitted. Rather more general submissions were made by the parties including the failure of Ms. Tandon in considering the applicant’s mental and behavioural impairments.
43I give more weight to the Form 1 prepared by Ms. Prestwood over Ms. Tandon because it is consistent with the totality of the medical evidence regarding the applicants’ impairments and functional limitations, specifically her psychological and cognitive impairments. I agree with the applicant that Ms. Prestwood considered the applicant’s physical impairments as well as her cognitive and emotional impairments that are impacting her ability to complete the aspects of her care. I find that Ms. Tandon’s assessment focused on the applicant’s physical needs and did not adequately consider the applicant’s mental and behavioural impairments. In her report, Ms. Tandon states that the applicant’s mood and emotional concerns did not appear to be of the level which would detract from her ability to keep herself safe or prevent her from completing her basic self-care activities from a functional perspective. This is clearly contrary to the psychological assessments that document the applicant’s ongoing psychological and cognitive issues as well as her CAT diagnosis. While the respondent submits that Ms. Tandon “supported that the claimant required intermittent support for encouraging activity as required”, this is not reflected in the attendant care services recommended. In addition, as noted by the applicant in her reply submissions, Ms. Tandon noted that the applicant suffered impairments to her left hand, was unable to descend stairs to the basement, reports dizziness with stooping, crouching and kneeling and has a history of falls due to issues of balance and dizziness, yet it does not appear that these impairments were considered in her recommendations.
44I further give weight to Ms. Prestwood’s report where she noted that the applicant is noticing gains, i.e. she is wanting to do more and she is carrying out activities “outside of her comfort zone” with support. Ms. Prestwood stated that it is premature to reduce the attendant care benefit at this time, given that services are just being introduced and some gains are being noted and the applicant continues to experience ongoing symptoms and functional barriers as assessed at this time. I find that as Ms. Prestwood has been involved in the applicant’s ongoing care, she is in a better position to assess the applicant’s ongoing needs than Ms. Tandon who only assessed the applicant on one occasion for the purposes of an IE assessment. I find that Ms. Humphrey who is the applicant’s case manager is also in a better position to assess the applicant’s ongoing needs as she is intrinsically involved in the management of the applicant’s care. Ms. Humphrey set out in her letter that “there is grave concern” that the attendant care services are removed. I find that both Ms. Prestwood and Ms. Humphrey disagreed with the conclusions of Ms. Tandon who recommended limited attendant care assistance.
45I therefore find, on a balance of probabilities that the applicant is entitled to attendant care benefits in the amount of $3,155.86 per month from March 23, 2024 to date and ongoing.
46With respect to the respondent’s arguments that no further attendant care benefits have been incurred pursuant to s. 3(7)(e) of the Schedule, I find that the applicant has not made any submissions with respect to same. I find based on the letter from counsel for the applicant dated November 22, 2024, that there are no outstanding incurred expenses for attendant care. Counsel indicates that the applicant “has not been able to incur attendant care benefits from that date to present given the amount approved by the respondent is insufficient to support putting in place a professional to provide the recommended attendant care services.” Consequently, I find there is insufficient evidence before me to support that the applicant received the expenses to which the services relate, and I find that the applicant has not proven that additional attendant care benefits were incurred. No submissions were provided with respect to whether the services were deemed incurred pursuant to s. 3(8) of the Schedule. As a result, the applicant is not entitled to payment of the additional attendant care benefits that I found to be reasonable and necessary for the time period in dispute.
Entitlement to the treatment plan for housing modifications
47I find on a balance of probabilities that the applicant has not proven that the treatment plan for housing modifications is reasonable and necessary.
48Section 16(1) of the Schedule provides that the insurer shall pay for rehabilitation benefits for all reasonable and necessary expenses for the purpose of reducing or eliminating the effects of any disability resulting form an impairment. Section 16(3)(i) states that the insurer shall pay for home modifications, to accommodate the needs of the insured person, or the purchase of a new home if it is more reasonable to purchase a new home to accommodate the needs of the insured person than to renovate his or her existing home.
49The applicant claims entitlement to $133,758.24 for home modifications, proposed by Ms. Prestwood, in a treatment plan dated May 10, 2023. Upon my review of the attached treatment plan, I find that it recommends the following:
Home modifications to provide a main floor powder room and safer access to basement and back garden/secondary egress: $115,900.00
Railings to front entrance - $1,075.19
Grab bars for bathroom safety - $289.97
Handrail on stairs on right descending - $589.99
Stair treads - $337.98
Documentation support activity for claim form - $200.00
50By letter dated December 14, 2023, the respondent partially approved the treatment plan in the amount of $3,560.00. The respondent agreed to fund front entry railings, stair treads for the main to second floor staircase, and a grab bar for the main bathroom.
51The applicant submits the recommendations in the treatment plan are supported by Ms. Prestwood in her Occupational Therapy Treatment Plan report, dated May 25, 2023, as well as the quote of Brookview Builders Inc., dated April 4, 2023, which provided a cost outline of the proposed home modifications. The applicant submits that based on Ms. Prestwood’s various reports, dated July 7, 2022, March 29, 2023, and May 25, 2023, the applicant’s home environment presents with numerous barriers that effect her ability to function safely given her functional impairments.
52The applicant submits that the respondent’s IE reports provide negligible value to this Tribunal in determining whether the recommended home modifications are reasonable and necessary. She submits that the respondent failed to provide its s. 44 IE assessors with fundamental documentation required to provide well-informed and non-partisan opinions. She submits that neither Ms. Tandon nor Mr. Brothwick reviewed the subject treatment plan, the occupational therapy assessment reports of Ms. Prestwood, or the quote provided by Brookview Builders.
53The applicant relies upon the Tribunal decision in S.M. v. Unica Insurance Inc., 2020 CanLII 12718 (ON LAT), where it was held that home modifications that provide safe access to key areas of the home and allow an insured person to access areas of the home for ordinary living will be considered reasonable and necessary.
54The respondent submits that the treatment plan for housing modifications is not reasonable and necessary as there needs to be a connection between the proposed modifications and the applicant’s accident-related impairments.
55The respondent submits that the applicant has not provided any medical evidence in her submissions besides the Housing Report, which justify the need for the sorts of home modifications proposed. The respondent submits that the applicant’s recovery from her physical injuries has been substantial, at least insofar as mobility issues are concerned. It submits that the applicant has not submitted any medical documentation or clinical notes and records (“CNRs”) in her submissions from her family doctor which support her difficulties with ambulation, or accident-related bladder issues, or which reasonably justifies the need for a bathroom installation in her home as a consequence of the accident. In addition, the respondent submits that there is no mention of, referrals or attendances with a urologist to support the applicant’s urinary “urgency” issues.
56The respondent relies on various surveillance reports as evidence of the applicant’s functional abilities. It submits that the surveillance depicts a relatively able-bodied person who appears capable of carrying out a wide range of everyday tasks with little, if any, need for assistance. It submits that there is no indication in the surveillance that the applicant has any difficulties with ambulation or requires any walking aids whatsoever.
57The respondent further submits that the applicant’s reports of falls are based on her self-report and are not supported in the medical records. The respondent argues that even if the falls did take place, they do not warrant or support the funding of extensive amounts of renovations to the applicant’s home.
58In reply, the applicant submits that there is no authority to support the respondent’s proposition that CNRs of the applicant’s family physician are required to determine if the treatment plan is reasonable and necessary. With respect to the surveillance reports, the applicant submits that the surveillance reports date back to September 4, 2016, nearly seven years prior to submission of the treatment plan and therefore lack probative value. She submits that her difficulties ascending and descending interior staircases has been directly observed and documented in Ms. Prestwood’s reports.
59In my view, it is not the Tribunal’s role to sort through the applicant’s medical evidence, or to search for support for the applicant’s position in the reports provided: see Dooman v. TD Insurance Co. 2025 ONSC 184 at para. 50. I find that the applicant has not identified in her submissions the specific home modifications she is seeking except to state that she is claiming entitlement to the home modifications listed in the treatment plan in dispute. I further find that while the applicant attached the reports of Ms. Prestwood to her submissions, she did not direct the Tribunal to the specific recommendation or the justification for the modifications within Ms. Prestwood’s reports. It is the applicant’s onus to prove entitlement, and the Tribunal cannot make a case for the applicant by connecting the dots between Ms. Prestwood’s recommendations and the medical evidence of disability to show those modifications will reduce or eliminate the effects of the applicant’s disability. In addition, I find that the applicant did not submit any medical evidence to support her ongoing disability, functional impairments or the need for the housing modifications, other than the reports of Ms. Prestwood.
60I find that the applicant’s submissions are focused on establishing that the respondent’s IE reports are deficient, rather than pointing to evidence that addresses whether the recommended home modifications could reduce or eliminate her disability. I further find that the applicant’s submissions do not provide submissions on the individual recommendations and instead make broad statements as to the reasonableness and necessity of the entire treatment plan. I find that the applicant is required to address each proposed modification and to provide support for the reasonableness and necessity of each component of the recommendations.
61I find that as the applicant has not met the test for entitlement to the subject treatment plan, it is not necessary for me to address the deficiencies in the IE reports or the probative value of the surveillance provided.
62For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to the treatment plan for home modifications.
Interest
63Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that the applicant is not entitled to the treatment plan in dispute, no payment is overdue, and thus no interest is payable.
ORDER
64For the reasons outlined above, I find,
i. The applicant is not entitled to $4,802.50 for tutoring sessions for her daughter, in the treatment plan dated August 20, 2022;
ii. The applicant is entitled to attendant care benefits in the amount of $3,155.86 per month from March 23, 2024 and ongoing. However, she has not proven that additional attendant care services have been incurred for the time period in dispute pursuant to s. 3(7)(e) of the Schedule.
iii. The applicant is not entitled to attendant care benefits in the amount of $3,155.86 for the period from March 23, 2024 to date and ongoing;
iv. The applicant is not entitled to $133,758.24 for home modifications in the treatment plan, dated May 10, 2023;
v. The applicant is not entitled to interest; and
vi. The application is dismissed.
Released: November 28, 2025
Melanie Malach
Adjudicator