Etehadolhagh v. Co-operators General Insurance Company, 2025 CanLII 519

Citation: Etehadolhagh v. Co-operators General Insurance Company, 2025 ONLAT 22-007266/AABS

Licence Appeal Tribunal File Number: 22-007266/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:

Foad Etehadolhagh

Applicant

and

Co-operators General Insurance Company

Respondent

DECISION

ADJUDICATOR: Kieffer Norton

APPEARANCES:

For the Applicant: Nick de Koning, Counsel

For the Respondent: Amanda Lennox, Counsel

HEARD: In Writing

OVERVIEW

1Foad Etehadolhagh, the applicant, was involved in an automobile accident on May 5, 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, Co-Operators, 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 $1,389.76 for a meal kit from Hello Fresh, proposed by Kristen Wood in a treatment plan/OCF-18 (“plan”) submitted April 22, 2022?

ii. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

iii. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3I find that the applicant has not met their onus to demonstrate that the OCF-18 from Hello Fresh are a reasonable and necessary accident-related expense. I find that the respondent is not liable to pay an award under s. 10 of O. Reg. 664, and I find the applicant is not entitled to interest on any overdue payments.

ANALYSIS

Hello Fresh Meal plans

4Section 16 of the Schedule states that rehabilitation benefits shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person in undertaking activities and measures described in subsection (3) that are reasonable and necessary for the purpose of reducing or eliminating the effects of any disability resulting from an accident-related impairment.

5The applicant submits that the denied treatment plan for meal kit delivery services is payable as a rehabilitation benefit pursuant to s. 16 of the Schedule. The applicant submits that the meal kit delivery services would assist in their recovery. In an OCF-18 submitted by Kristen Wood, the applicant’s occupational therapist, she states that she and the applicant set a goal of gradually returning to meal preparation activities to improve his tolerances for standing and walking, as well as to reduce the demands on his wife.

6The applicant submits that meal plans from Hello Fresh are reasonable and necessary. In a letter dated April 18, 2022, from Ms. Wood, the applicant’s occupational therapist, Ms. Wood states that the meal plan would provide the applicant with ingredients necessary to participate in meal preparation that would help the applicant with their cognitive recovery. I find it reasonable that the meal kits might provide the applicant with an exercise to assist with their cognitive recovery, however, I do not have any evidence before me as to the necessity of why these meal kits would be necessary for the applicant’s cognitive recovery.

7The applicant submits that the meal kits would be more cost effective than having a support worker complete the shopping and creating of recipes. However, the applicant has not provided any information with regards to how many meals would be provided. Without a comprehensive breakdown of what the meal kits entail it is difficult to make any findings on cost effectiveness that would speak to their reasonableness.

8Furthermore, I find that applicant’s attempt to frame the meal plans under s.16(3) as a life skill or social rehabilitation does not succeed. The meal plans are not necessary for the applicant to secure ingredients and prepare meals where the attendant care benefit the applicant is already receiving provides for these shortcomings.

9Without greater detail as to the duration of the meal kit plan or how many meals are to be included it is difficult to ascertain if there is a reasonable or necessary cognitive benefit that could be derived from such an activity. Furthermore, the applicant has not provided any authority to justify why meal kits would be considered reasonable and necessary.

10I find the submissions of the respondent to be compelling because the applicant already has access to meal preparation services, meaning this proposal is likely duplicative. I further agree with the respondent and find that the food charges are not a medical or rehabilitative expense. Food is an everyday expense which the applicant would be required to incur, regardless of whether they were involved in an accident.

11I also agree with the submission of the respondent that the applicant has not led any evidence that they are hindered by the current attendant care that provides assistance with meal preparation. If the applicant is already receiving assistance with their meal preparation, then I find the meal kits at the cost proposed are unreasonable and unnecessary.

12I find that while these meal plans may be reasonable in providing the applicant with a task that would improve their cognitive function, they cannot be considered necessary because the applicant is already receiving an attendant care benefit which includes assistance with meal preparation. As such I find that meal plan constitutes an unnecessary treatment, which the insurer is not liable to pay for.

Interest

13Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.

14The benefit is not payable, therefore the applicant is not entitled to interest.

Award

15The 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.

16The application is dismissed; therefore the applicant is not entitled to an award

ORDER

17For the reasons above:

i. The OCF-18s in dispute are not payable; and

ii. The applicant is not entitled to interest.

iii. The applicant is not entitled to an award