Licence Appeal Tribunal File Number: 23-015000/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:
Tiffany Ly
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR: Brian Norris
APPEARANCES:
For the Applicant: Anil Hampole, Counsel
For the Respondent: Christopher Lupis, Counsel
HEARD: By way of written submissions
OVERVIEW
1Tiffany Li (“the Applicant”) was involved in an automobile accident on August 12, 2022, and sought benefits from Aviva Insurance Company of Canada (“the Respondent”) 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 and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues to be decided in the hearing are:
- Is the Applicant entitled to a medical benefit in the amount of $4,217.00 for chiropractic treatment, proposed by UHeal Rehab Centre in a treatment plan/OCF-18 (“plan”) dated December 29, 2022?
- Is the Applicant entitled to a medical benefit in the amount of $3,701.88, less $2,654.68 approved by the Respondent, for psychological services, proposed by Somatic Assessments and Treatment Clinic in a plan dated May 23, 2023?
- Is the Respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the Applicant?
- Is the Applicant entitled to interest on any overdue payment of benefits?
RESULT
3The Applicant is not entitled to the benefits claimed.
4No interest or award is payable.
BACKGROUND
5The Applicant was the driver of a vehicle that was struck on the driver’s side by another vehicle while she was making a left turn in an urban intersection. She was taken from the scene of the accident to the hospital by ambulance due to complaints of left-sided neck pain. At the hospital she was examined, given pain medication, and discharged with instructions to follow up with her family physician.
6The Applicant had a telephone call with her family physician, Dr. H. Thai, about a week later, and noted that her whiplash symptoms were improving, but she felt anxious about driving in a vehicle. Dr. Thai discussed the typical timeline for recovery of whiplash injuries, advised the Applicant to use heat and non-steroidal anti-inflammatory medication, recommended that the Applicant should wait for her symptoms to resolve prior to engaging in sports, and discussed counselling options for her psychological complaints.
7The Applicant initially engaged in treatment pursuant to the Minor Injury Guideline (“the MIG”). However, she developed psychological injuries as a result of the accident and was no longer subject to the MIG.
8At issue is the Applicant’s entitlement to a chiropractic treatment plan, as well as her entitlement to the unapproved balance of the psychological treatment plan.
ANALYSIS
Chiropractic treatment plan, dated December 29, 2022
9Amongst other fees, this plan proposes chiropractic treatment, exercise sessions, and acupuncture.
10The Applicant submits that this is reasonable and necessary as a result of the accident based on the assessment of Dr. R. Tavares, chiropractor, completed for the plan. She submits that Dr. Tavares identified thoracic, lumbar, and shoulder impairments, the presence of radicular, neurological, and psychological symptomology, and her decrease in functional capacity results in difficulty performing her work and housekeeping duties. In the plan, it notes that the Applicant presents with difficulty with sustained postures, standing, sitting, lifting, pushing/pulling, bending, and overhead reaching.
11The Respondent submits that the Applicant has not met her burden to demonstrate that the plan is reasonable and necessary. It submits that it previously approved $3,500.00 in chiropractic treatment and none of her evidence indicates that the treatment was effective, or whether she requires further treatment as a result of the accident. The Respondent suggests that the Applicant’s ongoing treatment needs are related to an ankle injury sustained while playing sports.
12I find that the Applicant has not provided evidence to support a finding that ongoing chiropractic treatment is reasonable and necessary as a result of the accident. The CNRs from the Applicant’s family health team do not include any referrals for chiropractic or similar treatment. The CNRs show that the Applicant had no contact with her family health team from that initial visit until June 19, 2023, nearly a year after the accident. During that visit in June 2023, the Applicant met with Dr. N. Chattergoon, physician, and complained of a twisted ankle while wearing heels that has prevented her from participating in sports. She was diagnosed with an ankle sprain and referred for x-rays and an ultrasound. A clinical note from a week after, again by Dr. Chattergoon, includes a referral for physiotherapy to address the Applicant’s ankle sprain. There is no reference to the accident, or any neck injury in the family health team CNRs after the initial visit in August 2022.
13I give no weight to the information provided in the treatment plan by Dr. Tavares. It is trite law that treatment plans, and the information in them, alone are insufficient to find the proposed treatment to be reasonable and necessary. This remains the case with this treatment plan. Dr. Tavares’ CNRs are not before me, leaving no information on when or how Dr. Tavares arrived at the conclusion outlined in the plan.
14Accordingly, I find that the Applicant has not met her onus to demonstrate that this plan is reasonable and necessary as a result of the accident.
The Applicant is not entitled to the unapproved balance of the psychological treatment plan
15This dispute relates to the hourly rate of the service provider. The Applicant sought funding for services from a registered psychotherapist – a profession that is not included in the Professional Services Guideline – Superintendent’s Guideline no.03/14 (“the PSG”). The Respondent approved the services, but at the hourly rate of $99.75 instead of the hourly rate of $149.61, as proposed in the plan.
16The Applicant submits that the PSG does not state that a registered psychotherapist must be paid less than a psychologist, and that the supervision her psychotherapist received from Dr. B. Cook, psychologist, ensures effective service and justifies the higher rate. She submits that J.V. v. Intact Insurance Company, 2019 CanLII 76995 (ON LAT) (“JV v Intact”) concluded that a psychotherapist conducting psychotherapy services that are within their expertise shall not be disentitled to be paid the same rate as a psychologist.
17The Respondent submits that the Applicant had not met her burden to demonstrate that the higher hourly rate is reasonable and necessary. It notes that Clarke v. Aviva Insurance Company of Canada, 2024 CanLII 121087 (ON LAT) distinguished JV v Intact, noting that the psychotherapist must have special training and experience akin to a psychologist in order to be entitled to the enhanced hourly rate. It submits that in this case, the Applicant has not provided information on her service provider’s education, experience, or qualifications to warrant an enhanced rate.
18I agree with the Respondent find that the Applicant has not demonstrated that she is entitled to the enhanced hourly rate for a psychologist. The Applicant has not provided any information as to the training or experience of the service provider, nor has she provided any information on the services provided by the psychotherapist that would permit me to find that they are providing services akin to the services of a psychologist as was the case in JV v. Intact. Moreso, there is no information in the plan to suggest that the service provider works with or is under the supervision of Dr. Cook. Thus, I find that the Applicant has not demonstrated that she is entitled to an enhanced hourly rate as sought.
19Accordingly, I find that the Applicant had not met her onus to demonstrate that this plan is reasonable and necessary as a result of the accident.
Interest
20Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. Having found no benefits payable or overdue, it follows that no interest is payable.
ORDER
21The Applicant has not met her onus to demonstrate that the benefits claimed are reasonable and necessary as a result of the accident.
22No interest is payable.
23The application is dismissed.
Released: August 18, 2025
Brian Norris
Adjudicator