Citation: Parsons v. Wawanesa Mutual Insurance Company, 2025 ONLAT 24-008439/AABS

Licence Appeal Tribunal File Number: 24-008439/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:

Stephen Parsons

Applicant

and

Wawanesa Mutual Insurance Company

Respondent

DECISION

PANEL:

Caley Howard

Gordon Stencell

APPEARANCES:

For the Applicant:

Stephen Parsons, Self-Represented

For the Respondent:

Morgan MacDonald, Counsel

OBSERVER:

Jennifer Finlayson, Case Worker

Heard by Videoconference:

May 13, 2025

OVERVIEW

1Stephen Parsons, the applicant, was involved in an automobile accident on July 26, 2009, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Accidents on or after November 1, 1996 (the “Schedule”). The applicant was denied benefits by the respondent, Wawanesa Mutual Insurance Company, 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 $90.30 for prescription expenses, submitted on a claim form (OCF-6) dated January 23, 2023?

ii. Is the applicant entitled to $366.38 ($2,068.26 less $1,701.99 approved) for advanced service dog training, proposed by Jennifer Finlayson in a treatment plan/OCF-18 (“plan”) dated January 23, 2023?

iii. Is the applicant entitled to $600.00 ($4,289.20 less $3,689.20 approved) for assistive devices, proposed by Jennifer Finlayson in a plan dated July 6, 2023?

iv. The applicant is partially entitled to $4,099.05 ($5,289.25 less $1,199.20 approved) for air brush supplies, a service dog licence, an iPhone, a case, and Apple Care proposed by Jennifer Finlayson in a plan dated December 11, 2023, and denied December 20, 2023.

v. Is the applicant entitled to $1,005.18 ($20,710.30 less $19,705.12 approved) for sibling visitor expenses, submitted on a claim form (OCF-6) dated October 23, 2023?

vi. Is the applicant is entitled to $690.54 ($20,395.66 less $19,705.12 approved) for sibling visitor expenses, submitted on a claim form (OCF-6) dated July 9, 2023?

vii. Is the applicant entitled to $419.52 ($20,124.64 less $19,705.12 approved) for sibling visitor expenses, submitted on a claim form (OCF-6) dated January 21, 2024?

viii. Is the applicant entitled to $104.88 ($20,582.35 less $20,477.47 approved) for sibling visitor expenses, submitted on a claim form (OCF-6) dated May 2, 2024?

3At the start of the hearing, the parties made corrections to issues 6 and 8 from the Case Conference Report and Order dated June 10, 2024. These corrections are reflected at paragraph 2(vi) and (viii) above. We have also made corrections to issues (iii) and (iv) above to reflect the language of the OCF-18s.

RESULT

4We find as follows:

i. The applicant is not entitled to $90.30 for prescription expenses.

ii. The applicant is not entitled to $366.38 for advanced service dog training.

iii. The applicant is not entitled to $600.00 for a home device/chair.

iv. The applicant is not entitled to $4,099.05 for air brush supplies, a dog licence, an iPhone, case, and AppleCare.

v. The applicant is entitled to $1,005.18, $690.54, $419.52 and $104.88 for sibling visitor expenses.

PRELIMINARY ISSUE

5The respondent objected to the applicant relying on documents that he had not served on the respondent pursuant to Licence Appeal Tribunal Rules, 2023 (“Rules”) Rule 9.4.3 as it would be procedurally unfair and inefficient given the respondent had no opportunity to plan a response to the evidence.

6The applicant did not comply with the Tribunal’s pre-hearing requirements under Rule 9.4.3.

7Rule 9.4.3 requires that no later than 21 days before an electronic or in-person hearing, each party must file with the Tribunal and serve on the other party:

i. a list of witnesses the party will call to give evidence at the hearing;

ii. a summary of the evidence each witness will give at the hearing, along with the anticipated amount of time needed for each witness to testify;

iii. a PDF copy of the evidence and authority brief; and

iv. a completed form for electronic and in-person hearings that is provided on the Tribunal’s website.

8The applicant did not comply with the requirements outlined above. The applicant did not intend to call any witnesses to testify other than himself. The applicant had some documents in his possession that he intended to rely on at the hearing.

9The applicant submitted he had submitted his documentary evidence to the Tribunal prior to the case conference and that he did not understand the rules because he is self-represented. However, the applicant was unable to identify or direct us to these documents. We gave the applicant some time to determine which documents he needed to rely on and send copies of those to the Tribunal and to the respondent so that we could decide whether to admit them. He did not provide the respondent or the Tribunal with any documents.

10While the respondent raised the possibility of adjourning the hearing, the applicant submitted he did not wish for the hearing to be adjourned. He agreed that he would rely on the respondent’s document brief when addressing issues in dispute and would not be referring to other documents.

ANALYSIS

Prescription expenses

11We find that the applicant has not demonstrated, on a balance of probabilities, that he is entitled to be reimbursed for the cost of prescription expenses. As such, the applicant is not entitled to $90.63 for an expense claim dated January 23, 2023.

12Section 38(2)(c) of the Schedule provides that an approved treatment plan is not needed to claim expenses for drugs prescribed by a regulated health professional that are reasonable and necessary as a result of the impairment sustained by the insured person.

13The applicant submits that the prescription in question is commonly prescribed to persons experiencing similar catastrophic impairments. However, he has not directed us to any medical evidence that the prescription is reasonable and necessary as a result of his accident-related impairments.

14Accordingly, we find that the applicant has not proven on a balance of probabilities that he is entitled to be reimbursed for the cost of the prescription expenses.

Advanced service dog training

15Although the CCRO lists the issue in dispute as entitlement to advanced service dog training, the Treatment Plan lists a “Fluent Pet, “They Can Talk Kit” We find that the applicant is not entitled to the treatment plan for pet care kit also referred to as advanced service dog training in the submissions.

16To 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.

17The treatment plan dated January 23, 2023, was submitted by Jennifer Finlayson, an occupational therapist and the applicant’s case manager, and sought funding of $366.38 for advanced service dog training. The goals of the treatment plan are to enable the applicant to live independently and safely and a return to the activities of normal living.

18The applicant testified that he has a service dog, which he had trained himself. It is his second service dog. The applicant explained the purpose of advanced service dog training is to enable the service dog to convey its needs to an owner by pushing on a system of buttons. This communication device has become available only in the past two or three years.

19We find that the applicant has not directed us to any evidence that the advanced dog training device was required to fulfill the medical benefit of having a service dog or that it would otherwise help the applicant meet the goals set out in the treatment plan. We find that the applicant has not proven, on a balance of probabilities, that the treatment plan for advanced dog training is reasonable and necessary.

A home device/chair

1The unapproved amount is $600.00 for an office chair. We find that the applicant is not entitled to the unapproved amount for the office chair.

20The respondent denied the amount as it was a duplication of a previously approved benefit that the applicant had not incurred. The respondent submits that it approved a treatment plan for an office chair purchase in the amount of $500.00 by letter dated April 3, 2023.

21The applicant submits that it took some time to find a chair that met his needs and by that time, July 2023, the price of chairs had gone up, exceeding the $500.00 that the respondent approved and warranting the filing of the new treatment plan.

22The respondent submits that it undertook a search of the price of chairs when considering approving or denying the expense on July 12, 2023, and it found several options available within the previously approved $500.00 amount.

23We find that the applicant has not directed us to evidence that the additional cost is necessary. Therefore, we find that the applicant has not proven, on a balance of probabilities that the treatment plan is reasonable and necessary.

Air brush supplies, a service dog licence, an iPhone, a case, and Apple Care

21We find that the applicant is not entitled to the following:

i. Air brush supplies, at a cost of $1,500; and,

ii. A Service Dog Licence, at a cost of $187.50; and,

iii. iPhone, case, and AppleCare, at a cost of $2,411.55.

Air brush supplies

24We find the applicant is not entitled to $1,500.00 for air brush supplies.

25The applicant submitted that his profession is Artist and that he is in pursuit of this new medium for his profession. The applicant reported that the respondent has funded art supplies in the past and should continue to do so.

26The respondent submitted that it has approved $1,500.00 for art supplies that has not yet been incurred, making the request duplicative. The respondent relies on the plan dated July 6, 2023, that claimed $500.00 for art supplies and the plan dated December 17, 2021, that claimed $1000,00 for art supplies, and the explanation. The respondent submits that it approved both of these amounts and they have not yet been incurred.

27The applicant did not direct us to any evidence that the $1,500.00 that has been approved for art supplies was already incurred. We find that this treatment plan is duplicative with the previously approved plans.

28Therefore, we find that the applicant has not proven on a balance of probabilities that he is entitled to the air brush expense of $1,500.00 claimed.

Service Dog Licence

28We find the applicant is not entitled to the total cost of a Service Dog Licence in the amount of $187.50.

29The applicant submitted a service dog is an important part of his treatment and care. The applicant submits that because of the accident and catastrophic impairment, he is nervous and anxious and that the service dog is trained to be responsive and protective while in the community. The applicant submitted that the Licence is a regulatory requirement implemented by the Province of Nova Scotia, approximately three years ago. The applicant relies on a copy of his service dog licence.

30The respondent submits that the applicant has provided no medical evidence that he requires a service dog as a result of the accident. The accident was in 2009 and the respondent submits that it is not reasonable to assume that every need of the applicant is related to the accident. The respondent further submits that a service dog licence is not listed in the Schedule.

31The applicant replied that the service dog as a treatment has never been in dispute. Should a person not be so licenced, their service dog can not travel on buses or access many public spaces such as medical appointments and restaurants.

32The applicant did not provide medical evidence corresponding to the period the treatment plan was received that a service dog is needed related to the accident and therefore did not satisfy the balance of probabilities that a support dog license is a reasonable and necessary expense.

33Therefore, we find the applicant is not entitled to the treatment plan for the service dog licence.

iPhone, a case, and AppleCare

29We find that the applicant has not proven on a balance of probabilities that he is entitled to the iPhone, a case, and AppleCare expenses in the amount of $2,411.55.

30The applicant submits that his current iPhone, which was funded by the respondent, is four or five years old and has been acting up in various ways. He submits that he needs a replacement because the timer doesn’t work and because his eyesight has deteriorated and he needs a phone with a bigger screen.

31The respondent submits that it funded the applicant’s current iPhone in July 2021. At the time the treatment plan was submitted, the phone was 2.5 years old. The respondent submits that without evidence that the phone was not fit for its intended purpose, a replacement was not warranted at the time. The respondent further submits that it funded a battery replacement for the existing phone in July 2024, suggesting that the existing phone was still in use.

32The applicant did not direct us to any evidence setting out the particular problems he had with his existing phone at the time the treatment plan was submitted that rendered it unfit for use as a communication device. Neither did the applicant direct us to any medical evidence that his eyesight had deteriorated as a result of the accident.

33Therefore, we find that the applicant has not proven, on a balance of probabilities, that a replacement phone was reasonable and necessary.

34A case and AppleCare package for protecting the new proposed iPhone are not necessary given above, that a replacement phone is not reasonable and necessary.

Visitor expenses

34We find that the applicant is entitled to visitor expenses of $1,005.18 in a claim dated October 23, 2023; $690.54 in a claim dated July 9, 2023; $419.52 in a claim dated January 21, 2024; and $104.88 in a claim dated May 2, 2024

35The applicant sustained a catastrophic injury in the accident. The applicant submits that sibling visits are reasonable and necessary to prevent his physical and emotional isolation from his family. The applicant also submits that the Schedule requires the insured person to complete OCF-6 expense claims for visitors and that this process was set up with his lawyer in 2015 and satisfied the respondent until recently.

36The respondent submits it had previously directed that a visitor must complete an OCF-6 expense claim. The respondent also submits that the visitor expenses are not reasonable and necessary given that applicant was receiving attendant care benefits and housekeeping benefits at the time of the visits.

37The applicant completed various OCF-6 expense claim forms on behalf of his visitors and attached summaries setting out the number of visits made by each sibling and the distance travelled to visit him. These summaries were signed by the relevant sibling and included each sibling’s address.

38We relied on Section 22 of Statutory Accident Benefits Schedule, O. Reg. 34/10 in making our decision. According to O. Reg. 34/10, s. 22 (2), an applicant deemed catastrophically impaired is entitled to claim visitor expenses beyond 104 weeks post accident.

39We find that the respondent did not explain its concern with the process used by the applicant for claiming visitor expenses. The respondent made no submissions about an authority within the Schedule that OCF-6 forms must be completed by a visitor. We find that the documents attached to the OCF-6 expense claim forms contain all the relevant information needed to determine if the expenses are reasonable and necessary, including the signatures of the visitors confirming the information provided.

40There is no dispute that the applicant suffered a catastrophic impairment and continues to undergo treatment. We find that the applicant’s siblings live between 15 and 150 km away from the applicant and visit him approximately once per month or once per week. They are claiming $0.38 per KM. We find these expenses are reasonable and necessary in the circumstances because the siblings not only help the applicant when they visit, but they prevent him from becoming isolated because of his impairments.

41We find that the applicant has proven on a balance of probabilities that he is entitled to the visitor expenses claimed on the OCF-6 expense claim forms.

ORDER

42We find:

i. The applicant is not entitled to $90.30 for prescription expenses, submitted on anOCF-6 dated January 23, 2023.

ii. The applicant is not entitled to $366.38 for advanced service dog training.

iii. The applicant is not entitled to $600.00 for a home device/chair.

iv. The applicant is not entitled to $4,099.05 for air brush supplies, a service dog licence, an iPhone, a case, and AppleCare.

v. The applicant is entitled to $1,005.18 for sibling visitor expenses.

vi. The applicant is entitled to $690.54 for sibling visitor expenses.

vii. The applicant is entitled to $419.52 for sibling visitor expenses.

viii. The applicant is entitled to $104.88 for sibling visitor expenses.