Lee v. Co-operators General Insurance Company, 2026 CanLII 12732

Lee v. Co-operators General Insurance Company, 2026 CanLII 12732

Citation: Lee v. Co-operators General Insurance Company, 2026 ONLAT 23-009843/AABS-R

RECONSIDERATION DECISION

Before:

Craig Mazerolle, Vice-Chair

Licence Appeal Tribunal File Number:

23-009843/AABS

Case Name:

Danielle Lee v. Co-operators General Insurance Company

Written Submissions by:

For the Applicant:

Laurie Tucker, Counsel

For the Respondent:

Jamie Pollack, Counsel Nicholas Wine, Counsel

OVERVIEW

1On November 26, 2025, the applicant requested reconsideration of the Tribunal’s decision released November 6, 2025 (“decision”).

2Stemming from an accident on August 19, 2021 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”), the parties participated in a written hearing. In the decision, the Tribunal found the applicant was not entitled to an attendant care benefit (“ACB”), a series of treatment plans, an award, or interest.

3The grounds for a request for reconsideration are found in Rule 18.2 of the Licence Appeal Tribunal Rules, 2023 (“Rules”). To grant a request for reconsideration, the Tribunal must be satisfied that one or more of the following criteria are met:

a) The Tribunal acted outside its jurisdiction or committed a material breach of procedural fairness;

b) The Tribunal made an error of law or fact such that the Tribunal would likely have reached a different result had the error not been made; or

c) There is evidence that was not before the Tribunal when rendering its decision, could not have been obtained previously by the party now seeking to introduce it, and would likely have affected the result.

4The applicant relies on all three criteria under Rule 18.2 to support her request. She is asking the Tribunal to vary the decision to find she is entitled to all the disputed benefits. In the alternative, she is seeking a new hearing.

5The respondent asks the Tribunal to dismiss the request for reconsideration.

RESULT

6The applicant’s request for reconsideration is granted, in part. Specifically, the applicant has shown that the Tribunal erred in its denial of the ACB and the treatment plans proposing meal delivery plans. The applicant has not established any grounds for reconsideration based on the denial of the visual skills assessment treatment plan.

7Pursuant to Rule 18.4, I am varying the decision to find the applicant is entitled to an ACB in accordance with my order below. The denial of the two treatment plans for meal delivery plans are confirmed.

ANALYSIS

8The test for reconsideration under Rule 18.2 involves a high threshold, and the requesting party must show how or why the decision falls into one of the categories in Rule 18.2. The reconsideration process is not an opportunity for a party to re-litigate its position where it disagrees with the Tribunal’s decision, or with the weight assigned to the evidence.

9I find the applicant has established grounds for reconsideration, pursuant to Rule 18.2(b), in relation to the ACB and the treatment plans for meal delivery plans. She has not established grounds for reconsideration concerning the denial of the visual skills assessment treatment plan. I will address all the applicant’s grounds for reconsideration in turn.

Rule 18.2(a) – Material Breach of Procedural Fairness

10I do not find the applicant has established a material breach of procedural fairness, pursuant to Rule 18.2(a).

11To support this ground, the applicant mainly claims that the Tribunal breached her right to procedural fairness by not issuing the decision “in a timely manner”. Citing Rule 3.1 and s. 2 of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22, the applicant claims that, by issuing the decision over a year after the written hearing date had passed, the Tribunal breached its “obligation to ensure efficient, proportional and timely resolution”. The applicant also raises the 5-year limit for funding of non-catastrophic impairment claims to highlight the importance of a timely decision in her case. Finally, in reply, the applicant adds that she first filed her application with the Tribunal on August 21, 2023—over a year before the written hearing date.

12The written hearing took place on November 1, 2024, with the parties’ submissions filed in September and October 2024. Once again, the decision was issued on November 6, 2025, meaning there was just over a year between the conclusion of the hearing and the release of the decision. Though the applicant may take issue with this timeline, she has not provided a compelling explanation for how this wait constitutes a material breach of procedural fairness.

13The applicant also alleges that the Tribunal’s assessment of the treatment plans for meal delivery and ACB amounts to a material breach of procedural fairness. For instance, she challenges the Tribunal’s preference for the respondent’s Form 1 and assessment report from Saoussen Ataya, OT (dated November 15, 2022). These arguments were mainly raised by the applicant as alleged errors, so I will address them below.

Rule 18.2(b) – Error of Fact or Law

14As it relates to the ACB and treatment plans for meal delivery plans, I find the applicant has established an error of fact or law that triggers Rule 18.2(b). I further find the applicant has not established an error based on the denial of the visual skills assessment.

Attendant Care Benefit

15First, the applicant claims the Tribunal erred in its handling of the ACB claim. Specifically, the applicant submits it improperly focused on her physical ability to feed herself, while downplaying “the impact of [her] physical, cognitive and psychological symptoms on her ability… to shop for and prepare nutritious meals.” According to the applicant, this “excessively narrow approach” to the ACB meant the Tribunal misapprehended the evidence, e.g., the improper preference of Ms. Ataya’s report. The applicant cites several cases from the Tribunal involving meal preparation and feeding to support this submission, such as, A.A. v. Unifund Assurance Company, 2020 CanLII 37859 (ON LAT) and 17-004828 v. Aviva Insurance Canada, 2018 CanLII 81908 (ON LAT).

16The respondent disputes this part of the request by claiming that she is attempting to improperly use the reconsideration process to re-weigh evidence considered at first instance. Specifically, the respondent argues that the Tribunal fairly assessed the relative merits of the parties’ expert reports, and it provided a clear indication for why its report from Ms. Ataya was preferred.

17Though I accept the respondent’s argument that reconsideration is not a venue for parties to re-litigate evidence considered at first instance, I find the applicant has shown the Tribunal erred by primarily focusing on her physical capacities to assess ACB entitlement. This focus stands in stark contrast to how the applicant framed her arguments on this issue, namely, with a strong emphasis on her cognitive and psychological limitations.

18From paragraphs 5 – 14 of the decision, the Tribunal considered and dismissed the applicant’s ACB request, i.e., the recommendation from the Form 1 (dated October 30, 2022) for seven hours per week to assist with preparing meals and feeding. The Tribunal considered the reports from the applicant’s OT, Sara Ubbens (dated October 28, 2022), and Ms. Ataya. It found Ms. Ataya’s rejection of any attendant care assistance was more in line with the applicant’s observed physical capacities. This analysis is found at paragraphs 11 – 13 of the decision:

Ms. Ataya writes that the applicant was observed to simulate eating with no observed difficulties. She further writes that the applicant is opting for more simple meals like rice, beans, tuna, oatmeal or instant food. Specifically, noting the following:

i. The applicant was observed to simulate eating with her right hand with no observed difficulties;

ii. The applicant demonstrated sufficient static and dynamic sitting tolerance and upper extremity range of motion to independently and safely feed herself;

iii. The applicant was observed to have adequate static and dynamic standing tolerance and adequate range of motion to reach above head and below knees cabinets/drawers; and

iv. The applicant demonstrated the ability to lift and carry light kitchenware with no issues observed.

Ms. Ubbens, in her assessment did not make mention of the applicant’s physical ability to feed herself. There is no mention that Ms. Ubbens observed the applicant preparing or eating a meal. There is also no mention of Ms. Ubbens observing the applicant simulating the motions that are required to prepare a meal.

As it does not appear that Ms. Ubbens observed the applicant preparing a meal or simulating the preparation of a meal, I give the report of Ms. Ataya increased weight over that of Ms. Ubbens.

19In contrast to the Tribunal’s focus on her ability to physically perform the actions of feeding and meal preparation, the applicant’s written submissions focused much more on her motivation levels and cognition. For example, at paragraph 44 of her initial submissions, the applicant quoted Ms. Ubbens’ report (emphasis added):

[The applicant] continues to have significantly reduced engagement in meal planning and meal preparation due to physical, cognitive, and psychosocial difficulties. Barriers to participation include: low energy, pain, low motivation, overwhelm, cognitive difficulties associated with planning and following instructions, anxiety, low mood, disrupted sleep-wake cycle, and disrupted appetite, [sic] During OT treatment, I have observed that [the applicant] will skip meals when not provided with assistance for meal preparation due to these barriers. At this time, [the applicant] has not yet been able to increase engagement in meal preparation, so ongoing assistance at 60 minutes per day is recommended. Continued support in this area is important to help with maintaining [the applicant’s] nutrient intake to support recovery and health and to allow her to focus energy on other areas of daily activity and therapies. [The applicant] is currently independent with mobility.

20This quotation largely speaks to the applicant’s cognitive and psychological condition. The applicant also chose to include the finding that she was “independent with mobility”, a sign that physical limitations played a minor role in her ACB arguments.

21While the Tribunal is entitled to assign different weight to expert reports, I find the applicant’s reconsideration request is not simply an attempt to re-weigh her evidence. Rather, I am satisfied that the applicant has shown how the Tribunal did not demonstrate an accurate understanding of the applicant’s claim, as its reasons focused almost exclusively on a minor aspect of her ACB argument. At the very least, while it was entitled to find that the physical capabilities demonstrated during Ms. Ataya’s testing was a compelling reason to prefer her opinion over the other, the Tribunal erred by not explaining why the applicant’s focus on non-physical limitations was not afforded more weight in the analysis. This lack of a comprehensive explanation left the parties uncertain as to why this key part of the applicant’s argument was dismissed.

22I am then further satisfied that, had this error not occurred, the outcome of the ACB claim would likely have been different. Once again, the Tribunal’s reliance on the applicant’s physical condition to deny the claim suggests that there was a fundamental misunderstanding of this aspect of her ACB submissions.

23Next, the applicant challenges the Tribunal’s denial of the treatment plans for a meal delivery plans, i.e., the treatment plan for a meal preparation services in the amount of $2,520.79 (dated July 11, 2023), and the denied request for a meal delivery plan from a partially approved treatment plan in the amount of $3,437.11 ($5,019.11 less $1,582.00 approved; dated October 12, 2023). Specifically, the applicant disputes the Tribunal’s determination that the “cost of food is not identified as a benefit which the insurer is liable to pay.” The applicant submits that this interpretation runs afoul of the rehabilitative nature of the Schedule, especially as it allows for “other goods and services” to be paid for under s. 15(1)(h) and s. 16(2)(l).

24The respondent disputes this claim by submitting that the applicant did not produce any legal authority to support this position during the hearing.

25I accept that the applicant has established that the Tribunal erred in its assessment of these plans, and that this error meets the standard of Rule 18.2(b). Though the Tribunal is entitled to weigh evidence as it sees fit, I find the applicant is not asking it to re-assess arguments or evidence dismissed at first instance. Rather, the applicant has shown that the Tribunal unduly limited the scope of its discretion by not, at least, considering the possible application of s. 15(1)(h) and s. 16(2)(l) to these plans.

26Section 15(1)(h) states that an insurer shall pay for all reasonable and necessary expenses related to: “other goods and services of a medical nature that the insurer agrees are essential for the treatment of the insured person, and for which a benefit is not otherwise provided in this Regulation”.

27Similar language is used in s. 16(2)(l), as an insurer shall pay for all reasonable and necessary expenses related to: “other goods and services that the insurer agrees are essential for the rehabilitation of the insured person, and for which a benefit is not otherwise provided in this Regulation”. This provision lists two explicit exclusions, i.e., no payments are owing for services provided by a case manager or for housekeeping and caregiver services.

28The Tribunal reviewed these treatment plans at paragraphs 16 – 41 of the decision. Since both plans were denied for similar reasons, I will focus on the reasons provided at paragraphs 21 – 26, wherein the Tribunal found the “cost of food” is not a benefit under s. 15 or s. 16 of the Schedule (emphasis added):

Sections 15 and 16 of the Schedule outlines the medical and rehabilitation benefits an insurer is liable to pay as a result of an accident.

The cost of food is not identified as a benefit which the insurer is liable to pay.

The applicant has not directed me to any authorities which support their submissions that food and supplements are benefits contained within the Schedule.

I also agree with the respondent’s position that the applicant would have to pay for food regardless of the accident.

Further, meal preparation is not included as medical or rehabilitation benefit per the schedule [sic]. Meal preparation services are specifically handled as an attendant care benefit on the Form 1. Level 1 care includes “provid[ing] assistance, either in whole or in part, in preparing, serving and feeding meals.”

As meal preparation is expressly identified as an attendant care benefit, I find that the applicant is not entitled to an OCF-18 for meal preparation services.

29I find the Tribunal’s statutory analysis does not account for the broad, discretionary language included in s. 15(1)(h) and s. 16(2)(l). Each subsection includes a specific allowance to fund proposals “for which a benefit is not otherwise provided in this Regulation”. By limiting the analysis to only those benefits that are explicitly identified in the Schedule, the Tribunal unduly limited the scope of this remedial legislation.

30I recognize the respondent’s submission that the applicant did not provide legal authorities to support this interpretation of the Schedule. Yet, I find the Tribunal erred in its lack of explicit engagement with these provisions as potential means for funding the plans. Put another way, while it was open to the Tribunal to conclude that the wording of s. 15(1)(h) and s. 16(2)(l) does not include funding for meals, it was necessary to at least engage with this discretionary part of the Schedule to see if the applicant’s request could fit in this wording.

31Then, as the Tribunal did not explicitly turn its mind to these possible avenues for funding (a key part of its reasons for denying these plans), I am satisfied that this error would likely have impacted the outcome of the decision.

Visual Skills Assessment

32Finally, the applicant challenges the Tribunal’s denial of the visual skills assessment in two ways. To start, the applicant claims the Tribunal narrowly interpreted the allowable purpose of assessments to be assessing whether a condition exists. According to the applicant, this interpretation ignores s. 38(3)(c) of the Schedule that “sets out the main purpose of the assessment as being ‘reasonable and necessary for the insured person’s treatment or rehabilitation’”. Second, while the Tribunal says it declined to rule on whether she sustained a concussion, the applicant not only argues that this finding was made, but that the Tribunal erred in this finding.

33After assessing the medical records relied upon by the applicant from Dr. D. Nowodworski, physician, the Tribunal noted that this doctor found the applicant’s dizziness and vision issues could be addressed through physiotherapy and vision exercises. Therefore, with no recommendation for a further assessment by an optometrist, the Tribunal concluded at paragraph 53 that :“…the applicant has not proven an assessment by an optometrist is reasonable or necessary.”

34I do not find the applicant has shown how the Tribunal erred in such a way as to trigger Rule 18.2(b).

35First, the Tribunal did note at paragraph 43 that “the purpose of an assessment is to determine whether a condition exists”. I accept the applicant’s position that this interpretation is a narrow understanding of the possible uses for an assessment. Specifically, I recognize that an assessment may play different roles in assisting with an insured person’s recovery of accident-related impairments, e.g., a practitioner may want to lay out a course of treatment for a known condition.

36However, I do not find the applicant has shown how this interpretation would likely have impacted the outcome of the decision. As the Tribunal noted at paragraph 44, it understood that the treatment plan listed several goals, including: pain reduction, “an assessment and diagnosis of visual symptoms”, etc. Further, as the denial of the plan was based on the lack of a referral from Dr. Nowodworski to an optometrist, this focus on the “assessment and diagnosis of visual symptoms” appears to have been at play in the Tribunal’s analysis.

37In a similar vein, I do not find the applicant has shown how the Tribunal erred as it relates to its assessment of a potential concussion. Though she argues that the Tribunal found she had sustained a concussion (even though it claimed it would not make such a finding), I find the applicant has not shown how making this finding would constitute an error. As noted above, the Tribunal showed it understood the goals of the proposed assessment, and it used this understanding to conclude the evidence presented did not support entitlement. I see no error in this analytical framework.

Rule 18.2(c) – Evidence that was not before the Tribunal

38The applicant has not established grounds for reconsideration based on Rule 18.2(c).

39To trigger Rule 18.2(c), the requesting party must establish three elements:

1. There is “evidence that was not before the Tribunal when rendering its decision”;

2. This evidence “could not have been obtained previously by the party now seeking to introduce it”; and,

3. This evidence “would likely have affected the result”.

40On October 1, 2025, the applicant participated in an Examination Under Oath (“EUO”) with the respondent. The applicant is asking the Tribunal to consider the transcript of this examination as new evidence that would trigger Rule 18.2(c).

41Though I accept that the EUO transcript was not before the Tribunal when rendering the decision, I do not find the applicant has shown why it “could not have been obtained previously”. While the transcript itself may not have been in the applicant’s possession until after the respondent had scheduled the EUO, the information included in the EUO is, by its very nature, within the sole control of the applicant. The applicant was testifying about her own understanding of her functional capacities, so she possessed this information during the leadup to the written hearing and beyond. I see no reason why this information could not have been entered into the hearing record through another means, e.g., asking the Tribunal for permission to file an affidavit.

Rule 18.4 – Varying the Decision

42Since the applicant has established grounds for reconsideration for the ACB and two of the treatment plans, I must determine the appropriate remedy under Rule 18.4 to address these errors. Considering both issues have been extensively argued in the parties’ written hearing submissions, I find I can adequately assess the claims for this treatment plan and the ACB within the confines of this reconsideration decision. I see no prejudice facing the parties from this arrangement, especially as it will foster a timelier resolution of the dispute.

Attendant Care Services

43I find the applicant has shown, on a balance of probabilities, that she is entitled to an ACB in the amount of $448.49 per month from April 18, 2023 to date and ongoing. Payment is owing if she incurs this amount in accordance with the Schedule.

44Section 19 of the Schedule states 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.

45Once again, the focus of the applicant’s ACB claim is the 420 minutes per week (or one hour per day) that was recommended on the Form 1 (submitted October 30, 2022) for meal preparation and feeding assistance. The primary piece of evidence the applicant has put forward in support of her claim is the October 28, 2022 report from Ms. Ubbens.

46In this report, the assessor noted that the applicant has “significantly reduced engagement in meal planning and meal preparation due to physical, cognitive, and psychosocial difficulties.” In particular, she found the applicant experiences a series of barriers that impact her engagement with meal preparation, including low energy, cognitive difficulties, low mood, etc. The assessor also reasoned that, by helping to maintain her nutrient intake, the applicant will be able to “focus energy on other areas of daily activity and therapies.”

47I find the observations and recommendations in this report are corroborated by other records cited by the applicant. For instance, the applicant highlights an earlier report from Ms. Ubbens (dated August 24, 2022), where the applicant’s cognition is directly linked to her ability to plan meals: “GOAL: [The applicant] will be able to implement 1-2 functional cognitive management strategies to improve satisfaction and performance with planning meals…”

48Similarly, during a treatment session on May 30, 2023, Ms. Ubbens noted that concerns about cognitive resources and meal preparation continued well after her Form 1 was prepared: “Client reported she has still been feeling extremely overwhelmed by food, repeating that it ‘takes all my energy just to feed myself’”. In addition to this self-reported limitation, Ms. Ubbens also observed a similar concern when she suggested a possible intervention: “Client was resistant to applying recommendations, like writing out meal plan and grocery list, due to ++overwhelm.”

49These records together form a picture of an individual who is struggling to muster the cognitive resources necessary to perform the daily task of meal preparation and feeding. This picture maps onto the recommendations Ms. Ubbens made on her Form 1, and the consistency of her observations show the necessary nature of these recommended services. Furthermore, considering the daily nature of these tasks, I am satisfied that one-hour per day of meal preparation and feeding assistance is a reasonable amount, especially as they will likely improve the efficacy of her other therapies.

50The respondent disputes this position by arguing that other medical evidence contradicts these alleged functional limits. I do not agree, and, in fact, I find these other records support the applicant’s position that her psychological and cognitive struggles impact her ability to consistently engage in meal preparation and feeding.

51The central piece of evidence presented by the respondent is the report from Ms. Ataya. During this assessment, Ms. Ataya observed the applicant performing the physical tasks necessary for meal preparation and feeding, e.g., the applicant was able to lift and carry kitchenware. The applicant also self-reported that she remained independent in a number of daily tasks.

52The respondent further highlighted treatment notes from Koru Nutrition, as the applicant reported during these sessions that she was able to prepare simple meals (such as oatmeal), and that she did not enjoy preparing meals due to the set up of her kitchen.

53Starting with Ms. Ataya’s report, I note this assessor primarily rejected Ms. Ubbens’ recommendations due to the applicant’s ability to perform the physical movements associated with meal preparation and feeding. While I accept the veracity of these observations, I find they do not address the key reasons why the applicant and Ms. Ubbens requested these services, i.e., psychological and cognitive limitations. By only addressing the physical nature of the tasks, I find Ms. Ataya’s analysis of the reasonable and necessary nature of these services is too narrow—a limited scope that challenges the reliability of her opinion.

54Ms. Ataya also noted in her report that the applicant self-reported less engagement in meal preparation after the accident “due to decreased appetite”. However, this comment was paired with the applicant’s further admission that she was only eating one meal per day. Regardless of the applicant’s own understanding of her reduced interest in meal preparation, the admission that she was only eating one meal per day further challenges Ms. Ataya’s conclusion that no meal preparation and feeding assistance is needed.

55Turning to the notes from Koru Nutrition, I do not find these records support the respondent’s position. Rather, they show the impact that cognitive impairments have on the applicant’s ability to maintain a consistent practice of preparing meals. For instance, in the initial intake form from September 11, 2023, the applicant indicated that energy levels are the “main issue for not eating”. Then, during a session on December 4, 2023, the applicant again noted how her energy levels impact her ability to eat: “Cant [sic] use my energy to eat before appointments or doing emails/thinking energy so eats afterwards. So stressed/takes lot of cognitive energy to think about.” Similarly, the applicant reported on February 6, 2024: “I don’t have an appetite going from crisis to crisis… starving”. Therefore, while I accept that there may be different reasons why she lacks the motivation to prepare meals (including her kitchen set up), these notes provide significant support to show that psychological and cognitive limitations are the major roadblock to these tasks.

56Taken together, I am satisfied that the applicant has demonstrated, on a balance of probabilities, that the attendant care services recommended on the Form 1 (submitted October 30, 2022) are reasonable and necessary, pursuant to s. 19 of the Schedule. Further, as the evidence suggests that the limitations underpinning this finding are likely to proceed into the future (namely, the consistent complaints found over time in the treatment notes from Ms. Ubbens and Koru Nutrition), I find the applicant has established that she is entitled to this ACB for the period at issue, i.e., April 18, 2023 to date and ongoing.

57I recognize that the applicant has not drawn the Tribunal’s attention to any evidence to show these services have been incurred. There is no payment owing at this time, but the applicant is entitled to payment for any attendant care services incurred in accordance with my order below.

58With no payment owing, there is no interest owing at this time.

59I also note that the applicant requested an award. However, there are no award arguments provided with her written hearing submissions, so I do not find she has met her onus to demonstrate entitlement to an award.

60Turning to the disputed treatment plans, I do not find the applicant has demonstrated that they are reasonable and necessary. As such, I am confirming the Tribunal’s earlier denials. In light of this conclusion, it is not necessary for me to determine whether these services fall under s. 15 or s. 16 of the Schedule.

61To receive payment for a treatment and assessment plan under s. 15 and s. 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.

62The fully denied treatment plan (dated July 11, 2023) proposes $2,053.80 for a meal preparation plan, along with a $200.00 form completion fee. The author of the plan hopes these meals will help “fuel [the applicant’s] body with the nutrients and calories required to remain engaged in other rehabilitation treatments”.

63The partially approved treatment plan (dated October 12, 2023) is seeking a total of $5,019.11 for nutritional counselling and meal/supplement delivery services. The respondent approved the counselling (as well as related planning services), but it denied the requests for: a meal delivery service, bloodwork, supplement delivery, documentation, and prescription support (together totalling $3,437.11). The goals of the plan include: providing nutritional support to boost energy, manage stress, reduce pain, improve sleep, etc.

64Support for these plans includes a progress report from Koru Nutrition (dated February 13, 2024). Prepared by Kylie James, certified nutrition practitioner, the report notes that a meal service will “ensure that [the applicant] is getting the necessary calories and nutrients to facilitate sleep and have the energy to participate in her rehab program and function in the day”. The report also cites “struggles with consistency due to being emotionally overwhelmed.” Support for the supplements and bloodwork are then linked to her nutritional deficiencies.

65The applicant also highlights a letter from Nicole Ritonja, registered psychotherapist (dated December 7, 2023). Ms. Ritonja opined that the “main barrier to recovery is [the applicant’s] difficulties sustaining a proper nutritional routine.”

66I again accept that there are psychological and cognitive barriers to the applicant’s ability to consistently prepare meals and feed herself—barriers that are explored at length in the evidence from Ms. James and Ms. Ritonja. However, I am not satisfied that the applicant has shown why these denied meal plans are necessary for her recovery. Specifically, the applicant has not provided a compelling explanation for why these plans are needed in addition to the approved attendant care services. These meal delivery plans (including the delivery of supplements and related services) appear to be a duplication of the assistance she will receive from her attendant care provider. As such, I am not satisfied that she has demonstrated that the denied aspects of these treatment plans are necessary on a balance of probabilities.

67Further, the records reviewed above for the ACB show that a major component of the applicant’s functional limitations is her lack of motivation to prepare meals and feed herself. The treatment notes from Ms. Ubbens and Koru Nutrition both speak to these motivation issues. I am, therefore, not clear on how meal delivery services will help to address her motivational issues with feeding. On the other hand, I can infer that the presence of an attendant care provider in the home will be an active encouragement for this act. Again, I find there is no compelling explanation for why the denied aspects of these plans are necessary when she will have access to the ACB.

68Taken together, I am not satisfied that the applicant has demonstrated the reasonable and necessary nature of the treatment plans for meal delivery plans. I am confirming the Tribunal’s earlier denial of these plans.

CONCLUSION & ORDER

69The applicant’s request for reconsideration is granted, in part.

70Pursuant to Rule 18.4, the decision is varied at paragraphs 69 and 70. These two paragraphs shall now read:

For the reasons above, I find the applicant is entitled to payment of an attendant care benefit, in the amount of $448.49 per month from April 18, 2023 to date and ongoing, if these services are incurred in accordance with the Schedule.

I find the applicant is not entitled to:

i. The disputed medical and rehabilitative benefits;

ii. Interest; or

iii. An award under s. 10 of Reg 664.

Craig Mazerolle

Vice-Chair