Licence Appeal Tribunal File Number: 24-011545/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:
Guoning Dai
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
John Mazzilli
APPEARANCES:
For the Applicant:
Ryan Olson, Counsel
For the Respondent:
Justin H. Chan, Counsel
HEARD:
By way of written submission
OVERVIEW
1Guoning Dai, (“the applicant”), was involved in an automobile accident on September 19, 2023, 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 Aviva Insurance Company of Canada (“the respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2On June 5, 2025, by way of notice of motion the applicant withdrew his claim for an income replacement benefit and requested that the video conference hearing be converted to a written hearing. On June 5, 2025, on consent of the parties the Tribunal granted the applicant these requests. Accordingly, the issues in dispute as listed below are in accordance with the Motion Order dated June 5, 2025.
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $747.96 ($2,804.12 less $1,696.25 approved) for psychological services proposed by Somatic Assessments & Treatment Clinic dated March 11, 2024.
ii. Is the respondent liable to pay an award under s. 10 of 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
4The applicant is not entitled to $747.96. for psychological services.
5As no benefits are owing interest is not owing.
6The applicant is not entitled to an award.
7The application is dismissed.
ANALYSIS
Psychotherapist hourly rates
8I find on a balance of probabilities that the applicant is not entitled to an hourly rate of $149.61 for psychotherapy services because it is not reasonable and necessary. Accordingly, the applicant is not entitled to $747.96 for psychological services.
9To receive payment for a treatment and assessment plan under sections 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.
10The applicant submits that the hourly payable rate for psychotherapy services ought to be $149.61 rather than the respondent’s approved hourly rate of $99.75. The applicant submits that a psychotherapist who is conducting psychological and cognitive behavioral therapy services shall not be disentitled to be paid the same rate as a psychologist. He submits that as the psychotherapist is performing the same services as a psychologist the hourly payable rate ought to be the same. He submits that in this case, the psychotherapist was able to communicate with the applicant in his native language of Cantonese, therefore the benefits of a Cantonese speaking psychotherapist outweigh that of an English-speaking psychologist.
11The respondent argues that it approved the disputed OCF-18 which proposes 12 sessions of psychotherapy. It argues that the plan requests the services of a psychotherapist; however, the hourly rate requested corresponds with an hourly rated paid to psychologists, namely $149.61. The respondent argues that a psychotherapist is not a regulated professional under the Professional Services Guideline (“PSG”) and that the amount it approved namely $99.75 has been determined by the Tribunal to be a reasonable hourly rate for psychotherapy services.
12The Professional Services Guideline sets the hourly rates for professional services covered under the Schedule. The PSG stipulates that for services provided by health care professionals and providers not covered by the Guideline, then the amount payable is to be determined by the parties involved.
13I find that the applicant has not met her onus to establish entitlement to $149.61 per hour for psychotherapy services. The PSG does not establish an hourly rate for psychotherapy services. The respondent has agreed to pay $99.75 which the Tribunal has consistently found to a reasonable hourly rate for psychotherapy services.
14In addition, the respondent’s explanation of benefits letter dated March 20, 2024, invites the provider to discuss rates, and requests information as to if the psychotherapist would be performing services under the direction of a psychologist. The applicant did not point to evidence that would suggest that he or the treatment provider undertook this invitation, therefore in my view an implied agreement of the hourly rate set out in the explanation of benefits, namely $99.75 is accepted by the applicant and the treating facility.
15Contrary to the applicant’s submission I was not pointed to the benefits that outweigh a Cantonese speaking psychotherapist over that of an English-speaking psychologist, nor was I pointed to evidence that the psychotherapist in this case did speak Cantonese.
16Finally, I was not pointed to evidence that the psychotherapist’s treatment goals were to assist the applicant with cognitive behavioral therapy. The applicant’s progress report shows that the treatment provided was focused on pain management, mindfulness practices, and mood and anxiety stabilization. Further supportive that an hourly rate of $149.61 is not reasonable or necessary for psychotherapy services.
17I find on a balance of probabilities that the applicant is not entitled to an hourly rate of $149.61 for psychotherapy services because it is not reasonable and necessary. Accordingly, the applicant is not entitled to $747.96 for psychological services.
Interest
18Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As no benefits are owing, interest is not owing.
Award
19The 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.
20The applicant submits that the relationship between him and the respondent is one of utmost trust, and that the respondent should be expected to investigate and assess the applicant’s claim fairly, and in a balanced and reasonable manner. The applicant advances the claim for an award in this matter to investigate the reasonableness of the denials and provide a deterrence to Insurers in acting in a high-handed manner.
21Having found that the respondent has not unreasonably withheld or delayed the payment of any benefits from the applicant, follows that the applicant is not entitled to an award.
ORDER
22It is ordered that:
i. The applicant is not entitled to $747.96 for psychological services.
ii. As no benefits are owing interest is not owing.
iii. The applicant is not entitled to an award.
iv. The application is dismissed.
Released: February 25, 2026
John Mazzilli
Adjudicator