Citation: Rida v. Wawanesa Insurance, 2026 ONLAT 23-011141/AABS

Licence Appeal Tribunal File Number: 23-011141/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:

Hiam Rida

Applicant

and

Wawanesa Insurance

Respondent

DECISION

ADJUDICATOR: Melanie Malach

APPEARANCES:

For the Applicant: Wayne Fryer, Counsel

For the Respondent: James Schmidt, Counsel Morgan MacDonald, Counsel

HEARD: By way of written submissions

OVERVIEW

1Hiam Rida, the applicant, was involved in an automobile accident on January 3, 2011, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (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.

2This decision is a partial rehearing as a result of the reconsideration decision dated December 17, 2025. The issue of attendant care benefits and the related claims for an award and interest were ordered to be reheard based on the parties’ submissions and evidence from the initial written hearing.

ISSUES

3The issues in dispute are:

i. Is the applicant entitled to attendant care benefits in the amount of $1,533.71 per month from July 17, 2021 to ongoing?

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

4I find that the applicant is entitled to attendant care benefits in the amount of $1,533.71 per month from September 16, 2021 to September 2022, plus interest. I find that the applicant is not entitled to attendant care benefits after September 2022.

5I find that the respondent is not liable to pay an award.

ANALYSIS

Entitlement to Attendant Care Benefits

6Section 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. Section 19(3)(4) states:

Despite paragraphs 1, 2, and 3, if a person who provides attendant care services (the “attendant care provider”) to or for the insured person did not do so in the course of the employment, occupation, or profession in which the attendant care provider would ordinarily have been engaged for remuneration, but for the accident, the amount of attendant care benefit payable in respect of that attendant care shall not exceed the amount of the economic loss sustained by the attendant care provider during the period while, and as a result of, providing the attendant care.

7Section 3(7)(e) provides that expenses are not incurred by an insured person unless:

i. They have received the goods or services to which the expense relates;

ii. They have paid the expense, have promised to pay the expense, or are otherwise legally obligated to pay the expense; and

iii. The person who provided the goods and services,

1. Did so in the course of the employment, occupation, or profession in which he or she would ordinarily have been engaged, but for the accident; or

2. Sustained an economic loss as a result of providing the goods or services to the insured person.

8The dispute in this matter concerns whether or not the applicant’s daughter sustained an economic loss as a result of providing attendant care services to the applicant. Substantive entitlement to attendant care benefits is not in dispute.

9Based on the Divisional Court’s decision in Simser v. Aviva Canada, 2015 ONSC 2363 (Div. Ct.) (“Simser”), which is cited by both parties, “economic loss” includes only a financial or pecuniary loss. However, the Court stated that the definition does not eliminate all potential opportunity costs.

10Both parties have also referred to the Tribunal decision in Y.K. v. Aviva General Insurance Company, 2020 CanLII 34443 (ON LAT), which set out that past cases have found that the following were included in the concept of “economic loss”:

(i) The cost of bus tickets or bus passes in order to travel to an applicant’s home to provide attendant care;

(ii) The loss of income;

(iii) A potential loss of opportunity cost. For example, deferring graduation in order to provide attendant care benefits, which resulted in a postponement of paid income;

(iv) Loss of money on paid tuition and books, and repayment of OSAP because of leaving school to provide attendant care.

11The applicant submits that as a result of the subject accident, she was deemed catastrophically impaired in 2018 due to chronic pain and psychological impairments. She claims entitlement to $1,553.71 per month in attendant care benefits from July 17, 2021 to date and ongoing, the amount of which has never been challenged by the respondent. The applicant claims entitlement to services provided by her daughter, Roukaya Rida (“daughter”) who sustained an ongoing economic loss due to foregoing a law school education and paid employment, in order to care for her mother. In support, she relies upon the Affidavits of Hiam Rida, dated July 13, 2023 and Roukaya Rida, dated July 20, 2024.

12The respondent submits that based on the decision in Simser, that to qualify for attendant care benefits provided by family members, only an actual financial or pecuniary sacrifice must be demonstrated to prove “economic loss”. It does not extend to non-financial opportunity costs or the general provision of care without an accompanying diminution of earnings or other tangible economic harm. The respondent submits that economic loss requires some form of loss whatsoever, rather than theoretical economic loss.

13I find based on the decision in Simser, that “economic loss” does not mean just wage loss, but also includes loss of opportunities. Simser made it clear that while “economic loss” must represent a financial loss, the Divisional Court did not rule out the possibility of it including the loss of opportunities. The decision provides the example of a student sustaining an economic loss by deferring graduation, at para. 40: “For example, a student might sustain an economic loss where s/he defers graduation in order to provide attendant care, resulting in postponement of paid employment. Of course, this type of “an economic loss” would need to be established by a proper evidentiary foundation.”

14The applicant submits that her daughter was accepted into a three-year law program at the University of Sunderland Law School in the United Kingdom that was set to begin in the Fall of 2021. After travelling to Sunderland on September 16, 2021, the applicant’s daughter made the decision to forego law school and return home to provide attendant care to her mother. She submits that her daughter has suffered an economic loss due to deferred graduation as had she not returned home, she would have graduated with a law degree and began her career working full-time. As a result of this decision, she claims that her daughter suffered a total economic loss of $10,936.29, including tuition, prepaid housing costs, travel charges, and incidentals, which is set out in detail in her daughter’s Affidavit.

15The applicant’s daughter subsequently enrolled in a four-year Bachelor of Arts program at Carleton University in the Fall of 2022 with a graduation date in April 2025. She also obtained part-time employment on December 1, 2022. She submits that due to her ongoing responsibilities, she continues to reduce her work schedule and course load. She values her economic loss over the past three years as equal to the loss of one 7.5 hour shift per week. In the summer of 2023, she lost two shifts per week. She claims that her economic loss for wages after returning home is $19,142.56 for December 1, 2022 to January 3, 2025.

16I accept the applicant’s claim that her daughter suffered a loss of opportunity by foregoing law school in the Fall of 2021. I find that this is the type of scenario contemplated in Simser. However, this loss of opportunity was then mitigated by the applicant’s daughter when she enrolled in a full-time program at Carleton University in the Fall of 2022. I agree with the respondent that the applicant has not provided any evidence to indicate what economic loss would arise from her daughter leaving law school or the job prospects of an individual with a UK law degree. She further has not provided any evidence of the loss of opportunity her daughter experienced by enrolling at Carlton rather than completing her education in the UK. While the applicant submits that had her daughter not returned home to provide her with attendant care, she would have graduated with a law degree and began her career working full-time in August 2024, other than her submission, no “proper evidentiary foundation” as contemplated by the Court in Simser has been provided in support of this position. I therefore find that the loss of opportunity was only from September 16, 2021 until September 2022 when the applicant’s daughter began classes at Carlton University.

17I further find that the applicant’s daughter obtained part time employment beginning on December 1, 2022. However, other than her submissions that she worked reduced hours because she was caring for her mother, insufficient evidence has been provided to support this. I agree with the respondent that the employment contract of the applicant’s daughter does not indicate that she was reducing her hours and there is no evidence to support that the hours she worked were reduced or based on the care she provided to her mother. I further accept the applicant’s submission that her daughter was not employed prior to the accident and only obtained this employment in 2022. Therefore, there is insufficient evidence to support that had the accident not occurred, the applicant’s daughter would have been working increased hours as this was her first employment. In addition, the applicant has not proffered any evidence to support that had her daughter stayed in school in the UK that she would have sought employment while attending school. I therefore do not find sufficient evidence to support that the applicant’s daughter suffered an economic loss following her employment beginning on December 1, 2022.

18With respect to the period claimed from July 17, 2021 to September 16, 2021, no submissions have been made with respect to this period and therefore I find that the applicant has not proved an economic loss for this period.

19I therefore find that the applicant has proved that her daughter sustained an economic loss for the period from September 16, 2021 to September 2022, and is entitled to attendant care benefits for this period of time.

20With respect to the expenses of $10,936.29, including tuition, prepaid housing costs, travel charges, and incidentals, I find that the applicant has proved that these are all reasonable and properly considered an “economic loss”. I agree with the applicant that these are economic losses based on her daughter’s decision to forego law school and return to Canada to care for her mother and are therefore linked to the provision of attendant care to the applicant. I find that had she not decided to forego her education in the UK, these expenses would not have been lost.

21For the reasons outlined above, I find that the applicant has proved an economic loss for the period from September 16, 2021 to September 2022 and attendant care benefits are payable for this period.

Interest

22Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that attendant care benefits are payable for the period from September 16, 2021 to September 2022, interest applies on any overdue benefits.

Award

23The 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.

24The applicant submits that the respondent has been non-communicative, stubborn and inflexible. The applicant relies on the decision in Jeyanathan Thangarajah v. State Farm Mutual Automobile Insurance Company, 2017 ONFSCDRS 164 and states that it is similar to the subject matter because “the insurer was aware that the insured was receiving attendant care services from family and was provided documentation in support of an economic loss.” The applicant argues that the respondent’s failure to make inquires unreasonably delayed payments.

25I find that just because I have found that the applicant is entitled to attendant care benefits for a period of time and that the respondent was incorrect in its denial, it does not automatically entitle the applicant to an award. An insurer is not held to a standard of perfection, but rather, it should be held to a standard of reasonableness. The purpose of an award is to make an insurer accountable for misconduct and to deter it and others from future similar acts.

26I find that the case law has established that an award should be granted only where there is unreasonable behaviour from an insurer in withholding or delaying payments, which can be seen as excessive, imprudent, stubborn, inflexible, unyielding or immoderate.

27I find that the applicant has not pointed the Tribunal to sufficient evidence to demonstrate that the respondent’s behaviour was excessive, imprudent, stubborn, inflexible, unyielding or immoderate. The respondent’s denial of the UK expenses, dated May 3, 2022, articulates the respondent’s position on the expenses claimed and provides the applicant with information on her right to dispute the determination. I do not regard the respondent’s behaviour to be non-communicative, stubborn or inflexible.

28For the reasons outlined above, I do not find that the applicant has proven on a balance of probabilities that she is entitled to an award.

ORDER

29For the reasons outlined above, I find that:

i. The applicant is entitled to attendant care benefits in the amount of $1,533.71 per month from September 16, 2021 to September 2022, plus interest. She is not entitled to attendant care benefits after September 2022; and

ii. The respondent is not liable to pay an award.