Licence Appeal Tribunal File Number: 25-007248/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:
Wanghao Jiang
Applicant
and
TD General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Tami Cogan
APPEARANCES:
For the Applicant:
Sherilyn Pickering, Counsel
Mercedes Lavoy, Counsel
For the Respondent:
Orest Kuchar, Counsel
Colin Birch, Counsel
HEARD by Videoconference:
April 20, 21, and 22, 2026
OVERVIEW
1Wanghao Jiang, the applicant, was involved in an automobile accident on September 5, 2012, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, TD General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant was four years old at the time of the accident and sustained a traumatic brain injury. He was deemed to have a catastrophic impairment as defined by the Schedule. As of the date of the hearing, the applicant is eighteen years old and no longer represented by a litigation guardian.
ISSUES
3The issues in dispute are:
i. Is the applicant entitled to $97,398.08 for home modifications, proposed by Entwistle Power Ahmad Occupation Therapy Corporation in a treatment plan/OCF-18 (“plan”) dated June 25, 2023?
ii. Is the applicant entitled to interest on any overdue payment of benefits?
iii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iv. Is the applicant entitled to costs pursuant to Rule 19 of the Licence Appeal Tribunal Rules, 2023 (“Rules”).
4At the start of the hearing, the applicant withdrew the issues of non-earner benefits, attendant care benefits, and three treatment plans, listed on the case conference report and order (“CCRO”).
5The applicant sought to add the issue of costs pursuant to Rule 19 of the Licence Appeal Tribunal Rules, 2023.
6I have added the applicant’s request for costs to the issues in dispute, above. Pursuant to Rule 19.2, which establishes that a party can make a request for costs “in writing or orally at a case conference or hearing, at any time before the decision or order is released”.
RESULT
7I have considered the parties’ submissions, witness testimony, and documentation to which I was directed, and I find the following:
i. The applicant is partially entitled to the proposed home modifications.
ii. The applicant is entitled to interest on any overdue payment of benefits.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664.
iv. The applicant is not entitled to costs.
ANALYSIS
OCF-18 for Home Modifications
8I find the applicant is partially entitled to the proposed home modifications. Specifically, the applicant is entitled to: bilateral handrailing on the exterior stairs at the front entry and releveling of the pre-cast concrete steps; bilateral handrailing on the staircase between the main level and the second level; bilateral handrailing on the staircase between the main level and the basement level; bilateral handrailing on the steps from the basement patio door to the patio. My reasons are as follows.
9To receive payment for a treatment plan under 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.
10Pursuant to s. 16(1) of the Schedule, the insurer shall pay for all reasonable and necessary expenses for the purpose of reducing or eliminating the effects of any disability resulting from the impairment, or to facilitate the person’s reintegration into his or her family, the rest of society, and the labour market. Pursuant to s. 16(3)(i) of the Schedule, this includes home modifications and home devices, to accommodate the needs of the insured person.
11I have reviewed the treatment plan in dispute completed by Allyson Weldon, Occupational Therapist, on June 15, 2023, proposing $97,398.08 for home modifications. At Part 6, the applicant’s injuries and sequelae are identified as fracture of skull and facial bones, multiple open wounds of the head, reaction to severe stress, and adjustment disorders. At Part 8, the applicant’s activity or functional limitations are identified as experiencing difficulty with mobility in his living environment as a result of his injuries and impairments, which include inattentiveness and reduced balance. At Part 9, the goals of the plan are to provide safety in the home.
12The treatment plan does not list the applicant’s current injuries or impairments. What is listed are the original injuries stemming from the accident 13.5 years ago. The details of the proposed modifications are not indicated on the OCF-18, but rather are on the Occupational Therapy Home Modifications Assessment report of Allyson Weldon dated May 30, 2023, and the Housing Assessment report by Darrell Booker, contractor of DH Consulting Group dated May 28, 2023.
13The applicant submits that he continues to have dizziness, poor balance, stumbling, and difficulty with stairs, as well as decreased concentration. He requires modifications to the home to prevent falls. The applicant relies on the reports of Ms. Weldon and Mr. Booker. The proposed modifications include:
i. bilateral handrails on all staircases;
ii. access to the backyard from the main level kitchen via a deck and stairs to ground level;
iii. a patio in the backyard, under the deck;
iv. a private space within the finished basement for a therapy room;
v. full renovation to the main bathroom to include a curb-less shower, a comfort height toilet, and non-slip tiles; and
vi. raising the level of the front porch with guardrails and bilateral handrails.
14The respondent submits that none of the proposed renovations are reasonable or necessary. The applicant is studious with high marks in school; he plays badminton; and is active in after school activities. It submits that this demonstrates that he does not currently have impairments from the accident. Therefore, the goals of the treatment plan are not necessary, and the cost is not reasonable. The respondent relies on the Occupational Therapy In-home Assessment report of Sarah Macrae dated March 4, 2024, and the Home Modification Report of Mr. David Borthwick, Construction Engineering Technologist dated March 4, 2024.
15The applicant and his family lived in their pre-accident home for four years post accident. At the age of eight the family moved to their current home and have resided there for the past ten years. The applicant is currently eighteen years old. To date, no modifications have been made to the home since the family took occupancy ten years ago.
16For context, the applicant lives in a two-storey carriage home (townhouse attached by a common garage wall) with a walk-out basement. As noted above, he lives with his parents in the family home. The following is a description of relevant parts of the home, taken from the witness testimony and the assessment reports of Mr. Booker and Mr. Borthwick:
Main level: The front entry has three steps up to the door and no handrailing. Entry is to the main level of the home. There is a two-piece bathroom on the main level. The kitchen is at the back of the home and has an external door with a Juliet balcony overlooking the backyard.
Second level: The staircase to the second floor is hardwood, with a spiral section on the lower end, a landing, and a straight section connecting to the second level. The staircase has one handrailing on the inside radius. The applicant’s bedroom is on the second level. The applicant has a desk on the second level in an open area at the top of the stairs. The home has a main bathroom on the second floor with a tub-shower combination, a raised elongated toilet, and vanity with a sink. There is an ensuite bathroom accessed through the primary bedroom on the second level. It has a step-in shower, a jacuzzi tub, a raised elongated toilet, and a vanity with a sink.
Basement: The staircase to the basement is straight with a landing and handrailing on one side. There is a bathroom in the basement with a step-in shower, an elongated toilet, and a vanity with a sink. The basement is finished. There is a patio door that accesses the backyard.
Exterior: The house is attached to the neighbouring house by a common garage wall. Behind the garages is an “alleyway” between the two houses of which both owners have right-of-way to the backyard(s). There is no access from the backyard to the right-of-way because the fence around the backyard abuts the back of the house, blocking the right-of-way.
Egress: There is a door at the back of the single car garage that accesses the right-of-way to the back of the property. There is a door into the house from the right-of-way, which leads to an interior landing. The landing is four steps down from the main level. The basement stairs lead down from the landing.
Backyard: There is a patio with two stairs up to the basement patio door. The yard is fully fenced with no rear neighbours.
17Based on her report and testimony, I find the foundation of Ms. Weldon’s recommendations is the medical records and expert reports that indicate that the applicant experiences intermittent dizziness due to fatigue and headaches as a result of the head injury, as well as poor balance due to the injury of his left ankle that he sustained in the accident. Further, the applicant has reduced concentration and cognition resulting from the traumatic brain injury as a result of the accident.
18As per Ms. Weldon’s May 30, 2023, report, Dr. MacGregor, neurologist, opined in his August 14, 2018 neurology assessment report that the applicant has left ankle spasticity and clonus with poor balance and difficulty coordinating hopping on the left foot, but that the applicant demonstrates only minor effect on functional motoric abilities. Nevertheless, he opines that the applicant does have deficits in balance and coordination.
19In 2018, Ms. Marla Tennen, Registered Nurse, documented that the applicant plays soccer at school twice weekly and participates in karate. The applicant testified that he currently plays badminton each Saturday, which leaves him fatigued.
20The applicant testified that his headaches, intermittent dizziness and fatigue are ongoing, as well as his tendency to fall easily. It is well documented that the applicant’s mother has consistently reported the applicant has a history of falling.
21The impairments that I find relevant to the issue in dispute are the applicant’s fatigue, dizziness, and poor balance, which result in an increased risk of falling.
22I note that, in the occupational therapy assessment report of Ms. Lisa Martin, occupational therapist, dated April 6, 2018, she documented that during the assessment the applicant was observed to ambulate safely and independently throughout his home, as well as ascend and descend the stairs between the main floor and the second floor at a brisk pace. He did not demonstrate any physical limitations during the assessment. Further, I note that neither Ms. Weldon, nor Ms. Macrae, observed the applicant to have difficulty with ambulation, transfers, or dizziness during their assessments. I find that these observations of Ms. Martin, Ms. Weldon, and Ms. Macrae do not confirm that the applicant does not experience dizziness on an intermittent basis with an increased risk of falling. I find that based on the intermittent nature of his symptoms it is plausible that it was not observed during the assessments.
23The occupational therapy progress reports of Ms. Patricia Saad, occupational therapist, dated January 10, 2024, and August 14, 2025, identify that that the applicant’s intermittent dizziness, headaches, fatigue, and poor balance from his accident-related injuries are persisting.
24The applicant’s mother, Ms. Wang, advised the assessors that the applicant complains of dizziness approximately once per month, and she testified to the same, and the applicant endorsed the complaint of dizziness during his testimony. I find that although it was not observed by the assessors during the sessions, I am persuaded by the consistent documentation of Ms. Wang’s ongoing reporting to assessors of the applicant’s complaints of dizziness, fatigue, and headaches because they have been ongoing complaints, prior to consideration of home modifications.
25Dr. Michel Rathbone, neurologist completed a neurological medical assessment report dated February 5, 2018, and opined that in terms of his lifestyle, the applicant will need to avoid recreational activities that involve high impact or increased chance of another brain injury. I am persuaded that the applicant is at risk of falling, and that modifications to reducing the applicant’s risk of falling are reasonable and necessary. I will now turn to consideration of the specifics of the proposed home modifications.
26I have considered that the recommendations and reasoning for the proposed modifications as stated by Ms. Weldon and Mr. Booker are not consistent. Mr. Booker testified that he relied on Ms. Weldon’s recommendation for the proposal. However, I find some of the proposed modification go beyond Ms. Weldon’s recommendations and are not supported by contemporaneous evidence and therefore I give his report less weight.
Front Entry
27Mr. Booker’s proposal for the front entry includes raising the height of the front porch to be level with the front door, which is approximately six inches. He testified that the purpose is to eliminate a step into the house, which is a trip hazard. I do not accept Mr. Booker’s proposed modification because, if the porch is elevated, the applicant will still have to step over the door threshold, and the trip hazard has not been eliminated. Further, elevating the porch will increase the number of steps up to the porch, thereby merely transferring the location of the risk. Also, Mr. Booker included a guard rail around the front porch. I have not heard evidence as to the purpose of the guard rail. I find the modification to the height of the porch is not reasonable and necessary, and it follows that the guard rail is also not reasonable and necessary.
28Ms. Weldon recommends installation of bilateral hand railings on the steps leading to the front door. I find that the bilateral handrails on the external steps to the front porch are reasonable and necessary. I heard consistent testimony that the front door is the primary entrance into the home. I have considered that the steps are exposed to weather, and rain, snow, and ice will increase the fall risk for the applicant, and the handrails will reduce that risk. I find the bilateral handrails are necessary for the applicant’s accident-related impairments.
29I also heard testimony from Mr. Booker and Mr. Borthwick that the precast steps at the front entry are uneven and a potential fall risk. Mr. Booker testified that the steps should be re-leveled. In the photos of the entry, the steps appear to be sinking, and I agree this increases the potential for falls. Therefore, I find that re-leveling of the pre-cast steps is reasonable and necessary.
Interior Handrails
30Ms. Weldon recommended bilateral handrails on both the stairs to the basement as well as the stairs to the second level. I heard evidence from Ms. Weldon, Ms. Macrae, Ms. Wang, the applicant’s mother, and the applicant himself, that he does not use the existing handrail. I also heard that the applicant rushes down the stairs when he is going out. I heard that the applicant has fallen on the stairs. I have considered that the staircase to the second level is hardwood, which can be slippery in sock-clad feet. It is also partially spiral, which means the interior radius closest to the existing handrail is also the narrowest part of the stair tread. The outside radius of the stairwell, which has the widest stair tread, does not have a handrail. It seems reasonable to conclude that the applicant is at risk of falling on the staircase and that having a second handrail on the stairs provides more opportunity for the applicant to guard against falling.
31Further, I find that the risk of falling on the stairs is a general risk for the applicant throughout the home. The risk is not isolated to hardwood or spiral staircases, although it may be a higher risk with certain staircase designs. Again, the purpose of a handrailing is to reduce the risk of falling, and if a handrail does not exist, then it cannot be used. Therefore, to reduce the risk of falling, I find the bilateral handrailing to the basement level is also reasonable and necessary for the applicant’s accident-related impairments.
32In sum, the handrails for the stairs to the basement and the second level are reasonable and necessary for the applicant’s accident-related impairments.
Main Bathroom
33Ms. Weldon proposed for the main bathroom to be fully renovated to create an accessible bathroom, which includes a roll-in shower, comfort height toilet, and non-slip tiles. The applicant submits that due to his increased risk of falling when he is tired, and the heightened risk of falling when in a wet environment, the modifications are reasonable and necessary.
34The respondent submits that a roll-in shower is not reasonable and necessary because the applicant does not use mobility aids which require the entry to be curb-less. Also, the applicant does not have any limitations with transfers on/off the toilet, therefore a comfort height toilet is not reasonable and necessary. Further, there are assistive devices that can meet the applicant’s needs with transfers in/out of the shower, without a full demolition.
[35]
35Shower and non-slip tiles: I heard testimony from both occupational therapists that the applicant did not endorse falling in the bathroom. I heard testimony from the applicant that when he is tired, stepping over the tub wall is a potential risk. The applicant did not endorse the need for a curb-less shower. There are currently no grab bars, or other assistive devices in the shower. I did not hear evidence as to the current flooring material and the applicant did not testify that the flooring material was a concern to him.
36I heard from Mr. Borthwick that there are more cost-effective alternatives, such as cut-out tubs that convert the existing bathtub into a step-in shower, while maintaining its function as a bathtub, when needed. Mr. Borthwick also testified that a floor to ceiling sturdy pole for transfers into and out of the shower would provide the applicant the support he requires.
37I have considered the applicant’s endorsed abilities and find that the curb-less shower and non-slip tiles are not reasonable and necessary.
38Toilet: The applicant did not testify to any difficulty with transferring onto or off of the toilet. I did not hear persuasive evidence that the applicant required a “comfort height” toilet for his accident-related impairments. I heard evidence from Mr. Borthwick who testified that the toilets in the main bathroom and the ensuite bathroom are raised and elongated, meaning that they are taller than the standard toilet. I did not hear evidence as to how high a comfort height toilet is, in comparison to what exists in his bathroom currently.
39I find that there is no corroborating evidence to support that a comfort height toilet would provide any assistance to the applicant for his impairment. Nor did I hear supporting evidence that the current toilet is not sufficient.
40Therefore, I find that the proposed comfort height toilet is not reasonable and necessary.
Basement Patio Door / Backyard Patio
41Ms. Weldon proposed the creation of an additional patio door to lead to the backyard space. The evidence indicates that there is currently a patio door from the basement to backyard. I did not hear evidence that justified replacing the existing door. Mr. Booker’s proposal includes a patio in the backyard to provide an outdoor space for the applicant. There is an existing patio in the backyard. Mr. Booker testified that the existing patio is a tripping hazard because the existing stones are uneven. I give Mr. Booker’s testimony regarding the existing patio little weight because the majority of the patio was covered in snow at the time of his assessment, as evidenced by the photographs in his report. I prefer the evidence of Mr. Borthwick, whose report includes clear photos of the existing patio area. He testified that the patio area is level does not pose a risk of falling.
42I find that the replacement of the existing patio door and patio are not reasonable and necessary.
Deck and stairs to ground level
43Ms. Weldon proposes an additional exit from the main level, in place of the current Juliet balcony located in the kitchen/dining area, to provide a secondary means of accessing the backyard for safety reasons. It would be achieved by installing a patio door in place of the Juliet balcony, creating a deck with stairs and handrails to the ground level. Mr. Booker proposes the creation of a deck to provide more space for the applicant. The proposed deck is 12’ x 14’. Mr. Booker did not provide information as to the number of stairs that would be required to reach ground level. I heard testimony from Mr. Borthwick that a secondary egress from the main level is not required by Building Code. However, the Building Code is not what is being considered for the home modifications. Instead, I am persuaded by Mr. Borthwick’s testimony that the interior stairwell to the basement for egress through the walk-out patio door was safer than exterior stairs off a deck, which would be exposed to the weather and potential snow and ice. There would be no more steps on the interior than on the exterior, therefore from a safety perspective, the proposed access to the backyard off the deck was not a safer option.
44Also, I heard testimony from the applicant’s mother that it was important for the applicant to go outdoors for the sunshine, and the deck would provide a space. I find that the existing backyard with a patio provides the applicant space to go outdoors. Further, I heard from the applicant that going outdoors “is not my thing”, and that he would not use the deck, and he doesn’t use the existing patio. I find that the deck and stairs to ground level are not reasonable and necessary.
45I have also considered that there is a secondary point of egress from the main level. It is an external door at the top of the basement stairs. I heard that none of the assessors opened that door, and no one evaluated if it was a suitable option for the applicant. I heard testimony from Mr. Borthwick that the side door should give access to the backyard, or alternatively access to the garage through a door at the rear of the garage, allowing egress through the garage. Mr. Borthwick also testified that it was very unusual for the fence to abut against the house, blocking the right-of-way. The installation of a gate would provide access. I have considered that if the purpose of the deck and stairs from the main level is a secondary egress for safety, then it is concerning that there is currently no exit from the backyard, which is fully fenced.
46In sum, I find that the deck and stairs to ground level are not reasonable and necessary.
Therapy Room
47Ms. Weldon proposes the creation of private, quiet space for therapeutic usage, which can also be used for his studies and leisure tasks. I heard testimony from Ms. Weldon that the applicant accesses his occupational therapy virtually and therefore needs a private space. Mr. Booker proposes to create a room in the finished basement, by installing a wall to cordon off the area. I find that it is contradictory for the applicant to submit the private space in the basement is accessible to him, while also submitting that the basement bathroom is not accessible due to the number of stairs.
48Ms. Weldon opined that it is reasonable for a teenage boy to have a private recreational space for leisure and studying. Ms. Weldon concluded that the therapy room would support applicant’s reduced concentration by eliminating noise and distractions and assist him with his studies.
49The respondent submits that the applicant’s grades are in the 90th percentile, which does not support an impairment with his concentration. Further, the applicant’s therapy is by virtual appointment, and privacy is achieved with noise cancelling headphones, and his bedroom can be used, if a separate room is necessary.
50I heard testimony from the applicant that his father has a desk downstairs, and he does not want to use that space, he only goes to the basement to use the printer/scanner and prefers to be at his desk on the second level. He testified that he uses noise cancelling headphones and is not bothered or distracted while he is studying or playing games. He testified that if the area in the basement was created, he doesn’t think he would use it. The applicant’s counsel submits that the applicant has poor insight into his own impairments, and his own views on this issue cannot be relied upon.
51The modifications are for the purpose of reducing or eliminating the effects of any disability resulting from the impairment. I find the applicant’s current space on the second level is meeting his needs because I am most persuaded by his testimony, which is strongly supported by his school grades, that his current desk and noise cancelling headphones are effective aids for his concentration. Therefore, I find the therapy room is not reasonable or necessary for the applicant’s accident-related impairments.
52I have considered the proposed modifications to the applicant’s home, and I find that the treatment plan goal of providing safety in the home can be met with some of the proposed modifications, as set out above. With respect to the cost of the modifications, Mr. Booker testified that the estimation of costs in his report are outdated because they were provided in 2024, and two years have passed with construction costs going up. I accept that there may be some inflationary impact from the passage of time, but the issue before me is the treatment plan dated June 25, 2023, and my assessment is rooted the evidence in and around the time of the treatment. I do not have other expert evidence as to the costs. If there is any inflationary impact that is for the parties to resolve.
[53]
53In sum, I find on a balance of probabilities, that the applicant is entitled to bilateral handrailing on the exterior stairs at the front entry, and releveling of the pre-cast concrete steps; bilateral handrailing on the staircase between the main level and the second level; bilateral handrailing on the staircase between the main level and the basement level; bilateral handrailing on the steps from the basement patio door to the patio, as set out in the treatment plan dated June 25, 2023.
Interest
54Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
Award
55I find that the applicant is not entitled to an award.
56The 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.
57The applicant submits that the respondent blindly followed the Insurer’s Examination assessors and ignored all medical evidence. This resulted in an unreasonable denial and delay of payment of benefits.
58The respondent submits that care had been taken in adjusting the claim, and the denial was not unreasonable, therefore the applicant’s claim for an award does not meet the test.
59I find that the respondent did rely on the Insurer’s Examination assessors’ opinions and conclusions, which it is entitled to do. I find that there are contradictory opinions in the medical evidence, and the respondent reached a different conclusion than the applicant. The fact that the applicant does not approve of the assessors’ process or conclusions, does not mean that the respondent is unreasonable in its reliance upon them.
60I find the applicant has not proven on a balance of probabilities that the respondent unreasonably denied benefits. It follows that no award is owing.
Costs
61I find that the applicant is not entitled to costs.
[62]
62Where a party believes that another party in a proceeding has acted unreasonably, frivolously, vexatiously, or in bad faith, that party may make a request to the Tribunal for costs pursuant to Rule 19. In deciding whether to order costs and the amount of costs to be ordered, the Tribunal shall consider all relevant factors including: the seriousness of the misconduct; whether the conduct was in breach of a direction or order issued by the Tribunal, whether or not a party’s behaviour interfered with the Tribunal’s ability to carry out a fair, efficient, and effective process; prejudice to other parties; and the potential impact an order for costs would have on individuals accessing the Tribunal system. The Tribunal may deny or grant the request for costs or award a different amount than requested. The amount of costs shall not exceed $1000.00 for each full day of attendance at a motion, case conference or hearing.
63The applicant submits that the respondent’s counsel acted unreasonably, vexatiously and in bad faith toward the applicant’s mother during cross-examination because two of the questions were inappropriate and in bad taste.
64The respondent submits that cross-examination of a witness is proper and is not misconduct, there was no breach of a direction or order issued by the Tribunal, there was no interference with the Tribunal’s ability to carry out a fair, efficient, and effective process, and there was no prejudice to the applicant. Therefore, costs are not appropriate.
65I find that the questions were in line with the respondent’s theory of its case and questioned whether the OCF-18 in dispute was submitted in good faith. While the questions caused emotional discomfort for the witness, this is not grounds for costs. The questions did not cause prejudice to the applicant or interfere with the Tribunal’s process or ability to carry out a fair and efficient hearing.
66I am denying the applicant’s request for costs.
ORDER
67For the reasons above, I find the following:
i. The applicant is partially entitled to the proposed home modifications:
Specifically, the applicant is entitled to: bilateral handrailing on the exterior stairs at the front entry, and releveling of the pre-cast concrete steps; bilateral handrailing on the staircase between the main level and the second level; bilateral handrailing on the staircase between the main level and the basement level; bilateral handrailing on the steps from the basement patio door to the patio.
ii. The applicant is entitled to interest on any overdue payment of benefits.
iii. The respondent is not liable to pay an award under s. 10 of Reg. 664.
iv. The applicant is not entitled to costs.
Released: May 27, 2026
Tami Cogan
Adjudicator

