Licence Appeal Tribunal File Number: 25-002371/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:
Dane Duhaney
Applicant
and
Security National Insurance Company
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Matthew Dale, Counsel
For the Respondent:
Robert Bowman, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Dane Duhaney, the applicant, was involved in an automobile accident on August 16, 2022, 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 the respondent, Security National 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 $2,337.32 for occupational therapy services (dog walking), proposed by Pursuit Health Management, in a treatment plan dated February 13, 2023?
ii. Is the applicant entitled to $2,612.22 for vocational/academic training, proposed by Fern Speech and Language Services, in a treatment plan dated September 27, 2023?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant is not entitled to the treatment plans in dispute or interest.
ANALYSIS
Entitlement to Medical and Rehabilitation Benefits
4To receive payment for a treatment plan under s. 14, 15 or 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 that the goals of treatment are reasonable, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
Entitlement to the Treatment Plan for Dog Walking
5The applicant is not entitled to the treatment plan for dog walking.
6The applicant claims entitlement to $2,337.32 for occupational therapy services (dog walking), proposed by Pursuit Health Management, in a treatment plan dated February 13, 2023. The treatment plan recommends the following:
60 Dog Walking services for client’s dog that he cannot walk/exercise: $1,800.00
Documentation, support activity for claim form: $200.00
Planning, service: $91.43
7The goals of the treatment plan are “extension of dog walking services while client continues to rehab his injuries. Dog will be walked on a daily basis and provided necessities of life.”
8The applicant submits that at the time of the accident, he owned a high energy German Shorthaired Pointer dog, who was over two years old and weighed approximately 55 pounds. The applicant claims that prior to the accident, he regularly ran 5-10 km with the dog almost every morning. The applicant states that he lives in a one-bedroom apartment with no suitable outdoor space for the dog to relieve itself, making regular outdoor walks an absolute necessity and not a convenience.
9The applicant submits that following the accident, he sustained profound orthopaedic injuries to his lower leg, rendering him physically incapable of walking his dog. After the respondent’s denial of the subject treatment plan, he hired a dog walker, incurring out of pocket expenses totalling $2,337.32 from January to October 2023.
10The applicant claims that the dog walking services recommended in the subject treatment plan are not only reasonable but essential. He claims that the therapeutic value of the relationship between a person and their dog is critical and a deeply human aspect of rehabilitation. The applicant argues that denying the dog walking services implies that such relationships are inconsequential to rehabilitation.
11The applicant acknowledges that the Schedule does not explicitly list dog walking services as a recognized rehabilitation expense. However, the applicant submits that s. 16(3)(l) of the Schedule would encompass dog walking services, as it captures “other goods and services” that are essential for the rehabilitation of an insured person, and for which a benefit is not otherwise provided in the Schedule. The applicant argues that this provision invites a broader, more compassionate interpretation, one that recognizes the evolving nature of rehabilitation and the unique needs of each individual.
12The respondent submits that as a medical and rehabilitation claim, the applicant must establish that funding this treatment plan is a reasonable and necessary expense as well as serving some medical or rehabilitation purpose for the applicant. The respondent submits that the proposed dog walking services do not fall within any part of s. 14, 15 or 16 of the Schedule.
13The respondent submits that it denied the subject treatment plan by letter dated February 24, 2023, on the basis that dog-walking services are not covered under the Schedule. The respondent submits that there is no indication or evidence that dog-walking services themselves provide any sort of medical or rehabilitative benefit to the applicant. The respondent states that the purpose of the treatment plan is “extension of dog walking services while client continues to rehab his injuries”, and the “dog is to be walked on a daily basis and provided necessities of life”. The respondent argues that the proposed dog walking services focus on the needs of the applicant’s dog, and not on him as the insured person who sustained the injury, which is implicit in the definition of a medical and rehabilitation expense.
14The respondent submits that the proposed dog walking services are replacement services, which had been provided by the applicant to his dog pre-accident, and are not expenses which in themselves provide any medical or rehabilitation benefit for the applicant. While the applicant may have required someone to walk his dog during a period of time while he was non-ambulatory, this need does not transform such services into a medical and rehabilitation expense for which the respondent becomes liable under ss. 14, 15 or 16 of the Schedule. It relies upon the Ontario Insurance Commission decision in Carlos Ferreyra and Blanca Ferreyra v. Roya Insurance Company of Canada, 1992 ONICDRG 24 (“Ferreyra”), where it was held that,
The principle focus of the No-Fault Benefits Schedule is on the needs of the insured person who sustained injury, not generally on replacement of services formerly provided by the insured person who sustained injury.
15The respondent further relies upon the Divisional Court decision in G.B. v. Pilot Insurance Co., et al, 2008 CanLII 2602 (ON SCDC) (“G.B. v. Pilot”), where the Court found that nanny services were not a rehabilitative benefit.
16The applicant in his Reply submissions states that Jennifer Arthurs, nurse practitioner, in her email to the respondent dated February 28, 2023, recommended that the respondent approve the dog walking services to prevent further injury and to avoid regression in the applicant’s rehabilitation. The applicant submits that this email supports that the dog walking services are a necessary measure to support the applicant’s recovery by ensuring safe mobility and reducing physical strain.
17I find that the applicant is not entitled to the treatment plan for dog walking services.
18I find that the Schedule does not specifically address the provision of dog walking services, as this is a novel request. I agree that the only potential section of the Schedule that could deal with these expenses is s. 16(3)(l) which provides for “other goods and services” that are essential for the rehabilitation of an insured person, and for which a benefit is not otherwise provided in the Schedule. However, the applicant must prove that these “other goods and services” are essential to his own rehabilitation.
19I accept that the dog walking services are for the well-being of the dog who needs to be walked and taken care of. I further accept that the applicant’s physical impairments as a result of the subject accident prevent him from walking his dog which is supported by Ms. Arthur’s email. However, I find that the proposed dog walking services focus on the needs of the applicant’s dog, and not on him as the insured person who sustained the injury. I find that the applicant has not provided sufficient evidence to support that the dog walking services are essential to his own rehabilitation and recovery except to state that he could further injure himself if he himself walks the dog.
20I further find that while the applicant submits that his dog provides therapeutic benefit to his rehabilitation, he has not pointed the Tribunal to any medical evidence or expert opinion that supports this position. I find that submissions are not evidence.
21I agree with the respondent that the proposed dog walking services are replacement services, which had been provided by the applicant to his dog prior to the accident. I find that replacement services are not covered under medical and rehabilitation benefits in the Schedule. I agree with the respondent that the focus of the Schedule is on the rehabilitation of the insured person who was injured in the accident, and not in replacing services which that person provided to his family, pets or any other similar obligations.
22I further find that the applicant has not pointed the Tribunal to any case law which supports the applicability of s. 16(3)(l) to the dog walking services or similar types of services. In contrast, the respondent has referred to several cases which it claims parallels may be drawn from. In Ferreyra, the Ontario Insurance Commission concluded that the principal focus of the No-Fault Benefits Schedule is on the needs of the insured person who sustained the injury. Thus, the cost of providing replacement transportation to soccer practices and games is not an expense compensable because it was not a service “which the insured person requires because of the accident.” I agree with the Ontario Insurance Commission that in this matter, the focus of the Schedule is on the rehabilitation needs of the applicant and does not provide for replacement of services formerly provided by the applicant.
23The respondent also relied upon the Ontario Divisional Court decision in G.B. v. Pilot, where the Court concluded that nanny expenses cannot be recovered as a rehabilitative benefit and can only be awarded as a caregiver benefit. I find that a comparison can be made in this matter between a dog and a child. Any services to take care of that pet or child cannot be recovered as a rehabilitation benefit.
24While I am sympathetic to the applicant’s love for his dog and that the dog needs care the applicant is unable to provide himself, I find that the applicant has not proven on a balance of probabilities that he is entitled to the proposed services in the treatment plan pursuant to the Schedule.
25The applicant is not entitled to the treatment plan recommending a laptop and accessories and an online college course.
26The applicant claims entitlement to $2,612.22 for vocational/academic training, proposed by Fern Speech and Language Services, in a treatment plan dated September 27, 2023. The treatment plan recommends the following:
Documentation, support activity for claim form: $ 112.22
Cost of a laptop and accessories required for the completion of his coursework and daily activities to support improved literacy and executive function: $2,000.00
Educational material – e.g. hand-outs, books: $ 500.00
27The goals of the treatment plan are to complete an online college-level course with support from speech language pathology services. The functional goals are to learn and apply strategies to improve reading, writing and executive skills using an online course as the curriculum.
28The applicant submits that the subject treatment plan recommending assistive technology and a compatible laptop, are reasonable and necessary to support his cognitive and communication rehabilitation. The applicant submits that the medical evidence clearly demonstrates that he suffers from cognitive impairments, which have impacted his ability to communicate and function effectively. As part of his rehabilitation plan, Elizabeth Skirving, speech language pathologist, at Fern Speech and Language Services, recommended enrollment in online college-level courses which would enhance his cognitive and communication skills. To support this academic endeavor, Ms. Skirving also recommended the use of assistive technologies, including voice-to-text and text-to-voice software. As the applicant’s existing laptop was incompatible with the system requirements for the software, a recommendation was made for a new device. By letter dated October 2, 2023, Ms. Skirving provided additional details regarding the rationale for proposing the goods and services in the treatment plan in dispute.
29The respondent submits that the treatment plan in dispute proposes the cost of an unspecified college level course and the purchase of a tablet, laptop or smartphone. The respondent submits that there is an absence of details provided in the treatment plan to assist in the determination of whether the treatment plan is reasonable and necessary. The respondent relies upon the Insurer Examination (“IE”) report of Jennifer Peacock, speech language pathologist, dated February 27, 2024 which concluded that the goods and services in the treatment plan were not reasonable and necessary as there is insufficient information to indicate that the proposed laptop and accessories and the proposed college-level course and expenses are reasonable and necessary at this time.
30The respondent further submits that the Tribunal in C.S. v. Co-Operators General, 2020 CanLII 51287 (ON LAT), has previously determined that upgrades of older technology devices such as iPhones, have previously been found not reasonable and necessary for that reason alone.
31With respect to the request for funding of an online college-level course and materials, I accept that this recommendation is supported by Ms. Skirving and her assessment of the applicant’s cognitive and learning difficulties. I further find that Ms. Peacock in her IE report confirms that the applicant exhibits cognitive communication dysfunction secondary to the effects of the accident. However, I agree with Ms. Peacock that in order to determine whether the college course is reasonable and necessary, specific information, including the specific course identified and how this will support retraining objectives, needs to be provided. Despite Ms. Peacock identifying the missing information, I find that no further information was provided on behalf of the applicant in order to allow the respondent to assess the reasonableness and necessity of this request. I therefore find that while the applicant may benefit from enrollment in a college online course, he has failed to provide the necessary information in order to assess whether it is reasonable and necessary.
32With respect to the request for a new laptop and accessories required for completion of the applicant’s coursework and daily activities, I again find that this was a reasonable request. I find that it is reasonable to conclude that a new laptop with updated technology would be required if the applicant’s old computer was not compatible with the technology needed to engage in an online college course. However, I find that there are no particulars provided in the treatment plan as to the type of laptop or accessories being proposed. Rather the request is simply for $2,000.00 with no breakdown provided. I find that Ms. Peacock in her IE report specifically states that the specific laptop and accessories for which funding is requested have not been specified. She notes that apart from the ability to access voice-to-text and text-to-voice applications, the specific features and functionality considered to be required to support the stated objectives have not been outlined. I agree with Ms. Peacock that there is insufficient information to determine whether the proposed items are reasonable and necessary. Again, despite the issues with the treatment plan raised in Ms. Peacock’s report, no further information was provided on behalf of the applicant to support the purchase of the laptop and accessories. I therefore find, that while the proposed laptop and accessories might be found reasonable and necessary, without providing the specifics of the specific laptop and accessories being requested, there is no way for the respondent to properly determine if the proposed devices are reasonable and necessary.
33For the reasons outlined above, I find that the applicant has not proved on a balance of probabilities that the treatment plan dated September 27, 2023 is reasonable and necessary.
Interest
34Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that the treatment plans in dispute are not payable, there are no overdue benefits payable and there is no interest payable.
ORDER
35For the reasons outlined above, I find that the applicant is not entitled to the treatment plans in dispute or interest. The Application is dismissed.
Released: June 10, 2026
Melanie Malach
Adjudicator