Citation: Fournier v. The City of Ottawa, 2026 ONLAT 24-008011/AABS

Licence Appeal Tribunal File Number: 24-008011/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:

Brigitte Fournier

Applicant

and

The City of Ottawa

Respondent

DECISION

ADJUDICATOR: Aric Bhargava

APPEARANCES:

For the Applicant: Frank McNally, Counsel

For the Respondent: Amanda Lennox, Counsel

HEARD: By way of written submissions

OVERVIEW

1Brigitte Fournier, the applicant, was involved in an automobile accident on December 22, 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, The City of Ottawa, and applied to the Licence Appeal Tribunal — Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2The applicant listed Northbridge General Insurance Company on the Licence Appeal Tribunal application. However, the respondent’s counsel provided a Declaration of Representative on behalf of The City of Ottawa and advised the Tribunal by email dated May 20, 2026 that the listed insurer for this dispute is The City of Ottawa. In the respondent’s responding submissions for the written hearing it identified the insurer as The City of Ottawa and noted that the applicant had improperly indicated that Northbridge General Insurance Company was the insurer. The applicant did not provide reply submissions refuting that the proper insurer is The City of Ottawa. Since the applicant is not disputing The City of Ottawa is the proper insurer in this case for the purposes of this decision the respondent is identified as The City of Ottawa.

ISSUES

3The issues in dispute are:

i. Is the applicant entitled to attendant care benefits (“ACBs”) in the amount of $1,390.59 per month from August 27, 2023 to ongoing?

ii. Is the applicant entitled to $5,019.78 for other goods and services, proposed by dog walker in a treatment plan/OCF-18 (“plan”) dated April 25, 2024?

iii. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

4For the reasons below, I find that:

i. The applicant has not met her onus to establish entitlement to ACBs in the amount of $1,390.59 per month from August 27, 2023 to date and ongoing.

ii. The applicant is not entitled to the OCF-18 dated April 25, 2024 in the amount of $5,019.78 proposing other goods and services.

iii. The applicant is not entitled to interest.

Procedural issue

5The applicant filed a Notice of Motion on October 16, 2025 requesting that the Tribunal extend the deadlines for submission. The respondent consented to the request. A motion was granted on October 17, 2025 to extend the deadlines for submissions as follows:

i. Applicant’s written submissions – October 24, 2025;

ii. Respondent’s written submissions – November 7, 2025;

iii. Applicant’s reply submissions – November 14, 2025.

ANALYSIS

Is the applicant entitled to attendant care benefits?

6I find the applicant is not entitled to ACBs.

7Section 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 ACBs provided by an aide or attendant. Section 42(1) of the Schedule provides that an application for ACBs must be in the form of, and contain the information required to be provided in, the version of the document entitled Assessment of Attendant Care Needs (“Form-1”).

8Section 3(7)(e) of the Schedule provides guidance on when an expense is incurred: (i) the insured person has received the goods or services to which the expense relates, (ii) the insured person has paid the expense, has promised to pay the expense or is otherwise legally obligated to pay the expense, and (iii) the person who provided the goods or services, (A) 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 (B) sustained an economic loss as a result of providing the goods or services to the insured person.

9Pursuant to section 3(8) of the Schedule, the applicant may still be entitled to ACBs if she can show that the expense was not incurred because the respondent unreasonably withheld or delayed payment of the benefit. In these cases, the Tribunal may deem the expense to have been incurred. The applicant bears the burden of proving entitlement to ACBs on a balance of probabilities.

10The applicant submits she should be entitled to ACBs because her accident-related injuries have resulted in her being unable to bear weight or bend with her right leg, she has difficulty grasping with her right hand, and she has a reduced tolerance for standing. The applicant further submits that the ACB be deemed incurred because the expenses were unreasonably withheld and the respondent relied on flawed assessments or failed to consider compelling medical documentation. The applicant relies on 17-001681 v. Motor Vehicle Accident Claims Fund, 2018 CanLII 112134 (ON LAT) to support the position that ACBs are payable under section 3(8) of the Schedule even if they are not incurred because respondent relied upon flawed medical reports or failed to review all medical documentation available.

11I am not bound by other decisions of the Tribunal, and I find 17-001681 is distinguishable from the facts in this matter. Here, the applicant has not established that the respondent overlooked medical evidence or relied on flawed reports.

12The applicant directs me to the clinical notes and records (“CNRs”) of her family physician, the MRI of her wrist and right knee dated February 23, 2023, and February 28, 2023. The applicant’s accident-related injuries include injury to her right ribs, buttocks/hips, and hand/wrist. The applicant continued to experience pain in her right hand for a period of six to seven months after the accident based on the orthopaedic consultation dated July 7, 2023 prepared by Dr. Alenko Sakanovic, orthopaedic surgeon. However, Dr. Sakanovic notes on examination that “the MRI studies do not correlate with her clinical picture”, that the applicant’s wrist has full range of motion in extension and flexion, the radial and ulnar deviation were normal although her wrist is problematic and surgical interventions are not recommended for the applicant but it was suggested that the applicant continue with physiotherapy and exercises at home.

13The applicant also relies on the section 25 occupational therapy in-home functional assessment dated May 30, 2023 prepared by Magdalena Mirkowski, occupational therapist, that notes the applicant has a reduced ability to bend and assume lower-level positions, she has challenges lifting and carrying heavy items, and her fine motor coordination is significantly reduced. Ms. Mirkowski notes the applicant has a reduced ability to work, is only partially able to maintain her house keeping activities such as laundry, dishwashing, vacuuming and dusting, partially able to engage in leisure activities, and partially able to care for her teenage son as a result of her accident-related impairments.

14The section 25 occupational therapy in-home functional assessment notes the applicant requires 940 weekly minutes for Level 1 for routine personal care, 280 weekly minutes for basic supervisory functions, 70 weekly minutes for Level 3 complex functions, totaling ACBs of $1,390.60 per month.

15The respondent submits the applicant returned to work as a cash handler following the accident, she demonstrates full range of motion in all extremities, and she is independent in her personal care and housekeeping, although at times it may be with reduced frequency. The respondent also argues that the applicant stopped working due to her teenage son’s needs, and not due to her accident-related impairments. The respondent relies on the section 44 occupational therapy assessment report dated July 18, 2023, prepared by Jeena Abraham, occupational therapist, the CNRs of the family doctor, the orthopaedic consultation dated July 12, 2023 with Dr. Manisha Mistry, orthopaedic surgeon, the section 44 orthopaedic paper assessment dated May 26, 2023, prepared by Dr. Ato Sekyi-Out, orthopaedic surgeon, and the section 44 psychology assessment report dated June 8, 2023, prepared by Dr. Ronald Frey, psychiatrist.

16I find the applicant’s evidence does not persuade me as to her entitlement. I find it difficult to reconcile the section 25 occupational therapy in-home functional assessment with the other medical evidence before me. The applicant’s family doctor’s CNRs note the applicant stated she was off for two weeks after the accident; however, the applicant reported to Dr. Frey that she was working one week after the accident as a cash handler and stopped working because she needed to attend to her teenage son. Dr. Frey also notes the applicant reported doing the groceries, cooking for herself and her son, walking her son to school, taking the dog for walks two times daily, and being able to walk up and down stairs in her home, albeit with concerns for falling.

17The section 44 occupational therapy assessment report notes the applicant is independent in her self care and Dr. Mistry notes that her right wrist shows normal range of motion in extension and flexion. Ms. Abraham notes in the section 44 occupational therapy assessment report that the applicant is “able to complete self-care activities by taking her time and doing some of the activities … less frequently”. Based on the overall medical evidence, including the section 44 report and the family doctor CNRs, I am not persuaded the applicant’s reduced grip strength and reduced standing tolerance prevents her from engaging in her previous self-care activities.

18The Tribunal has consistently stated that a Form 1 is not determinative; it must be supported by convincing medical and functional evidence demonstrating a need for attendant care arising from accident-related impairment. The applicant provided no reply submissions to address the inconsistent reporting with the various medical assessors or how she was able to return to a job that requires fine motor tasks and repetitive motion work with her hands, such as cash handling.

19I place limited weight on the section 25 occupational therapy in-home functional assessment and Form 1 because the family doctor CNRs do not note a functional impairment, the right hand ultrasound notes that there is no “etiology to explain the patient’s clinical symptoms”, and while the applicant self reports pain and limited grip strength, in the evidence I have been directed to, the only prescribed treatment has been for physiotherapy and over the counter vitamin/supplements such as vitamin C and topical capsaicin ointment.

20The applicant submits that the section 44 occupational therapy assessment report dated July 18, 2023 should be given less weight because it ignores observations including the applicant’s minimal weight bearing on the right leg, her inability to bend at the knee, difficulties with right hand grasping, and her reduced standing tolerance. The applicant argues that the section 44 occupational therapy report does not account for her change in clothing choices, her change in mood, changes to her meal preparation routine, and her need for emotional support. In turn, the applicant relies on the review of occupational therapy insurer examination report dated July 8, 2024, 18 months after the accident, and one year after the section 44 report, prepared by Prianka St. John, occupational therapist.

21However, I prefer Ms. Abraham’s report that notes the applicant demonstrates functional range of motion in her lumbar, shoulder, elbow, wrist, hip, knee, and ankle. While I agree with the applicant that the section 44 report notes the applicant did not complete the grip strength test, however, she was able to scroll on her phone with her right hand and index finger. Similarly, while the applicant demonstrated she cannot bend with the supportive knee brace on, and that she shifted her weight while standing, the occupational therapist determined that there was no functional limitation as a result.

22Accordingly, on a balance of probabilities, I find that the applicant has not established entitlement to ACBs from August 27, 2023 to date and ongoing, in the amount of $1,390.59 per month.

Is the applicant entitled to $5,019.78 for other goods and services?

23I find the applicant is not entitled to $5,019.78 for other goods and services.

24To receive payment for a treatment and assessment plan under section 15 and16 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 the treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.

25The treatment plan dated April 25, 2024 for $5,019.78 for dog walking was submitted by Prianka St. John, occupational therapist. The stated goals include pain reduction, to support care giving activities, and to return to activities of normal living. Progress will be evaluated through occupational therapist observations and client reporting. The plan features form completion for $200.00, other supplies for $50.00, prescription for $87.29, dog grooming for $960, and dog walking services for $3,168.00.

26The applicant submits the costs of dog walking and grooming services is an essential service to assist with eliminating the effect of her disability resulting from her accident-related impairments. The applicant submits that the ongoing care for her dog challenges her physical and emotional recovery. In this case, the applicant did not direct me to specific evidence in support of the disputed treatment plan, and I infer she is relying on the totality evidence discussed above.

27The respondent submits that the treatment plan for dog walking is not reasonable and necessary and not essential for her rehabilitation. The respondent argues that the expense does not fit within the definition of rehabilitation, and the applicant has not demonstrated how it is essential for the applicant’s rehabilitation. The respondent relies upon F.V. v. Wawanesa Mutual Insurance Company, 2017 CanLII 44824 (ON LAT), and B.(G.) v. Pilot Insurance Co. (2008), 2008 CanLII 2602 (ON SCDC), 89 O.R. (3d) 228.

28When I consider the evidence on a balance of probabilities, I find the treatment plan is not reasonable and necessary pursuant to section 16(3) of the Schedule. In particular, section 16(3)(l) refers to “other goods and services 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, except, (i) services provided by a case manager; and (ii) housekeeping and caregiver services.”

29I find the applicant has not demonstrated that dog walking is essential for her recovery and I am not persuaded by the applicant’s arguments because Dr. Frey’s section 44 psychology report that notes she takes her dog outside for long walks and she also receives assistance from her teenage son who also takes the dog for walks. Additionally, Ms. Mirkowski’s section 25 occupational therapy report also notes that walking her dog is one of the social/leisure activities that she persists with since the accident. Also, the applicant did not direct me to contemporaneous medical evidence describing a need for this treatment.

30Lastly, in my view, section 16(3)(l) does not apply as this requires the insurer to agree that the other goods and services are essential, which the respondent expressly denies is essential to her rehabilitation or that it is reasonable and necessary for the purpose of reducing or eliminating the effects of her accident-related impairments.

31I find the applicant has not met her onus to demonstrate entitlement to the treatment plan for dog walking in the amount of $5,019.78.

Interest

32Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As the applicant has not established entitlement to any of the disputed benefits, no interest is payable.

ORDER

33For the above reasons, it is ordered that:

i. The applicant has not met her onus to establish entitlement to an ACB in the amount of $1,390.59 per month from August 27, 2023 to date and ongoing or $5,019.78 for the treatment plan dated April 25, 2024.

ii. The applicant is not entitled to interest.

iii. The application is dismissed.