Aviva lost a session-duration dispute at Ontario's Licence Appeal Tribunal after citing a general website to override a treating practitioner's clinical recommendation.
The decision, released July 23, 2026, arose from a July 15, 2023 automobile accident. The claimant sought statutory accident benefits and submitted three psychological treatment plans through Pinnacle Health Network & Assessments, each requesting $4,959.75 for counselling sessions, preparation, documentation, and planning fees. Aviva partially approved each plan.
Two disputes sat at the centre. The first was the hourly rate for a registered psychotherapist. The treatment plans billed sessions at $149.61 per hour - the maximum the Professional Services Guideline sets for psychologists and psychological associates. Aviva approved $99.75, arguing the Guideline sets no specific rate for psychotherapists.
The adjudicator agreed with Aviva on the rate. Superintendent's Guideline No. 03/14 is silent on psychotherapist rates, and the onus fell on the claimant to justify a higher one. The adjudicator found that the psychotherapist's resume contained nothing in its education, training, or certifications sections to support specialized training in cognitive behavioural therapy. A reference to CBT under one employment entry was insufficient, the adjudicator held.
The adjudicator also applied the principle from a prior Tribunal decision, finding that the claimant's decision to proceed with treatment at the approved rate without negotiating was tantamount to an agreement to the lower amount.
On session duration, however, the claimant prevailed. Aviva had reduced the June 3, 2025 treatment plan from 1.25-hour sessions to one hour, citing general information from the CAMH website stating that psychotherapy sessions generally last between 20 and 50 minutes. The adjudicator rejected that reasoning, finding the website offered a general statement that did not consider the claimant's individual injuries or needs. The treating practitioner, who had worked with the claimant through two prior treatment plans, was in the best position to assess appropriate session length, the adjudicator held. The claimant was awarded $598.44 plus interest for the additional quarter-hour across 16 sessions.
Aviva also prevailed on ancillary fees. The adjudicator denied charges for planning, documentation, and preparation across all three treatment plans, finding that communication, homework checking, and note-taking were costs already covered by the provider's hourly rate. A progress report fee was denied on the basis that progress information could be captured through a subsequent treatment plan.
The claimant's bid for HST on the February 27, 2025 treatment plan also failed. The adjudicator noted that psychotherapy services delivered by a registered psychotherapist in Ontario have been exempt from HST under the Excise Tax Act since June 20, 2024.
A separate treatment plan for a driving reintegration assessment, dated April 13, 2025, was partially denied. The adjudicator found the treatment provider did not give sufficient detail about the services recommended, and the claimant did not make specific submissions explaining why the individual denied components were reasonable and necessary.
The Tribunal denied a special award under section 10 of Regulation 664 after the claimant made no submissions on entitlement.
