A tribunal denied translation costs tied to approved psychological counselling, finding the claimant never justified why the service was reasonable or necessary.
The Ontario Licence Appeal Tribunal ruled on a dispute between a claimant and Definity Insurance Company over statutory accident benefits following a December 2022 collision. Definity had denied several treatment plans, sending the matter to a written hearing before adjudicator Nadia Mauro.
Among the disputed items was a $2,097.62 treatment plan for translation services, tied to psychological counselling the claimant had already been approved for. Definity pointed to guidance from the Financial Services Regulatory Authority of Ontario stating "the cost of interpreter is not intended to be covered under the SABS." Mauro found the claimant had not explained why the service was needed, cited no authority supporting the claim, and made no submissions on why the cost was reasonable. The plan was denied.
The larger issue in the case was whether the claimant's injuries fell within the Minor Injury Guideline, which caps medical and rehabilitation benefits at $3,500. The claimant's psychologist, Dr. Jacqueline Brunshaw, diagnosed Adjustment Disorder with Mixed Anxiety and Depressed Mood, along with a specific phobia related to driving. Definity's own assessor, Dr. Rod Day, found no accident-related psychological impairment at all.
Mauro noted both reports relied heavily on the claimant's self-reporting and limited documentation, but found the treating physician's clinical notes, along with counselling records showing ongoing emotional distress, aligned more closely with Brunshaw's diagnosis. On that basis, she ruled the claimant's injuries fall outside the Minor Injury Guideline and approved a $3,697.14 treatment plan for psychological counselling, plus interest.
The claimant fared less well on other claims. A $2,486.00 chronic pain assessment was denied after Mauro found the treating physician had made no chronic pain diagnosis or referral. A $2,706.14 physiotherapy plan was denied for lack of contemporaneous evidence of ongoing accident-related pain, and a separate $1,402.40 physiotherapy plan was denied because the claimant made no submissions on it at all. A $1,402.40 massage therapy claim was also denied, as the services had not been pre-approved by Definity and did not fall within any statutory exception for pre-approval. A small unapproved portion of an earlier physiotherapy plan, worth $200, was awarded along with interest.
Mauro also declined to order a special award against Definity for unreasonably delaying or withholding benefits, finding no evidence the insurer had ignored medical evidence in favour of its own assessor's conclusions.
A separate procedural dispute arose when Definity asked the tribunal to strike the claimant's reply submissions entirely, arguing they were filed late and improperly raised new arguments. Mauro found parts of the reply did overstep proper scope but declined to strike any of it, noting Definity had not shown it was prejudiced.
