What happened: An Ontario tribunal turned down three of four disputed accident benefits claims against Aviva.
Who’s involved: Aviva General Insurance Company and a claimant hurt in a May 2024 road accident.
What’s at stake: Treatment plans of $4,580.08, $5,325.13 and $595.32, plus a $22.94 prescription.
Why it matters: Surveillance, thin medical records and a silent rate guideline decided most of the case.
Where it stands: Decided October 8, 2026; the claimant won only the $22.94 prescription, plus interest.
A $1,300 robotic cleaning system topped the price list in a $5,325.13 treatment plan for an Ontario woman hurt in a road accident.
The plan also covered an anti-fatigue mat, a lumbar support cushion, a foam roller for her left calf and a $150 installation fee. It relied on an occupational therapist’s report that reduced standing tolerance and stamina had left her unable to complete household tasks.
Aviva General Insurance Company said no. So did Ontario’s Licence Appeal Tribunal, in a decision released October 8, 2026.
The claimant told her therapist she had not returned to work as a hairdresser, or to the gym, since the accident.
A surveillance report dated August 24, 2025, showed her on a treadmill, stretching and using a weight resistance machine. Later, she was seen at her workplace, styling and cutting hair.
The tribunal said her reports to the therapist were “in direct contradiction to the Surveillance Report where the applicant is seen exercising and working.” She never responded to that evidence in her submissions. The tribunal found her “credibility is in question as to her true functional limitations” and gave the therapist’s report limited weight.
An occupational therapist who examined her for Aviva found she “presented with a high level of functioning” and called the devices and sessions excessive. The tribunal sided with Aviva on the plan.
Her other claims ran into a records problem. A $4,580.08 chiropractic plan, with 16 sessions each of manipulation, therapy and acupuncture, leaned on her family doctor’s notes, but only a few visits mentioned accident-related complaints.
One January 2025 visit recorded “no headaches/dizziness, no back pain/knee pain/joint pains.” She also never filed notes from the clinic treating her.
The tribunal’s message on that was short: “a treatment plan itself is not evidence of the applicant’s impairments or need for ongoing treatment.”
The last fight was over $595.32 and one question: what is an hour of therapy from a social worker worth?
Her psychological treatment plan priced 12 one-hour sessions at $149.61, the top hourly rate for psychologists. Aviva approved the plan in part in June 2025 but paid $100 an hour, since a registered social worker was providing the therapy.
The claimant argued the social worker offered the same cognitive behavioural therapy as a psychologist, worked under a psychologist’s supervision and could treat her without an interpreter. Aviva pointed to four earlier tribunal rulings that accepted $100 an hour for social workers providing psychological therapy.
The Superintendent’s rate guideline sets maximum hourly fees for psychologists, at $149.61, and for unregulated providers such as counsellors, at $58.19. It says nothing about social workers, so the tribunal said the rate is for the parties to work out, and it is up to the claimant to show a higher rate is reasonable.
She couldn’t. The tribunal had nothing on the social worker’s education, training, experience, usual rate or expertise, and no records showing how the supervision worked or how often it happened.
It also couldn’t see how skipping an interpreter changed what the social worker could charge. Aviva’s $100 rate stood.
The claimant did take one round. Aviva had turned down $22.94 for cyclobenzaprine, a muscle relaxant also sold as Flexeril, arguing she had not provided an itemized receipt.
The tribunal found a pharmacy receipt and hospital records showing the drug was prescribed for her accident injuries. It ordered Aviva to pay, with interest.
Her bid for a special award, which can add up to 50 per cent of the benefits payable when an insurer unreasonably withholds or delays payment, did not succeed. The tribunal found no evidence Aviva had done either.
In the end, the only new money ordered was $22.94, plus interest.
With no set rate for social workers in the guideline, this ruling gives Ontario accident benefits adjusters a recent example of a tribunal holding the line at $100 when a claim comes with no proof of the provider’s credentials or supervision.
The tribunal decided the case on written submissions, and the decision does not say whether either side plans to challenge it.
