What happened: An Ontario tribunal turned down a claimant's bid for six treatment and assessment plans from Intact.
Who's involved: Intact Insurance Company and a driver claiming statutory accident benefits after a 2022 crash.
What's at stake: Plans worth $1,194.38 to $2,435.80 each, plus interest and a possible penalty award.
Why it matters: A therapist's credentials, not job title, decide the rate, and clinic visits don't prove treatment works.
Where it stands: Decided September 23, 2026. The application was dismissed in full.
One psychotherapist, two possible hourly rates: $58.19 or $149.61. The claimant wanted the higher one. She never showed the tribunal her therapist's credentials.
Ontario's Licence Appeal Tribunal sided with Intact Insurance Company on September 23, 2026, in an accident benefits dispute stemming from a December 5, 2022 crash. The claimant had challenged six treatment and assessment plans and asked for interest and a penalty award. She came away with nothing.
Psychological care was the biggest ticket. A plan from her psychologist came to $4,015.13. Intact funded $1,579.33 and refused the remaining $2,435.80.
Intact paid the psychotherapy at $58.19 an hour, the figure it said the Professional Services Guideline sets for psychotherapists. The claimant argued past tribunal rulings had allowed $99.75 an hour for treating diagnosed disorders, and more again where a psychotherapist's credentials closely matched a psychologist's.
Her best example was an earlier Intact case. There, a registered psychotherapist trained in Cognitive Behavior Therapy was paid the full psychologist rate of $149.61 an hour.
The tribunal didn't disagree with the idea. A psychotherapist doing a psychologist's work can earn more than the guideline rate, it said. The catch: someone has to prove the credentials first.
That proof never came. The file had no degrees, no designations, no work history and no CV.
There was a second gap. Intact had asked, in a July 11, 2023 explanation of benefits, why the plan needed 1.5-hour sessions instead of one hour. That question never got an answer.
Three chiropractic plans, worth $2,023.03, $1,525.84 and $1,194.38, ran into a different problem. The claimant had attendance charts proving she was going to treatment.
That wasn't the point. In the tribunal's words, "attendance alone does not provide support that the proposed plan is reasonable and necessary."
What the tribunal wanted to see was progress, such as less pain, more movement or more strength. She pointed to no clinic progress notes, and her family doctor's records mentioned no benefit from the treatment.
Intact's own medical assessor had found full range of motion and no evident impairment. The tribunal gave that report more weight than a chronic pain assessment the claimant relied on.
The records didn't line up either. Headaches, blurry vision and light sensitivity she described to one assessor never showed up in her family doctor's notes. "I cannot reconcile the discrepancy in the reporting of physical impairments to an assessor as compared to the family doctor," the adjudicator wrote.
Two $2,200 assessments, one by an occupational therapist and one for attendant care, went the same way.
On attendant care, the claimant argued that being taken out of the Minor Injury Guideline entitled her to an in-home assessment. She leaned on Co-operators Insurance Company v Bennett, a 2024 Divisional Court ruling.
Intact read the case differently, and the tribunal agreed. She was "potentially eligible, but not entitled," and the assessment still had to be shown to be needed.
It wasn't. She told an occupational therapist assessing for Intact that she handled all her own self-care, cooked meals while pacing herself and looked after her youngest daughter, with some help from family.
With nothing owing, there was no interest. The tribunal also found Intact had not unreasonably held back or delayed payment, so there was no penalty award either.
Adjusters handling Ontario accident benefits can ask for a therapist's credentials before paying above the guideline rate, and for proof of progress rather than a stack of attendance sheets.
The decision does not say whether either side plans to seek reconsideration or appeal.
