Ontario's accident benefits tribunal slashed an attendant care claim from $2,058.90 to $522.30 a month, partly citing devices the insurer had already approved.
In Kelly v Intact Insurance Company, 2026 CanLII 56646 (ON LAT), the Licence Appeal Tribunal awarded Fiona Kelly $522.30 per month in attendant care benefits from January 30, 2026, to date and ongoing - far less than the $2,058.90 she had sought.
Kelly was hurt in an automobile accident on September 1, 2018, and claimed benefits under Ontario's Statutory Accident Benefits Schedule. Intact Insurance Company denied the benefits, and she brought the dispute to the Tribunal.
The decision was a partial rehearing. A January 30, 2026 ruling had found Kelly was not entitled to attendant care benefits "to the date of this decision." A reconsideration dated April 29, 2026 found the original adjudicator had not addressed whether benefits should continue past that date, so the rehearing examined her entitlement from January 30, 2026 onward.
The two sides relied on competing occupational therapists. Kelly's assessor, Afsha Husain, recommended $2,058.90 a month based on a Form 1 dated May 15, 2024. Intact's occupational therapist recommended $0 in a Form 1 and report dated November 20, 2024. Intact's medical assessors - a general practitioner, a neurologist and a psychologist - found Kelly had no impairments requiring attendant care, though the psychologist diagnosed accident-related major depressive disorder and post-traumatic stress disorder in partial remission.
Adjudicator Ulana Pahuta worked through the claim item by item. She accepted that Kelly needed prompting and assistance for hair washing and shaving, citing low motivation, pain and fatigue and a disheveled appearance. She allowed 315 minutes a week for meal preparation rather than the 630 minutes claimed, and 90 minutes a week for bathroom and bedroom hygiene.
Several items were rejected. Pahuta found Kelly had not established a need for help with mobility, overnight supervision, medication management or bathing. She also found parts of the supervisory care claim duplicated assistance already counted elsewhere.
For claims professionals, the notable thread was how Intact's own approvals shaped the outcome. On April 30, 2025, more than seven years after the accident, the insurer had approved treatment plans and assistive devices, including a staircase railing, an eight-cup food processor and a shower hose. Pahuta repeatedly pointed to those approvals when trimming the claim, reasoning that the devices promoted independence and reduced the need for hands-on care. Approved rehabilitation therapy and the staircase railing, for example, helped defeat the request for mobility assistance.
The Tribunal set total attendant care benefits at $522.30 per month, payable once incurred under section 3(7)(e) of the Schedule. The award runs from January 30, 2026, to date and ongoing.
The decision, heard by way of written submissions, was released on June 9, 2026.
