An Ontario tribunal ordered TD General Insurance to fund attendant care and most disputed treatment - while drawing a firm line on providers' travel costs.
The Licence Appeal Tribunal released its decision on July 15, 2026, following a written hearing. The claimant was hurt in an automobile accident on March 11, 2023, and sought statutory accident benefits. TD General Insurance Company denied the benefits, and he brought the dispute to the Tribunal.
At the centre was attendant care. The applicant claimed $10,516.23 per month from September 9, 2023, to date and ongoing, relying on his occupational therapist's assessment. TD countered with its own examining occupational therapist, who recommended $1,210.50 a month and found the applicant largely independent.
The adjudicator placed significant weight on the applicant's assessor, who had monitored him across multiple assessments and documented persistent pain, dizziness, balance concerns and cognitive difficulties. She found the insurer's assessment overestimated the applicant's independence, offered little detail on his post-accident function, and did not address his dizziness, fall risk or cognitive concerns. Because the applicant held optional benefits capping attendant care at $6,000 per month, the Tribunal awarded up to that amount - not the higher figure claimed - payable once incurred.
For claims professionals, the sharpest line was on transportation. The applicant could not drive, so several treatment plans called for in-home physiotherapy and occupational therapy, along with the provider's travel time and mileage. The adjudicator held that once an insurer approves in-home services as reasonable and necessary, the provider's travel time to those sessions becomes a necessary expense to complete them. Mileage was different. There is "no provision in the Schedule for payment of mileage expenses" for service providers, the adjudicator found, so a $1,188.00 mileage component was struck from one plan.
That distinction shaped the treatment-plan awards. The Tribunal granted the full $2,992.56 balance of a June 9, 2023 physiotherapy plan, all of it provider travel time. It partially allowed a November 6, 2023 physiotherapy plan at $13,403.12, removing only the mileage. A December 4, 2023 occupational therapy plan was partially allowed at $3,840.88 plus tax, with a sleep-and-focus device rejected because the applicant supplied no particulars on why it was needed.
The applicant fared better on two March 11, 2025 plans. The Tribunal approved $5,261.72 for speech-language services and a 13-inch iPad Air recommended as a memory aid, and $1,160.00 for the balance of a social work plan covering an assessment report.
The applicant also sought a special award under section 10 of Regulation 664, which lets the Tribunal order up to half of benefits payable where an insurer unreasonably withholds or delays payment. He made no submissions on the point, and the Tribunal declined to make an award. Interest on any overdue benefits was granted under section 51 of the Schedule.
The decision was heard by way of written submissions.
