An Ontario tribunal has ordered Wawanesa Mutual Insurance Company to fund a $16,686.70 standby generator for a catastrophically impaired auto accident claimant.
The Licence Appeal Tribunal released its decision in Douglas v Wawanesa Mutual Insurance Company, 2026 CanLII 48400 (ON LAT) on May 15, 2026, partially granting Alcinda Douglas's claim for statutory accident benefits following an August 11, 2018 auto accident.
Wawanesa had previously deemed Douglas catastrophically impaired under Criterion 7 by letter dated November 18, 2021. The dispute before adjudicator Caley Howard involved three treatment plans proposed by occupational therapist Justyne Russell.
The centrepiece plan, dated February 6, 2023, sought $16,686.70 for the purchase and installation of a standby gas generator system in Douglas's home. She had undergone a number of surgeries to her leg after the accident and continues to rely on a walker or quad cane for all ambulation. She argued her mobility limitations made her unable to manipulate a portable generator, gas tanks and extension cords.
Douglas lives alone on a rural property in Ontario's snow belt region. In the winter of 2022, she was without power for 50 hours, with no access to heat, hydro or telephone communication. The experience exacerbated her accident-related PTSD and anxiety, and she has since rented a room in Mexico for the winter months.
Wawanesa argued the cost was excessive for what would only be used in rare power outages. The insurer pointed to battery back-ups proposed for the porch lift, automated door and stair lift being installed in Douglas's home. It also relied on a surveillance report dated July 15, 2022 and the paper review report of occupational therapist Dan Gauthier dated January 17, 2023.
Adjudicator Howard rejected those arguments. The battery back-ups would maintain power to the mobility devices but not to heat and communication systems necessary for the applicant's general safety. Howard gave little weight to Gauthier's report because he had not addressed whether Douglas could use a portable generator or clear snow herself. The surveillance, conducted in fair weather, did not address her mobility in winter conditions.
The tribunal also approved a treatment plan dated September 6, 2023 for massage therapy. Wawanesa had relied on the paper review report of orthopedic surgeon Dr. David Stevens, who opined Douglas had reached maximal medical recovery. Howard gave Stevens's opinion less weight because he did not consider whether massage therapy could provide temporary pain relief - a goal the tribunal accepted as valid in this case.
A third treatment plan dated May 4, 2023 seeking $1,083.23 was denied. Neither party made submissions on that plan and Douglas had not withdrawn the issue, so she failed to meet her burden of proof.
Howard rejected Douglas's bid for a special award under section 10 of Regulation 664, finding Wawanesa's reliance on its existing OT report and surveillance was not unreasonable. The respondent, Howard noted, "is not required to obtain an independent examination for each treatment plan."
Douglas is also entitled to interest on the overdue benefits.
