LAT Success: Successful Written Hearing Before the Licence Appeal Tribunal – De Angelis v. Aviva Insurance Company of Canada, 2026 ONLAT 24- 009572/AABS

For years now, auto insurers have been paying social workers and psychotherapists an hourly rate that is lower than the rate they charge their clients when providing psychotherapy services such as CBT. Auto insurers have been arbitrarily paying the lower hourly rates in an effort to save money on increasing medical and rehabilitation costs. Occasionally, a client will push back and refer the issue to the License Appeal Tribunal (the “LAT”) on behalf of the service provider.

In one such recent case, the LAT ordered the auto insurer to pay a social worker her stated hourly rate of $139 instead of the $100 per hour rate the auto insurer wanted to pay. Oatley Vigmond, acting for the applicant, was successful in obtaining payment of the higher hourly rate for social work services provided by an experienced and qualified practitioner of psychotherapy. Read the full decision here.

Key Takeaways

• The Financial Services Commission of Ontario Professional Services Guideline does not set a specific hourly rate for social workers or psychotherapists providing psychotherapy services.
• When the Guideline does not establish a rate, the parties may negotiate the fee, and disputes can be decided by the Licence Appeal Tribunal (LAT).
• The LAT found that a social worker providing psychotherapy and Cognitive Behavioural Therapy (CBT) could be compensated at a rate comparable to psychologists and psychological associates when supported by appropriate qualifications and evidence.
• Treatment plans are important, but the LAT confirmed that progress reports and treatment records may also help establish the nature of services being provided.
• Insurers have an ongoing obligation to review available information when adjusting claims and assessing treatment requests.
• The qualifications, clinical experience, and professional credentials of a treatment provider can be important factors when determining whether a proposed hourly rate is reasonable.

Facts:

Oatley Vigmond acted for the applicant in this case and they submitted two treatment plans for social work services by Elizabeth Waisberg, social worker and psychotherapist. For both plans, the insurer refused to pay Ms. Waisberg her hourly rate of $139 and instead agreed to fund the rate of $100 per hour.

Hourly rates for the services of health care providers are found in the Financial Services Commission of Ontario Professional Services Guideline (the “Guideline”). However, the Guideline is silent on the maximum hourly rate for a psychotherapist or social worker. Services not covered by the Guideline are to be determined by the parties. If the parties cannot come to an agreement, the Tribunal must decide the appropriate rate.

Issue:

The issue before the Tribunal was the appropriate hourly rate for the services of a social worker providing psychotherapy/Cognitive Behavioural Therapy (“CBT”).

Positions of the Parties:

Oatley Vigmond argued that by setting a $100.00/hour rate for Ms. Waisberg’s services, the insurer failed to properly consider her extensive qualifications or education, and the nature of the proposed services, which included the provision of psychotherapy and CBT.

The insurer submitted that the Tribunal has only found social work services to be payable at a higher rate where a provider has specialized training for specialized treatment that has been specifically proposed in the relevant plan.

Analysis of the Tribunal:

The Tribunal found that the omission of specific reference to the provision of CBT in the treatment plans was not solely determinative of the issue in dispute. Rather, the Tribunal found that progress reports documenting the treatment sessions of Ms. Waisberg indicated the provision of CBT to the applicant for her benefit. The Tribunal further found it was not an unreasonable expectation for the insurer to review the progress reports for evidence of the provision of CBT to the applicant, in light of its duty to continuously adjust the file.

Furthermore, the Tribunal determined that Ms. Waisberg possesses the requisite qualifications and licensure to provide psychotherapy owing to her registration with the Ontario College of Social Workers and accreditation from the Adler Graduate Professional School.

The Tribunal therefore concluded Ms. Waisberg was in fact providing psychotherapy services comparable to other providers for a fee rate prescribed by the Guideline, namely that of a psychologist and/or psychological associate, paid at the rate of $149.61 per hour.  As such, the LAT found her proposed fee of $139/hour to be reasonable and it ordered the insurer to pay her rate.

Frequently Asked Questions

What was the main issue in this Licence Appeal Tribunal decision?

The central issue was whether a social worker providing psychotherapy and Cognitive Behavioural Therapy (CBT) should be paid her proposed rate of $139 per hour or the insurer’s proposed rate of $100 per hour. The dispute arose because the applicable Professional Services Guideline did not specify a maximum hourly rate for social workers or psychotherapists providing these services. As a result, the Licence Appeal Tribunal was asked to determine what constituted a reasonable rate based on the provider’s qualifications, experience, and the nature of the treatment being delivered.

Why did the insurer refuse to pay the social worker’s full hourly rate?

The insurer took the position that the proposed hourly rate exceeded what it considered appropriate for the services being provided. It argued that higher rates had generally been approved in situations involving specialized training and specialized treatment that were clearly identified within the treatment plan. Based on its assessment, the insurer agreed to fund the services at a lower hourly rate. The disagreement ultimately required a determination by the Tribunal regarding whether the provider’s qualifications and services justified the higher proposed fee.

How did the Tribunal determine the appropriate hourly rate?

The Tribunal considered several factors, including the provider’s education, professional credentials, licensure, experience, and the actual treatment being delivered to the injured person. It reviewed treatment records and progress reports to determine whether psychotherapy and CBT were being provided in practice. The Tribunal also examined comparable services recognized under the Professional Services Guideline. After considering the evidence, it concluded that the provider’s proposed rate was reasonable given the nature of the psychotherapy services being delivered.

Did the absence of specific CBT references in the treatment plan affect the decision?

The Tribunal found that the omission of specific references to CBT in the treatment plans was not determinative. Instead, it looked beyond the treatment plans and reviewed the available progress reports and treatment documentation. Those records demonstrated that CBT techniques were being used during the course of treatment. The decision highlights the importance of considering the complete treatment record rather than focusing exclusively on the wording contained in a proposed treatment plan when assessing the services being provided.

Why were the social worker’s qualifications important to the outcome?

The Tribunal placed significant weight on the provider’s qualifications and professional credentials. The evidence showed that the social worker was registered with the Ontario College of Social Workers and had additional accreditation supporting her ability to provide psychotherapy services. These qualifications helped establish that she possessed the training and expertise necessary to deliver psychotherapy and CBT. The Tribunal ultimately concluded that her services were comparable to those provided by other regulated mental health professionals whose rates are specifically recognized under the Guideline.

What role did progress reports play in the Tribunal’s decision?

Progress reports were an important part of the evidence. Although the treatment plans did not explicitly emphasize CBT, the progress reports documented the treatment being provided and demonstrated that psychotherapeutic techniques were being used. The Tribunal relied on this information when evaluating the nature of the services delivered. This aspect of the decision underscores the importance of maintaining detailed and accurate treatment records, particularly when disputes arise regarding the necessity, scope, or value of treatment services.

What does this decision mean for social workers providing psychotherapy in Ontario?

This decision suggests that social workers with the appropriate qualifications, experience, and expertise may be entitled to compensation that reflects the psychotherapy services they are providing. The Tribunal recognized that where psychotherapy and CBT are being delivered by a qualified practitioner, it may be appropriate to consider comparable rates paid to other professionals providing similar services. However, each dispute will depend on its own facts, the available evidence, and the qualifications of the individual provider involved.

Does this decision apply to every psychotherapy treatment plan submitted after a motor vehicle accident?

No. Tribunal decisions are highly fact specific and depend on the evidence presented in each case. This decision was based on the qualifications of the provider, the documented treatment being delivered, and the specific dispute before the Tribunal. While the ruling may provide useful guidance for similar cases involving psychotherapy services, it does not automatically guarantee a particular rate in every situation. Insurers, providers, and adjudicators will continue to assess each claim on its own merits.

What should injured individuals know if treatment fees become an issue after a motor vehicle accident?

Individuals receiving treatment after a motor vehicle accident should ensure that treatment plans, progress reports, and supporting medical documentation accurately reflect the services being provided. In communities such as Toronto, Mississauga, and throughout Ontario, disputes can arise regarding the reasonableness of treatment costs or the amount insurers are willing to fund. Maintaining thorough records can help clarify the nature of the treatment and support discussions between providers, insurers, and, where necessary, the Tribunal.

When should someone seek legal assistance regarding a treatment funding dispute?

Legal advice may be helpful when there is a disagreement about whether treatment should be funded, whether a proposed fee is reasonable, or whether an insurer has properly assessed the available evidence. For accident victims in Barrie, Vaughan, or elsewhere in Ontario, disputes involving rehabilitation and treatment funding can have a significant impact on access to care. An experienced personal injury lawyer can review the circumstances, explain the applicable accident benefits framework, and help determine what options may be available for resolving the dispute.