*Since the writing of this blog the decision has been refused reconsideration or rehearing.
While Disneyworld may be the happiest place on earth, the recent decision of the LAT in F.V. v Wawanesa Mutual Insurance Company, 2017 CanLII 9817 (ON LAT) confirmed that trips there are not necessarily payable by accident benefits insurers as rehabilitation benefits. In F.V. v Wawanesa the claimant was catastrophically injured in a motor vehicle accident on October 25, 2010. He claimed for $4,689.81 of rehabilitation benefits in relation to three treatment plans submitted in September and November of 2015. The treatment plans requested payment for expenses incurred during a trip to Florida and Disneyworld with his daughter’s family and grandchildren, and included items such as flights, accommodations, meals for an attendant and medical supplies. The claimant argued that as the expenses were for the purpose of facilitating reintegration into his family, they fell within the scope of rehabilitation benefits as identified in section 16 of the SABS.
In interpreting the scope of section 16, Adjudicator Lester referred to the activities identified in section 16(3) of the SABS, and confirmed that the activities identified as payable were counselling, training, home, work or vehicle modifications, and devices to assist the injured person, with the goals of reducing the effects of the Claimant’s disability, or facilitating his reintegration into his family, society, or the labour market. Section 16(3) did not contain a “catch all” provision that allowed for payment of any and all additional expenses that related to these rehabilitative goals. As such, the expenses related to the trip were not found to fall within the ambit of section 16.
Overall, this decision is viewed as a continuation of the LAT’s somewhat strict interpretation of the SABS provisions. It is also consistent with Arbitrator Evans’ (as he then was) decision in Johnston and Pafco (FSCO A99–001086, September 28, 2000), in which the claimant’s travel expenses to spend Christmas with a family member when other family members could not attend to her at home were found not to be payable as rehabilitation expenses.
If you have a question about this blog or a similar file, please contact Eric Grossman at 416-777-5222
