Dispute focused on funding renovations to daughter’s residence to support appellant’s 24-hour care
The Ontario Superior Court of Justice has ordered an insurer to pay for home modifications, finding that the Licence Appeal Tribunal (LAT) erred in law by adopting an unduly narrow interpretation of “existing home” under the Statutory Accident Benefits Schedule (SABS).
The appellant, now 92, was injured in a motor vehicle accident in April 2016 and was subsequently deemed to have sustained catastrophic impairments. At the time, she was living independently in a condominium.
Following the accident, she sought funding for home modifications. She initially proposed renovations to her condominium unit, but later withdrew that plan due to concerns about structural feasibility and approval requirements.
The appellant then pursued an alternative plan to move into her daughter’s home, where she would receive continuous care. A report recommended modifications to that home for $388,082.53. The insurer did not assess the daughter’s home and instead approved approximately $22,825.53 for limited modifications to the appellant’s condominium.
The appellant applied to the LAT seeking payment of the additional amount for the daughter’s home modifications. The LAT denied the claim and upheld that denial on reconsideration.
The appellant elevated the matter to the Ontario Superior Court of Justice. The central issues on appeal included whether the LAT erred in its interpretation of “existing home” under the SABS and whether it improperly imposed a threshold requirement before considering the proposed move to the daughter’s home.
The court held that the LAT erred in law by applying a two-step analysis that required the appellant to prove that her condominium could not be modified before considering the alternative plan. The court found that no such threshold exists in the SABS.
The court further determined that the LAT adopted an unduly narrow interpretation of “existing home” by limiting it to the appellant’s residence at the time of the accident. The court noted that the LAT ignored the practical realities facing the appellant after the accident, such as structural barriers, the need for 24-hour care, and her intention to live with her daughter to receive that care.
“The purpose behind s.16(1) is to accommodate an applicant to a level that reduces or eliminates the effects of any disability caused by the accident. They are also intended to be sufficient to reintegrate the person into her family,” the court explained. “The objective of these provisions is to require the insurer to provide payment for home modifications and devices to accommodate the needs of the insured person in an existing home.”
The court found that the LAT’s approach failed to properly apply the statutory framework governing rehabilitation benefits and home modifications. It concluded that requiring proof of infeasibility of the original residence before considering an alternative location constituted an error of law.
Ultimately, the court allowed the appeal and set aside the LAT’s decision. It ordered the insurer to pay the appellant $365,257 forthwith for the proposed home modifications. The court relied on its authority to make any order that the tribunal could have made and found that an immediate payment order was appropriate in the circumstances.
