Navigating Social Work Hourly Rates in Motor Vehicle Accident Claims: Practical Insights and Best Practices from Recent LAT Decisions

Social workers play a crucial role in the medical rehabilitation of clients injured in motor vehicle accidents. Despite clear contributions, many practitioners continue to face challenges when seeking remuneration rates equivalent to psychologists, who are currently recognized at $149.61 per hour by the Professional Services Guideline which has not been revised since 2014. Recent decisions by the Licence Appeal Tribunal (LAT), including the notable Adamusiak v. Aviva Insurance Canada (2025 ONLAT 23-006449/AABS), have underscored specific, actionable steps that social workers should take to substantiate their claims for equitable compensation.

This guide synthesizes essential learnings from recent LAT decisions, professional standards as endorsed by the Ontario Association of Social Workers (OASW), and best practices for ensuring a successful claim for higher hourly rates.

Key Lessons from Adamusiak v. Aviva Insurance Canada

Although the outcome in Adamusiak was unfavourable for the applicant, this decision offers helpful guidance on achieving recognition for rates commensurate with psychologists:

1. Specialized Training and Explicit Documentation are Essential

• The LAT emphasized the absolute necessity of providing explicit documentation regarding specialized training and qualifications.
• Merely holding membership in professional bodies such as the Ontario College of Social Workers and Social Service Workers (OCSWSSW) and the College of Registered Psychotherapists of Ontario (CRPO) was deemed insufficient.
• Social workers must provide robust evidence, preferably through detailed curriculum vitae (CV) submissions, to demonstrate specialized training in the treatment modalities being used, such as Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), or Mindfulness-Based Stress Reduction (MBSR).

2. Clear Indication of Treatment Modalities

• The LAT reiterated that treatment plans (OCF-18 forms) should explicitly outline the modalities employed.
• Generalized descriptions, such as “counselling, interpersonal relationships,” are inadequate to meet this standard. Instead, explicitly state specialized psychotherapeutic techniques (e.g., CBT, DBT, MBSR) in the plan’s comments section or supplementary attachments to further substantiate the higher hourly rate proposed.
• The lack of such specificity was central in the LAT’s denial of a higher rate.

3. Proactive Communication and Evidence Submission

• Social workers should proactively communicate their specialized qualifications and the rationale for the higher hourly rate early in the process.
• When insurers request supporting information, timely responses and complete disclosure of qualifications and treatment methodologies significantly bolster claims.

Relevant Case Law and LAT Precedents

Several LAT decisions have further clarified the benchmarks social workers must meet:

• J.V. v. Intact Insurance Company, 2019 CanLII 76995 – $149.61 per hour
  Successfully demonstrated that a psychotherapist with specialized training in CBT should be compensated at rates equivalent to psychologists. The key to success was explicit documentation of the therapist’s training and the clear proposal of CBT in the treatment plan.
• R.O. v. Aviva Insurance Company of Canada, 2019 CanLII 122721 – $130.00 per hour
  Notably found that a social worker’s claimed rate of $130/hour was reasonable based on the specific evidence provided. The LAT:
  • Rejected the insurer’s claim that social workers should be treated as “unregulated providers” at $58.19/hour.
  • Acknowledged the OASW-prescribed fee of $130/hour as valid and undisputed in this case.
  • Accepted that the same provider had been previously approved at $100/hour by the insurer, undermining their position.
  • Confirmed that the LAT does have jurisdiction even where a treatment plan is partially (not wholly) approved.
  • Critically, the adjudicator emphasized that this decision was not setting a precedent but rather was based on the balance of evidence in this particular case.
• Baranov v. Aviva General Insurance, 2020 CanLII 87933 – $99.75 per hour
  Reinforced the necessity of explicitly referencing specialized psychotherapeutic treatments within treatment plans. In this case, although the psychotherapist held advanced qualifications (master’s degree and CBT specialty), the failure to explicitly propose CBT within the treatment plan itself resulted in the denial of the higher hourly rate sought ($224.42/hour). The LAT affirmed the insurer’s approved rate of $99.75/hour as reasonable, given the provider’s credentials but the absence of explicit documentation of specialized treatment in the submitted plans.
• Dhanji v. Aviva Insurance Company of Canada, 2021 CanLII 19424 – $100.00 per hour
  Emphasized again the critical importance of demonstrating specialized training, qualifications, and explicitly indicating treatment modalities. The absence of these details led to refusal of higher compensation rates.
• Kane v. Aviva Insurance Company, 2021 CanLII 55137 – $100.00 per hour
  Further distinguished the essential need to explicitly propose CBT or similar specialized treatments in OCF-18 forms. Absence of explicit mention of specialized psychological modalities resulted in an hourly rate being limited to $99.75.
• Rawana v. Aviva Insurance Company, 2021 CanLII 60468 – $99.75 per hour
  Underscored the critical importance of submitting detailed documentation regarding a social worker’s training and qualifications, including a comprehensive curriculum vitae (CV). In this decision, the LAT denied the higher hourly rate ($127/hour) primarily due to:
  • Absence of a submitted CV and insufficient evidence detailing the provider’s specific qualifications and training.
  • Reliance solely on Ontario Association of Social Workers (OASW) recommended rates was considered insufficient without clear evidence of the social worker’s specific qualifications and experience level.
  • The decision emphasized that, despite OASW’s suggested rates ($110 to $150/hour), the LAT requires clear proof of qualifications and explicit evidence demonstrating why higher-than-guideline rates are reasonable and necessary.
• Jindal v. Novex Insurance Company, 2023 CanLII 87429 – $99.75 per hour
  Reinforced the necessity for psychotherapists/social workers to clearly substantiate specialized psychological interventions and training. Generic service descriptions or inadequate documentation of specialization resulted in denial of psychologist-level rates.

Best Practices: How Social Workers Can Successfully Claim Higher Rates

1. Comprehensive Documentation of Qualifications

• Maintain a detailed, current CV explicitly listing specialized training and experience in recognized psychological modalities. Attach your CV or Bio to each treatment plan (OCF-18) submitted for approval, along with a rationale for the rate proposed.

2. Explicit Treatment Plan Submissions

• Clearly specify treatment methods like CBT, DBT, and MBSR in the “additional comments” or attachments to the OCF-18. If a progress report is accompanying the OCF-18, ensure to provide clarification of the specific type of treatment modality being proposed with the accompanying plan, and why this modality is reasonable and necessary for your client.
• Avoid generic terms (such as “psychotherapy”, or “mental health counselling”); ensure specific psychotherapeutic techniques that will be utilized are mentioned in the plan.

3. Proactive Communication

• Engage insurers early in detailed discussions about your professional expertise and rationale for higher fees. Make sure to forward copies of this communication to your client’s legal representative to ensure they have a record of this communication with the insurer.
• Provide insurers with authoritative references to relevant LAT cases and the OASW recommended rates, enhancing transparency and facilitating agreement.
• Any negotiation in your rate should be done bearing in mind the historically approved rates, in keeping with your training and qualifications. When an agreement is reached with the insurer, document this agreement and refer back to it when needed in future discussions with the same insurer.

4. Strategic Use of OASW Guidelines

• Cite OASW-recommended hourly rates explicitly in treatment proposals and communications with insurers, reinforcing that the requested fees align with recognized industry standards. Attach any communique from the OASW to the profession for the adjuster’s reference.

Practical Example from Adamusiak

The Adamusiak decision explicitly outlines what the LAT expects:

• Explicitly Proposed Specialized Therapy: Clearly indicate specific therapies (e.g., CBT) on OCF-18.
• Documented Specialized Training: List/attach any certifications, training certificates, or provide your detailed CV explicitly listing specialized training in the treatment modality proposed within your plan.
• Transparent Submissions: Provide comprehensive and timely documentation proactively to avoid adverse inferences or gaps in evidence that may undermine the claim.

Moving Forward: Respecting the Role of Regulators and Driving Change

While the Adamusiak decision did not grant the desired outcome, it provided critical clarity on the LAT’s expectations. Social workers aiming for equitable compensation must clearly document their specialized skills and explicitly outline therapeutic modalities in treatment submissions. By aligning your approach with these clear LAT guidelines, relevant LAT precedents, and professional standards set by the OASW, you will significantly improve your prospects for achieving fair remuneration reflective of your professional expertise and contribution.

In our submissions to the LAT, we firmly argued that it is not the role of the LAT to assess the adequacy of a regulated professional’s credentials. We firmly believe that responsibility belongs to Ontario’s regulatory colleges, including the OCSWSSW and CRPO, which are uniquely qualified to assess training, experience, and ethical compliance (including the requirement to limit treatment to the therapeutic modalities they are qualified to by way of education, training and experience). When a provider is in good standing with no licensing restrictions, that should be sufficient for insurers and adjudicators to accept their qualifications without further scrutiny. Requiring therapists to defend their standing through excessive documentation has created a harmful precedent, one that risks undermining trust in our regulated professions and delaying access to care for injured Ontarians.

The time has come for the Financial Services Regulatory Authority of Ontario (FSRA) and the provincial government to address the longstanding gap in the Professional Services Guideline. Social workers have been providing psychotherapeutic care to accident victims for decades, and the omission of a defined hourly rate in the PSG undervalues their indispensable role. As mental health needs across Ontario become increasingly pronounced, continuing to deny fair compensation to those who are trained, regulated, and actively filling this care gap is both unjust and unsustainable.

We continue to stand shoulder to shoulder with the social worker community. While the Adamusiak decision may not have ruled in favour of the injured victim, it provides a clear blueprint for what is now required. We know what the LAT expects. We know the evidence that must be produced. And most importantly, we know that fairer, more consistent results are achievable if therapists work together with their clients and insurers, to ensure a just outcome. It is now up to us (social workers, advocates and legal professionals alike) to carry this guidance forward and begin shaping case law that genuinely reflects the value of the care social workers provide.