Introduction

You finish a 45-minute treatment session with an MVA patient. You spend the next 15 minutes writing clinical notes, updating the file, and sending a quick update to the patient's lawyer. When you submit the invoice, you bill one hour of treatment.

This is standard practice at most Ontario clinics. It is also, according to a 2026 Licence Appeal Tribunal decision, not payable.

The Tribunal examined exactly this scenario in a 2026 Allstate decision, 2026 CanLII 51004 (ON LAT), a dispute between Allstate and a clinic billing for psychological treatment. What it found should change how every clinic in Ontario structures their invoices.

What Happened

The clinic submitted an invoice for one hour of psychological treatment. The patient was seen, the session was real, and the treatment was necessary. But only 45 minutes of that hour was actual face-to-face treatment. The remaining 15 minutes was spent on:

  • Clinical note-taking
  • Session setup and preparation
  • Inter-professional dialogue with other providers on the file

The insurer denied the 15 minutes of admin time. The clinic pushed back. The Tribunal reviewed the OCF-18 and found something the clinic had overlooked: the administrative work was already paid for.

The OCF-18 had separately approved:

  • $448.83 for assessment
  • $149.61 for planning service
  • $299.22 for documentation support activity
  • $200.00 for form completion

Note-taking, preparation, and provider communication are exactly what those line items fund. By embedding 15 minutes of admin work into the treatment hour, the clinic was billing for the same activity twice - once through the dedicated line items on the OCF-18, and again inside the treatment session.

The Tribunal ruled the 15 minutes of admin time not payable. The invoice was deemed not incurred per the approved plan.

What Your OCF-18 Already Pays For

Most clinic directors and billing administrators do not think about their OCF-18 this way. You submit the treatment plan, the insurer approves some or all of it, and you start treating. The invoice goes in, and you assume the math will work out.

But the OCF-18 is not just a permission slip. It is a line-by-line budget. Every service category on an approved OCF-18 represents money the insurer has already agreed to pay for that specific purpose.

Here is what a typical psychological treatment plan might include, with the corresponding 2026 Professional Services Guideline rates:

| Line Item | Purpose | Guideline Max | |-----------|---------|---------------| | Assessment | Initial or re-assessment of the patient | $448.83 | | Planning service | Treatment planning, care coordination | $149.61 | | Documentation support | Clinical notes, report writing, file maintenance | $299.22 | | Form completion (OCF-18) | Preparing and submitting the treatment plan | $200.00 PR | | Treatment sessions | Direct patient care, face-to-face | Hourly rate |

Each of these is a distinct bucket of money. When you bill one hour of treatment at your hourly rate, that hour is for treatment. The planning, the notes, the coordination - those are already covered by the other line items.

The $200 form completion fee in particular is well established. In a 2025 Intact decision, 2025 CanLII 111707 (ON LAT), the Tribunal confirmed the guideline caps documentation support at $200 per procedure and treated a form-letter EOB that cut the fee to one hour as a statement, not a denial.

If you spend 15 minutes of a treatment hour on documentation, you have not delivered 60 minutes of treatment. You have delivered 45 minutes of treatment and 15 minutes of work that was already paid for elsewhere. The Tribunal's position is clear: that 15 minutes is not an incurred expense under the plan.

This matters because the "incurred" test under section 3(7)(e) of the Schedule is strict. An expense is only incurred if the goods or services were actually provided. If you billed for one hour of treatment but only provided 45 minutes, the remaining 15 minutes fails that test - regardless of how clinically valuable the note-taking was.

The Real-World Scenario

Consider a multi-disciplinary clinic in Mississauga treating an MVA patient with both physical and psychological injuries. The patient sees a psychologist for one hour and a physiotherapist for one hour on the same day.

The psychologist spends 40 minutes in session, then 20 minutes writing detailed clinical notes and emailing the physiotherapist about overlapping symptoms. The physiotherapist does 50 minutes of hands-on treatment and 10 minutes of note-taking.

Both providers bill one hour of treatment.

On paper, the clinic has billed two hours of direct patient care. In reality, the patient received 90 minutes of treatment and the clinic spent 30 minutes on administrative work that the OCF-18 already funds through assessment, planning, and documentation line items.

If this pattern repeats across 20 patients per week, the clinic is overbilling by roughly five hours of treatment time weekly - time the insurer did not agree to fund under the treatment category. Over a year, that is approximately 260 hours of treatment billed but not delivered.

When an audit or a dispute catches up, the exposure is not theoretical. The Allstate decision shows the Tribunal will look at it line by line. And once a pattern is established, every invoice on every file becomes suspect.

How to Fix Your Billing

The fix is not complicated, but it does require changing how your clinic thinks about the treatment hour.

1. Separate treatment time from everything else.

When you are with the patient, you are treating. When you are writing notes, you are documenting. These are two different activities funded by two different parts of the OCF-18. Bill them accordingly.

2. Know what your OCF-18 already covers.

Before submitting an invoice, review the approved plan. If assessment, planning, documentation support, and form completion appear as separate line items, your treatment hour is for treatment only.

3. Track time by activity, not by session.

Instead of logging "Patient session - 1 hour," log:

  • Treatment: 45 minutes
  • Clinical documentation: 15 minutes

Then bill treatment against the treatment line item and documentation against the documentation support line item. If your practice management software does not support this, it is worth upgrading or adding a manual step.

4. Do not double-dip.

This is the core issue the Tribunal identified. If the OCF-18 already pays you for assessment, planning, and documentation, those activities cannot also appear inside your treatment hours. Pick one category per activity and stick to it.

5. If admin time exceeds what the OCF-18 funds, document why.

There may be cases where a treatment session generates unusually extensive documentation - a complex clinical finding, a safety concern, or a report requested by the insurer. If your documentation time genuinely exceeds what the plan covers, document the reason and be prepared to justify it. Do not silently roll it into the treatment hour.

The same discipline applies to any administrative charge. In H.R. v Intact Insurance Company, 2023 CanLII 56030 (ON LAT), brokerage and file-review fees were approved only where the provider specified what was reviewed and why; vague entries were denied.

6. Train your admin staff on the distinction.

Your billers may not know what each OCF-18 line item funds. If they see "one hour of treatment" on a clinician's timesheet, they bill one hour of treatment. Make sure everyone who touches invoicing understands that treatment time and admin time are separate categories with separate funding. A five-minute team meeting on this topic could prevent thousands of dollars in denied claims.

Conclusion

The Allstate decision is not about insurers nickel-and-diming clinics. It is about the structure of the OCF-18 itself. The form already separates treatment from administration and funds each one independently. When you combine them into a single billing line, you are working against the structure of the plan - and the Tribunal will notice.

The good news is that fixing this does not require more work. It requires labelling the work you are already doing with the right category. Treatment time goes under treatment. Documentation goes under documentation. Planning goes under planning.

If your clinic has been billing admin time inside treatment sessions, change the practice now. A denied invoice is one thing. A pattern of denied invoices across multiple files is harder to explain.