Introduction

A Treatment and Assessment (OCF-18) plan lands at the Licence Appeal Tribunal with three ancillary line items: Planning, service, $149.61. Documentation, support activity, $448.83. Preparation, service, $598.56. By the end of the decision, all three are denied.

That is what happened in a 2026 Aviva Insurance Company of Canada decision (2026 CanLII 74057 (ON LAT)), and it is the clearest 2026 statement of a rule the Tribunal has been applying all year: the hourly treatment rate already pays for the incidentals of treatment. Line items that bill those incidentals again are deniable by default.

The same decision, though, contains a win worth studying. The insurer cut the counselling sessions from 1.25 hours to one hour on the strength of a generic CAMH webpage, and the Tribunal restored the full sessions. The message is not "stop billing." It is "bill what the Guideline pays for, and justify anything beyond it in the plan." We have covered the plan-stage justification side in our brokerage fees framework. This post is about the fees themselves.

What the Guideline Already Covers

The Professional Services Guideline prices professional services, and its definition of what you are already being paid for is wider than most clinics assume. As the adjudicator put it in that decision, the Guideline states that expenses related to professional services "include all administration costs, overhead, and related costs, fees, expenses, charges and surcharges."

In practice, the hourly rate covers:

  • The treatment session itself
  • Brief documentation and file review related to the session
  • Routine communication with other providers, insurers, and adjusters
  • Session preparation, note-taking, and homework checking

That is the default. Any ancillary line item is an exception the provider must prove, not an entitlement to presume. It is the same principle the Tribunal applied in the Allstate admin time ruling: administrative work is only payable where the plan actually funds it as a separate category, and billing it twice is not an option.

The Three Denied Line Items

In that decision, all three treatment plans listed identical services, and the Tribunal walked through each disputed line item one at a time.

Planning, Service: The "Who and Why" Test

Line 2 described "communication with others, clients, therapist and setting up therapy." The adjudicator held that the reasonableness of communication fees "depends on factors like the complexity of treatment and the providers involved." The applicant's treatment came from a single clinic, and she pointed to no evidence the treatment was complex. Without particulars of who the psychotherapist would contact and why the communication was necessary, the fee failed.

The same test appears across 2026. In another Aviva decision (2026 CanLII 62976), a brokerage charge for "communication with others" was denied for the same reason: nobody identified whom the provider would contact or why. A planning fee is not paid for existing. It is paid for named, necessary coordination.

Documentation, Support Activity: The Premature Progress Report

Line 3 was a reassessment and psychological progress report, three hours. The Tribunal called it premature. The provider must document services and improvement in the clinical record as a matter of course, and if treatment continues past the plan, the next treatment plan carries the progress summary. A separately billed mid-course report adds nothing the file does not already need for other reasons.

Although, many practioners continue this practice, this is settled ground, not a one-off. The Tribunal reached the same result in a 2021 Aviva decision (2021 CanLII 45660) and a 2025 Aviva decision (2025 CanLII 84238): document in the chart, defer the report to the next plan.

Preparation, Service: Already in the Hourly Rate

Line 4 covered homework preparation and research, homework checking, and pre- and post-session note taking and observation recording. The Tribunal was blunt: these are "related costs of providing therapy sessions" and are "covered in the service provider's hourly rate."

There is no 2026 decision approving a separate preparation line item. Of the three fees, this is the clearest no.

What You Can Still Charge

The decision is not a fee ban. Five categories survive.

1. The treatment itself. Sessions at the correct Guideline rate for the provider type, at a session length the treating practitioner can defend. The win in this decision was exactly this: the insurer cited a CAMH webpage saying psychotherapy sessions generally run 20 to 50 minutes, and the Tribunal rejected that generic evidence against the treating practitioner, who had treated the applicant through two prior plans and knew the severity of her symptoms. The result was $598.44 restored on session length alone. Even though I've seen many sources stating that 1-hour is the industry standard, the Tribunal defers to the treating practitioner's patient-specific recommendation, and generic insurer evidence does not displace it.

2. The $200 documentation fee. In the same decision, the plan that lost a $448.83 documentation line kept its $200 documentation fee, which was approved. Treat $200 as the ceiling. In a June 2026 Co-operators decision, $1,047 in brokerage and planning fees was folded into the $200 document fee and lost, because the claimant filed no submissions on the point.

3. Brokerage justified on the OCF-18 in complex files. The plan has to establish the need before the work is done: what brokerage services you are proposing, who needs to coordinate and why, what makes the file complex, why the treatment rate does not already cover it, and how many hours are tied to which activities. We break that framework down in our brokerage fees post.

4. Assessments within the cap. Section 25 assessments up to $2,000 each, with add-ons separately justified. In a 2026 Commonwell decision (2026 CanLII 80207), a $99 brokerage fee and an $800 transportation fee on a capped assessment were denied.

Conclusion

The decision is a line-by-line map of what the 2026 Tribunal pays for and what it does not. The hourly rate already covers the incidentals. Planning, preparation, and mid-course progress reports are deniable by default. What survives is the treatment itself, brokerage justified on the OCF-18 for complex files, assessments within their cap, and the clinical judgment behind the sessions.

That does not mean these line items can never be charged. If a fee is genuinely beyond the hourly rate, justify it in the plan itself: who will be involved, why the coordination is needed, and what it will produce. An adjuster may deny the line without scrutiny, but the LAT will scrutinize it line by line if the plan is ever disputed. Write the justification as if an adjudicator is going to read it, because one day they may.

Bill what the Guideline pays for, document the exceptions in the clinical record with the same contemporaneous logging discipline used for invoices, and spend your disputes on clinical judgments like session length. That is the one place this decision shows providers still win, and it fits the pattern across the 2026 LAT decisions.