Introduction

A personal support worker submits attendant care invoices at $25 to $26 per hour. The insurer caps them at the Form 1 hourly rate, which is lower. The dispute goes to the Licence Appeal Tribunal.

The insurer loses. Not because the PSW's rate was unusually low or because of sympathetic facts. But because the Form 1 hourly rates - which many insurers treat as hard billing caps - are not caps at all. They are calculation tools for determining monthly entitlement. Nothing more.

The 2020 decision (2020 CanLII 94803, ON LAT) is one of the most practically useful rulings for attendant care providers, yet many clinics and caregivers still do not know it exists. It fits the broader pattern of 2026 billing decisions protecting provider rates. Here is what it says and how to use it.

What Happened

The claimant was a pedestrian struck by a vehicle. Her injuries were serious: a fractured leg, a dislocated knee, and associated impairments requiring significant attendant care. A personal support worker provided the care and billed at $25 to $26 per hour.

The insurer reduced the rate to the Form 1 hourly rates - the standardized figures used in the Form 1 Assessment of Attendant Care Needs to calculate monthly entitlement. The insurer's position was that the Form 1 rates function as a ceiling on what providers can charge per hour.

The Tribunal rejected this position outright. The adjudicator cited FSCO Superintendent's Guideline No. 01/18 and Bulletin A-03/18, both of which state clearly: the hourly rates in the Form 1 are meant to be used only for the purposes of calculating the monthly entitlement amount. They are not billing caps. They are not maximum allowable charges. They do not limit what providers can bill per hour.

The PSW's rate of $25 to $26 per hour was upheld. The monthly attendant care benefit exceeded the statutory maximum of $3,000 per month, but that is a separate calculation - the hourly rate itself was reasonable and payable.

Where the Form 1 Rates Actually Come From

Understanding why Form 1 rates are not caps requires understanding what the Form 1 actually does.

The Form 1 - Assessment of Attendant Care Needs - is an assessment tool. An occupational therapist or registered nurse completes it to determine how many hours of attendant care a claimant needs per month and at what level of care. It assigns maximum hourly rates to three levels of care, set out in Superintendent's Guideline No. 01/18, the Attendant Care Hourly Rate Guideline, which is incorporated by reference into section 19(2)(a) of the SABS:

  • Level 1 (routine personal care): $14.90 per hour
  • Level 2 (basic supervisory functions): $14.00 per hour
  • Level 3 (complex health/care and hygiene functions): $21.11 per hour

Two details in the Guideline matter as much as the numbers. First, these are maximums used to calculate the monthly dollar amount the claimant is entitled to receive. Second, the Guideline states outright that insurers are not prohibited from paying above the maximum hourly rates. The rates also include all administration costs, overhead and related charges, so no surcharge can be stacked on top of them.

The monthly amount is capped by statute. For post-April 2018 accidents, the maximum is $3,000 per month for non-catastrophic claims and $6,000 for catastrophic claims. But the hourly rates used inside the Form 1 calculation are inputs to a formula - not limits on what providers can charge.

This distinction is critical. An insurer will often point to the Form 1 rate and say, "This is the maximum payable per hour." The correct response, per the 2020 ruling, is: "The Form 1 rate is a calculation input, not a billing cap. Show me where the Schedule or Guideline caps my hourly rate."

What the Guideline Says for Unlisted Providers

The Professional Services Guideline sets hourly maximums for specific regulated professions: physiotherapists, chiropractors, psychologists, and others. Personal support workers are not on that list. Neither are many other providers who deliver attendant care and rehabilitation services.

For providers not covered by the Guideline, the rule is different. The Guideline states that the amounts payable are to be determined by the parties involved - meaning the provider and the insurer negotiate the rate. If they cannot agree, the Tribunal decides. But the insurer does not get to unilaterally impose a Form 1 rate as a cap.

The Tribunal in the same decision also addressed the rate for a social work assessment billed at $135 per hour. The provider cited the Ontario Association of Social Workers' recommended hourly rates for the MVA sector: $130 to $150 per hour for assessment and treatment. The Tribunal accepted this as reasonable evidence and upheld the rate.

The same principle applies: if your profession has a recognized association with published rate guidelines, use them. The Tribunal treats association rate schedules as credible market evidence.

How to Defend Your Rate Against a Form 1 Cap

If an insurer reduces your attendant care or support service rates to Form 1 levels, here is how to respond:

1. Cite the Guideline and Bulletin directly.

Reference FSCO Superintendent's Guideline No. 01/18 and Bulletin A-03/18. Quote the language: the hourly rates set out in the Form 1 are meant to be used only for the purposes of calculating the monthly entitlement.

2. Cite the 2020 decision.

Citation 2020 CanLII 94803 and the specific finding that Form 1 rates are not billing caps. The decision is published at canlii.ca/t/jbwwj and can be attached to your response.

3. Provide market evidence for your rate.

Like the osteopath who beat an insurer's unilateral cap in 2026 CanLII 34323 (see our osteopath rate cap breakdown) and the social worker in this case, submit evidence that your rate is reasonable. Association rate schedules, market surveys, comparable provider rates in your region. Anything that shows your rate reflects what providers in your field actually charge.

4. Distinguish between hourly rate and monthly cap.

If the insurer argues your rate would push the monthly total above the statutory maximum, that is a separate issue. The hourly rate can be reasonable even if the total monthly hours exceed the cap. The remedy is to adjust the hours or accept the statutory maximum as the monthly limit - not to reduce the hourly rate.

Conclusion

The Form 1 is an assessment tool. Its hourly rates calculate monthly entitlement. They do not cap what providers can charge. This has been the FSCO and LAT position since at least 2020, yet insurers continue to apply Form 1 rates as billing caps.

If your attendant care or support service invoices are being reduced to Form 1 levels, you have the law, the Guideline, the Bulletin, and the case law on your side. Use all four.