Introduction

A patient gains 50 pounds in the year after a car accident. A clinic submits a $1,050 OCF-18 for a nutritional assessment. In one Licence Appeal Tribunal decision, that plan was approved. In three nearly identical decisions, it was denied.

The difference was never the price, the clinic, or the dietitian. It was the file. Four LAT decisions released between August 2024 and June 2026 map out exactly what a nutritional assessment needs to survive, and they are consistent enough to read as a checklist. This is the same reasonable and necessary test the Tribunal applies to every non-traditional service, from meal delivery after an accident to home modifications.

The Statutory Frame in Plain Terms

A nutritional assessment is a cost of examination under the Schedule, not a treatment service. It falls under the $2,000 per-assessment cap in section 25(5), so the $1,050 and $850 amounts in these cases were never the issue. The issue is the same test every plan faces: is the assessment reasonable and necessary as a result of the accident. Reasonable covers the cost and whether a cheaper alternative would do the same job. Necessary covers whether a treating professional says the assessment is required to address an accident-related impairment. These four decisions turn on necessary, not reasonable.

The Three Questions the Adjudicator Asks

Every nutritional assessment in these four decisions came down to the same three questions.

1. Did a treating professional actually recommend it?

In the one approval, the family doctor's clinical notes did the work. In the three denials, no physician, psychologist, or occupational therapist recommended the assessment. In a 2024 Aviva decision (2024 CanLII 106229), a family doctor noted the weight gain in a report and still did not recommend a nutritional assessment. The adjudicator was blunt: a weight observation is not a recommendation.

2. Is the weight change tied to the accident?

The insurer's standard defense is "pre-existing." A Peel Mutual decision (2024 CanLII 81210) beat it because the family doctor's post-accident notes attributed the gain to immobility from the low back injury. The Aviva decision lost partly because there was a pre-accident note about bingeing when upset, and no one connected the post-accident weight to the collision.

3. Is the plan supported by evidence beyond itself?

In a Security National decision (2026 CanLII 53746), the adjudicator repeated a rule worth taping to the wall: a treatment plan must be supported by additional credible evidence, and the plan itself does not independently establish entitlement. That decision also shows how inconsistent self-reports sink a claim. The applicant told one assessor he lost weight and told another, five months earlier, that he gained it.

The One That Won

The Peel Mutual decision is the template. The applicant gained 50 pounds after the accident, reported it consistently to every assessor, and the family doctor's clinical notes recorded ongoing weight gain attributed to lack of mobility from the low back pain caused by the accident.

The insurer argued the weight issue was pre-existing, pointing to an old form where the family doctor wrote the applicant "tries to eat well but may binge when she is upset." That argument failed because the post-accident records showed the accident made it worse. Adjudicator Rebecca Hines found the assessment reasonable and necessary and ordered it paid, plus interest.

The lesson is specific: the winning ingredient is a contemporaneous medical record that ties the weight change to the accident. Notice what did not matter here: the price, the clinic, or the dietitian's credentials. What mattered was a doctor's contemporaneous record linking the weight to the injury. That is the entire case.

The Three That Lost

The Aviva decision is the clearest contrast. The applicant argued nutrition counselling was critical given his lifestyle changes and that it would provide "holistic benefits." The Tribunal answered that submissions are not evidence. No treating professional recommended the assessment, so there was nothing to hang the plan on.

A Wawanesa decision (2024 CanLII 123321) failed on the same ground. The applicant called the assessment "essential to recovery" but pointed to no medical source. Across the evidence, nutrition appeared only as "reduced appetite" and "weight gain due to lower levels of activity."

The Security National decision adds a third failure mode: inconsistency. The applicant relied on a psychological report that noted weight loss but made no nutrition recommendation, and he gave conflicting accounts of his weight to different assessors without ever reconciling them.

How to Build the File

1. Get the recommendation in writing first. Before submitting the OCF-18, have the family physician or treating specialist document the accident-related weight change and recommend the assessment in their own records. A specific, evidence-based recommendation is what gives any assessment weight, the same principle behind validity testing and report quality in psychological assessments.

2. Link the weight to the accident, at the time. The model is the Peel Mutual decision: "weight gain attributed to lack of mobility due to low back pain from the accident." State the causal link when it is observed, not after the denial.

3. File the plan. In the Security National decision and another case, the plan was not even in the evidentiary record. Make sure the OCF-18 is before the Tribunal.

Conclusion

A nutritional assessment is not a wellness add-on. It is a medical benefit that wins or loses on whether a treating professional recommended it, tied it to the accident, and documented it at the time. The Peel Mutual decision shows the bar is passable. The three denials show how easy it is to miss.

If your clinic bills assessments that depend on medical justification, the same discipline applies across the board. For the bigger picture, see our roundup of the 2026 LAT decisions affecting your HCAI invoicing.