Introduction

An occupational therapist submits an OCF-18 with planning and preparation fees billed as separate line items. The insurer denies them. The OT disputes the denial. The Tribunal agrees with the insurer.

The lesson is not "stop planning." Planning is real clinical work, and the Guideline has already bought it: the hourly treatment rate includes communication with other providers, coordination, and brief documentation. What the 2026 Aviva OT ruling actually teaches is where to put the planning. Build it into the treatment session itself, and let the patient's complexity set the session length.

This guide shows OTs how to bill planning without a planning line item. It uses the 2026 Aviva OT decision plus two LAT rulings on session duration to map the winning structure. It fits inside the broader 2026 billing decisions reshaping HCAI invoices.

Why the Separate Planning Line Keeps Losing

The 2026 Aviva OT decision (Adjudicator Laura Goulet) is the latest version of a consistent pattern. The OCF-18 carried "Planning, service" and "Preparation, service" line items. The insurer denied them. The Tribunal upheld the denial.

Two reasons. First, the Professional Services Guideline treats the hourly rate as covering communication with the patient's care team, so a separate planning line is asking to be paid twice for the same activity. Second, the burden sits with the claimant. The OT never explained what the planning involved or why it was needed. On the preparation line, eight 1.5-hour sessions added up to 12 hours of communication, and the OT did not identify who the other providers were or why that volume was necessary. Submissions are not evidence.

The same test appeared in a 2026 Aviva psychotherapy ruling (2026 CanLII 74057), where a planning line for "communication with others" was denied because nobody identified whom the provider would contact or why. For the full line-by-line treatment of how planning, preparation, and progress-report items get stripped, see our walkthrough of the 2026 ancillary fee denials.

What the Hourly Rate Actually Includes

The Guideline's professional services rate is not face-to-face time only. It includes:

  • Direct treatment
  • Communication with other health professionals on the file
  • Coordination with insurers and adjusters
  • Brief documentation and file review tied to the session

Fifteen minutes emailing a physiotherapist about a shared patient is already compensated. Billing it again as a planning line is double-dipping, and it will be stripped.

There is one more boundary to respect. Purely administrative work, like scheduling and form-filling, is not billable treatment at all, as the Allstate admin time ruling made clear. That leaves OTs with a clean structure: clinical planning lives inside the session, administrative work is not billable, and a separate planning line sits in neither category.

The Alternative: Design the Session to Carry the Planning

If the planning cannot be a separate line, it has to live inside the session, and that means the session gets longer. The mechanism the Guideline itself contemplates: the hourly rate pays for the session plus its incidentals. A 75-minute session that contains reassessment, a team check-in, a home-program adjustment, and documentation is simply a more complete session.

The complexity of the patient is what sets the duration. That is the core principle:

The more complex the patient, the longer the treatment session.

Complexity drivers that legitimately extend sessions include multiple impairments (chronic pain layered on a concussion, for example), cognitive or psychological barriers, a multi-provider treating team, and caregiver training needs. Each driver adds real clinical work to every visit: more reassessment, more communication with the team, more documentation, more home-program retraining. None of those are extras. They are the session.

Contrast two files. A straightforward wrist sprain: 30 minutes, minimal coordination, done. A patient with a brain injury, an OT, a psychologist, and a case manager on the team: every session involves progress review, team communication, and updated home programming. The second patient's session is genuinely 75 to 90 minutes, and the OCF-18 should say so.

What the LAT Says About Cutting Session Length

This is where the Tribunal works for the provider.

In the 2026 Aviva psychotherapy ruling (2026 CanLII 74057), the insurer approved 1-hour psychotherapy sessions instead of the claimed 1.25 hours, pointing to the CAMH website's statement that sessions generally run 20 to 50 minutes. The Tribunal rejected the cut:

> "I find that the recommendation for 1.25-hour sessions was made by the applicant's treating practitioner, who had been treating her through two prior treatment plans and was aware of her needs and the severity of her symptoms... I further find that the respondent's explanation in its denial letter that the CAMH website states psychotherapy sessions generally last between 20 and 50 minutes cannot be relied upon."

No section 44 opinion contradicted the treating practitioner's recommendation, and the insurer had previously approved 1.25-hour sessions. The duration stood.

A second Aviva ruling (2026 CanLII 31448) states the principle directly: "the service provider is best placed to understand and determine the time and associated effort required for the completion of the services."

The pattern across 2026 is consistent. Session duration is a clinical judgment. To rebut it, the insurer needs a section 44 medical opinion, a real assessment of this patient, not a website excerpt, not a fee-schedule note, not an adjuster's arbitrary cap. Without that opinion, the treating practitioner's duration stands.

Why the Treating Practitioner Wins on Duration

Practitioners are more qualified to set treatment duration for two reasons the Tribunal keeps recognizing. The first is training: an OT is licensed to assess and treat exactly what the plan proposes. The second is the assessment itself: the treating practitioner has examined the person, taken their history, and watched their response to treatment across prior plans. An adjuster looking at a fee line has none of that.

That asymmetry is the evidentiary basis of that result. The recommendation was tied to this patient's severity and needs. The insurer's counter was a generic website. The Tribunal sided with the person who had the history.

This is not a licence to pad sessions. It is an evidence standard. Duration must be tied to what this patient needs, and it must be documented in the plan.

How to Write the OCF-18 So the Duration Survives

1. Name the complexity drivers. State the impairments, the team members, and the cognitive or psychological barriers that make this file complex.

2. Tie session length to functional goals. "90-minute sessions to deliver graded exercise, team check-in, and home-program retraining" survives scrutiny. "75 minutes" alone invites it.

3. Describe what the longer session carries. Say that planning, team communication, and documentation are delivered within the session time, so nothing needs a separate line.

4. Keep incidentals off separate lines. No planning line, no preparation line, no mid-course progress report. Document progress in the clinical record and let the next treatment plan carry the summary.

5. If the insurer cuts the duration, answer with the clinical record. Submit the treating practitioner's rationale tied to the patient's presentation, note any prior approvals of the same session length, and point out that no section 44 opinion contradicts the recommendation. The same prove-it discipline applies to billing above Guideline rates.

Conclusion

Planning is real clinical work, and the Guideline already pays for it inside the session, not beside it. The 2026 OT ruling does not tell you to stop planning. It tells you to stop billing it twice.

Build planning into the session, let the patient's complexity drive the duration, and defend that duration with the treating practitioner's assessment. The Tribunal has shown it will protect session length. It takes a section 44 opinion to knock it down.

Before your next plan goes to HCAI, take the planning line out. Put the time into the session, then write down why this patient needs it.