Introduction

If you bill brokerage fees in Ontario, there is a number to know first: two. Across the published Licence Appeal Tribunal case law, exactly two decisions have ordered brokerage fees payable, both in catastrophic impairment files. Nearly every other decision is a denial, a partial approval, or a line item folded into the $200 document fee.

That does not mean non-catastrophic clinics cannot get paid for coordination work. It means the winning strategy in a non-cat file looks different. This post maps both brokerage wins line by line, then walks through the three paths that actually work without a catastrophic designation.

The starting framework is the plan-stage justification standard from HR v. Intact, covered in our breakdown of the 2023 ruling: what services, with whom, why this file, why beyond the treatment rate, and how much time.

The Scoreboard

An analysis of the ONLAT database turns up 41 decisions mentioning "brokerage-fees." Most are denials. Only two order brokerage fees payable:

  • HR v. Intact Insurance Company, 2023 CanLII 56030 (ON LAT), Adjudicator Ulana Pahuta
  • Aviva Insurance Company of Canada, 2026 CanLII 31448 (ON LAT)

Both are catastrophic files. The wall for everyone else is a 2024 Aviva General Insurance decision (2024 CanLII 123323), where the applicant invoked H.R. and lost:

> "H.R. is distinguishable from the present case as the applicant in H.R. was catastrophically impaired whereas the applicant in this matter has no such designation."

Before you plan a non-cat brokerage claim, know this: you are not arguing inside the H.R. precedent. You are arguing for the exception.

Win One: HR v Intact (2023 CanLII 56030)

The first win is the one clinics quote most often. On one OCF-18, the insurer approved 1.5 of 3 requested brokerage hours; the Tribunal ordered the remaining 1.5 paid ($179.88), plus $239.84 for documentation support and $80.08 for the rest of the form completion fee. On a second plan, the outstanding balance was partially payable: $141.25 for form completion, $355.95 for the remainder of the brokerage service fees, and $610.20 for documentation.

What carried those fees was a supplemented letter explaining the brokerage time would cover medical file review and consultations with the client and the health care team. The insurer argued coordination was the case manager's job. Adjudicator Pahuta rejected that framing:

> "I agree with the applicant that brokerage fees encompass not simply communications between the OT and the case manager, but also with other team members."

The fee was won on the plan and the letter, before any coordination took place. The denial was tested against a description of proposed work, not against invoices for completed work. That is the H.R. template.

Win Two: the Aviva decision (2026 CanLII 31448)

The second win shows a brokerage fee surviving inside a capped assessment. The plan was an occupational therapy OCF-18 for a Form 1 attendant care re-assessment: $1,722.98 proposed, $1,243.30 approved, and $479.68 denied, made up of brokerage/service fees and three hours of documentation support.

The adjudicator found the balance payable:

> "The respondent partially approved the assessment; however, the respondent does not refer to the Guideline to vary the fees stated within treatment plan. In my view, the service provider is within the limits set in section 25(5)(a) and the service provider is also best placed to understand and determine the time and associated effort required for the completion of the services."

Four elements made that finding possible:

1. The plan named the activities. The OCF-18 described the fee as covering "medical file review, advice telephone, delegation, clinical support activities on client's behalf, monitoring, referral, initiating or maintaining a collaborative process... to meet a client's health care needs." Specific enough to be tested. 2. The fee sat inside the cap. The whole plan, brokerage included, stayed under the s. 25(5)(a) $2,000 assessment limit. The brokerage-fee should be on the treatment OCF-18 instead. 3. The insurer never invoked the Guideline. The adjudicator noted the insurer cited no Guideline basis to vary the fees. An insurer that argues "overhead" without citing the Guideline leaves the fee standing. 4. The provider was treated as the expert on her own time. The "service provider is best placed" finding is the strongest line in the decision for clinics.

The same decision shows the limit of the doctrine. In the psychological plan, the applicant called planning, review of external materials, and progress items crucial services. The adjudicator denied them as "administration costs, overhead, and related costs" because no evidence showed what was crucial about them in this case. Same adjudicator, same day: the fee with a description won, the fees with labels lost. For more on how 2026 adjudicators treat planning and preparation line items, see our walkthrough of the 2026 OT planning fee denial. The Aviva decision also approved $3,690.39 in unapproved case management hours, the report supporting coordination needs on a complex file.

What to Expect on a Straightforward Non-Cat Plan

Set expectations for files with no team-coordination story. In a 2026 Wawanesa decision (2026 CanLII 2241), the adjudicator held administrative fees are capped by the $200 form fee in PSG 03/14 and denied two extra brokerage hours beyond the insurer's partial approval, which stood. Two Aviva decisions follow the same pattern.

On a straightforward non-cat file, the realistic goals are: protect the partial approval you already have; bill planning and preparation as named, explained line items; keep ancillary costs a small fraction of the plan; and attack a deficient denial letter under s. 38(8) and s. 38(11).

Conclusion

The scoreboard is humbling and clarifying. The Tribunal has paid brokerage fees twice, both times on catastrophic files, both times because the plan proposed identifiable coordination work before any of it happened. Everyone else wins through the side doors: named task-based fees with explanations, the insurer's own payment history, and deficient denial letters.

Put the two wins to work. Model your OCF-18 language on the Aviva description, keep the fee inside the cap, and answer the five questions from the HR v. Intact framework before the plan goes in. The Tribunal has shown what a payable brokerage fee looks like. Make yours look like those two.