Allstate ordered to pay a former Canada Post mail carrier income replacement benefits, while three related treatment plans were denied.
In a decision released September 3, 2026, a Licence Appeal Tribunal adjudicator found the applicant, who worked as a mail carrier since 2017, met the test for post-104-week income replacement benefits after a January 25, 2022 collision in which a tractor-trailer struck his vehicle. He had sought $400 per week from July 15, 2024, arguing chronic pain and psychological impairments left him completely unable to work in any job suited to his education, training and experience.
Adjudicator Bernard Trottier found the applicant met that test, citing the Ontario Court of Appeal's framework in Traders General Insurance Company v Rumball for assessing whether alternative employment exists in a real-world, competitive setting. Trottier preferred the evidence of a psycho-vocational assessment finding the applicant's cognitive and vocational abilities were significantly limited, over the insurer's expert opinions that his symptoms did not preclude sedentary work. The applicant's reported ability to take long-haul flights despite claiming he could not sit for extended periods was found immaterial, since his pain was tied mainly to lifting and physical movement rather than sitting.
Trottier also found the accident, not the applicant's pre-existing thyroid, cholesterol or gout conditions, was the direct cause of his current impairments, satisfying the "but for" causation test. A denial of short-term disability benefits was given little weight, since it stemmed from a missed medical documentation deadline rather than a finding on the merits. A separate denial of Canada Pension Plan disability benefits was also given little weight, since that program applies a different eligibility test than the Statutory Accident Benefits Schedule.
On treatment funding, the outcome went the other way. The Tribunal denied a proposed occupational therapy assessment, finding a similar assessment had already been completed by an OT of the applicant's own choosing in 2023. Two related OT services plans were also rejected, after the adjudicator found their stated goals were identical, differing only in the inclusion of assistive devices, with no explanation offered for the difference. A separate physical therapy plan submitted by a treating clinic was denied as well, after the insurer's orthopaedic expert testified the applicant would not benefit from further physiotherapy following extensive prior sessions.
The Tribunal declined to order a special award under section 10 of Regulation 664, finding Allstate's denials did not meet the threshold of being "excessive, imprudent, stubborn, inflexible, unyielding and immoderate." Interest was ordered only on the overdue income replacement benefits, calculated at 1 per cent per month, compounded monthly, from the date each payment became overdue.
