Ontario's tribunal rejected a catastrophic impairment claim after tax records, payroll filings and surveillance contradicted years of self-reported disability.
Aviva General Insurance Company denied statutory accident benefits to a claimant seeking catastrophic impairment (CAT) status following a June 21, 2018 automobile accident, prompting an application to Ontario's Licence Appeal Tribunal. After a five-day videoconference hearing, Vice-Chair Rebecca Hines dismissed the claim. The applicant, she ruled, did not meet the CAT threshold under either Criterion 7 or Criterion 8 of the Statutory Accident Benefits Schedule, and was not entitled to the disputed benefits, interest or an award.
The decision, released August 4, 2026, turned largely on credibility. The applicant told her medical assessors that her pre-accident health was stable, that she worked full time as a court translator, and that she was independent with self-care, housekeeping and driving. That account did not hold up against a psychiatric report prepared one day before the accident describing severe panic attacks and social isolation, an occupational therapy report from one month earlier confirming personal support worker assistance three times weekly, and family doctor records showing she had been off work since January 2017.
Income tax records placed the applicant's 2018 earnings at $4,191, rising significantly between 2019 and 2024, while Public Accounts of Ontario records confirmed continued and increased court translator earnings through 2025. An investigation report also turned up post-accident social media advertising for real estate agent and translation consulting services, and a physician's consult report placed her working as a real estate broker in 2021. Hines concluded the applicant was not a reliable witness.
Under Criterion 7, which requires 55 per cent whole person impairment, the tribunal accepted a combined rating of just 21 per cent, against the 53 per cent (rounded to 55 per cent) claimed by the applicant's assessors and the 16 per cent proposed by Aviva's. The applicant's orthopaedic assessor, Hines added, should have applied apportionment for pre-existing spine impairment - a step that would have reduced her cervical spine rating to zero. Under Criterion 8, the tribunal found no marked impairment in activities of daily living, pointing to a post-accident cruise, a trip to Las Vegas for her 70th birthday, a drive to Montreal, and surveillance showing her attending a poetry reading despite reported social withdrawal.
Aviva separately sought costs under Rule 19, arguing the case was frivolous and that the applicant repeatedly breached tribunal deadlines - serving award particulars 96 days late, assessment notices 91 days late, and other materials 104 days late. Hines refused. Rule 19.1 permits cost awards only where conduct is "unreasonably, frivolously, vexatiously, or in bad faith," and she found that bar unmet. Aviva was not prejudiced, since most materials arrived more than a month before the hearing, and it had itself relied on some of the late-served records while serving its own documents late.
For claims professionals, the case is a reminder that documentary evidence - tax filings, government payroll records and treatment history predating a loss - can outweigh a claimant's self-reported functional limitations in a CAT dispute. It also confirms that Rule 19 sets a high bar for costs, even where procedural non-compliance is repeated.
