Belair Insurance Company Inc. defeated an income replacement benefit claim after a tribunal favoured its neuropsychologist's findings over the applicant's treating physicians.
The applicant, a resource teacher who also owned and operated a dance company, was injured in an automobile accident on October 30, 2021. She sought an income replacement benefit of $400 per week from June 6, 2023, along with several disputed treatment plans, after Belair denied the claims and she applied to Ontario's Licence Appeal Tribunal. Adjudicator Harouna Saley Sidibé released the decision on September 2, 2026.
Sidibé found the applicant had not established a substantial inability to perform the essential tasks of either occupation during the pre-104-week period, nor a complete inability to engage in suitable work after the 104-week mark. The applicant's treating physicians supported multiple leaves of absence and documented ongoing post-concussive symptoms, but Sidibé found their evidence addressed diagnosis and treatment rather than the specific functional question before the tribunal. Her employer had implemented a workplace accommodation plan, including reduced hours and remote work options, after the accident.
The insurer's neuropsychologist, who conducted an extensive battery of cognitive and psychological testing, found no objective deficits severe enough to prevent a return to work. Sidibé gave that opinion significant weight, calling it the most persuasive evidence on the applicant's cognitive functioning and work capacity. The insurer's general practitioner similarly found no objective musculoskeletal impairments preventing a return to work.
By June 2024, the applicant reported working approximately 20 to 25 hours per week through a combination of vocational activities, including managing her dance company. "I am not persuaded that these limitations resulted in a substantial inability to perform," Sidibé wrote, rejecting the pre-104-week claim.
The tribunal split on the remaining disputes. The applicant was denied treatment plans for prescription eyewear, physiotherapy, optometric services and massage therapy after Sidibé preferred opinions from an ophthalmologist and the insurer's general practitioner over the applicant's own providers. A separate claim for an assistive device was denied because the expense fell outside what the Schedule allows for goods purchased before a treatment plan's approval. The applicant succeeded, in whole or in part, on plans for social work counselling services, speech-language pathology and occupational therapy, with Sidibé ordering payment of the outstanding amounts along with interest on overdue benefits.
A special award under section 10 of Regulation 664 was also denied. Because the applicant was not entitled to the benefit in the first place, Sidibé found it had not been unreasonably withheld or delayed.
