An Ontario tribunal has ordered a rehearing into a catastrophic impairment claim against Belair Insurance after ruling its own reasoning had been too rigid.
The applicant was hurt in a motor vehicle accident on August 31, 2021, and sought statutory accident benefits from Belair Insurance Company Inc. under Ontario's Statutory Accident Benefits Schedule. In a decision released March 10, 2026, the Licence Appeal Tribunal found she was not catastrophically impaired under either Criterion 7 or Criterion 8, and dismissed her claims for an attendant care benefit, housekeeping benefits, treatment plans, an award and interest.
The applicant sought reconsideration on March 31, 2026. In a decision released August 24, 2026, Vice-Chair Craig Mazerolle granted the request in part.
The Tribunal's original decision had rejected a whole person impairment rating for the applicant's headaches, finding her assessors failed to follow the prescribed method under the AMA Guides' Chapter 15, including a required pain intensity-frequency grid and identification of the nerve or organ system involved. Without that step, the Tribunal concluded, no headache rating could be made.
On reconsideration, the applicant argued that conclusion reflected an overly rigid reading of the Guides, pointing to Wilson v. Intact Insurance Company, 2025 ONSC 5305 (CanLII), where a court overturned a tribunal's zero percent vision-impairment rating for taking too technical an approach to the same methodology. Mazerolle agreed the analysis here was "akin to the rigid interpretation" criticized in Wilson, noting the Tribunal had acknowledged extensive medical documentation of the applicant's headaches yet still found no rating could be assigned. He found the Tribunal should have made some allowance for her accepted symptoms rather than rejecting a rating outright, and that the error likely affected her overall impairment calculation - the Tribunal had put her total whole person impairment at 47 percent, a figure short of the catastrophic threshold, while her proposed headache rating alone was 19 percent.
Mazerolle cancelled the portion of the decision addressing Criterion 7 and ordered a rehearing on that issue, along with the previously dismissed benefits, before a different adjudicator. The rehearing will proceed on the existing hearing record, the transcript or recording and exhibits from the original proceeding, rather than fresh evidence.
The applicant fared less well on Criterion 8. She argued the Tribunal should have assessed her for an extreme impairment in social functioning or adaptation, but Mazerolle found she had not shown that argument was raised at the original hearing, and it would have been procedurally unfair to Belair to introduce it now. He also rejected a bid to admit a new capacity assessment, finding it addressed her ability to instruct legal counsel rather than her impairment under the AMA Guides, and would not likely have changed the result. That portion of the original decision stands.
The party that brought the court reporter to the original hearing must provide Belair, the applicant and the Tribunal with a copy of the recording or transcript within 30 days of the reconsideration decision. Mazerolle is not seized of the rehearing, which will go before a new adjudicator.
