CAA Insurance Company has failed to overturn a ruling that a crash claimant is catastrophically impaired, winning only a fix to the order's wording.
The Ontario Licence Appeal Tribunal released its reconsideration decision on July 22, 2026, largely upholding an earlier finding that the claimant met the catastrophic impairment threshold under the Statutory Accident Benefits Schedule. For insurers and claims professionals, the decision underlines how much latitude adjudicators have when they add up the numbers behind a catastrophic designation.
The claim stems from a July 25, 2021 accident. The man was standing outside his parked car, helping his mother-in-law, when a neighbour's SUV reversed and pinned him between the two vehicles. The blunt trauma caused a crush injury to his abdomen. He spent about three weeks in hospital, underwent multiple emergency surgeries including a subtotal colectomy that removed roughly 75% of his colon, and lost more than 50% of the function in his left kidney.
In its original decision, released January 27, 2026, the tribunal found the claimant catastrophically impaired under Criterion 7, which requires a 55% whole person impairment rating. The adjudicator accepted ratings of 15% for the musculoskeletal system, 9% for scarring, 2% for treatment and medication, 25% for gastrointestinal injuries, and 20% for mental and behavioural impairment - a combined 54.5%, rounded to 55%.
CAA sought reconsideration on several grounds, arguing the tribunal erred across those ratings, failed to specify the attendant care benefit in its order, and showed a reasonable apprehension of bias. The insurer wanted the claimant found not catastrophically impaired, or a rehearing before a different adjudicator.
The tribunal was not persuaded. It reaffirmed that reconsideration is not a chance to re-litigate or re-weigh evidence, and it repeatedly found CAA's challenges amounted to disagreements with how the evidence had been assessed. On the gastrointestinal rating, the adjudicator noted that a decision-maker is not bound by the experts' figures, citing the Divisional Court in Paesano v. Coseco Insurance Co. that the tribunal "may diverge from the impairment ratings provided by both sides' experts." As the original decision put it, "I am not required to adopt an expert's selected percentage."
CAA's bias argument, built partly on the claim that the adjudicator showed "sympathy toward the Applicant" and produced inflated ratings, also failed. The tribunal held that disagreement with the ratings does not meet "the high bar needed to establish a reasonable apprehension of bias."
The insurer did secure one change. The original order never stated the ongoing attendant care amount the tribunal had calculated. The tribunal varied its order to specify that the claimant is entitled to attendant care benefits of $448.49 per month on an ongoing basis. The remainder of CAA's request was dismissed, and the claimant's own request for costs was turned down.
In this decision, challenging a catastrophic finding by pitting one expert's WPI ratings against another's proved an uphill fight once the adjudicator had tied those numbers to the medical record.
