Certas Home and Auto Insurance Company defeated every disputed claim in a catastrophic impairment case, including a rushed motion for insurer examination records.
The Licence Appeal Tribunal released its decision August 27, 2026, following a five-day videoconference hearing held July 6 to 10. The applicant, injured in a single all-terrain vehicle accident on October 16, 2022, sustained a complex left ankle fracture requiring fusion surgery. He argued the injury and its psychological toll left him catastrophically impaired, triggering claims for income replacement, attendant care and several treatment plans that Certas had denied.
Two business days before the hearing, the applicant filed a motion seeking production of insurer examination assessors' clinical notes and draft reports, or exclusion of their reports altogether. Adjudicator Tami Cogan found the request untimely - the applicant had received the reports more than three months earlier - and disproportionate, since cross-examination remained available. The motion was denied and the reports were admitted.
On the substantive claims, the tribunal weighed competing whole-person impairment ratings under criterion 7, which combines physical and mental-behavioural findings against a 55 per cent threshold. The applicant's assessors put his combined rating at 55 per cent; the insurer's assessors put it at 40 per cent. Cogan worked through each disputed component - medication effects, leg-length discrepancy, gait, muscle atrophy, range of motion and joint ankylosis - line by line, arriving at a physical rating of 22 per cent and a mental-behavioural rating of 10 per cent, for a combined 30 per cent.
Under criterion 8, which requires marked impairment in three of four functional spheres or an extreme impairment in one, Cogan found only adaptation reached the marked threshold, with activities of daily living and social functioning rated moderate and concentration, persistence and pace rated mild. That fell short of the standard.
The applicant also pointed to a severe employability rating the insurer's own psychiatrist had assigned on one sub-scale, arguing it supported his income replacement claim. Cogan gave that isolated score little weight. It came with no explanation, sat at odds with the same doctor's other ratings, and was contradicted by evidence that the applicant had run his self-employed business profitably for two years after the accident before relocating.
Attendant care benefits were denied as well, since the applicant offered no evidence the disputed care had actually been incurred. With no catastrophic impairment finding, his $65,000 non-catastrophic medical and rehabilitation funding limit remained exhausted, closing off the disputed treatment plans. The tribunal declined to order a special award, finding no basis to conclude Certas's conduct was “excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.” No interest was owed.
