An Ontario tribunal dismissed a claimant's bid for continued income replacement benefits after his submissions never addressed the actual test.
The dispute followed an accident on August 27, 2022. The claimant sought an income replacement benefit (IRB) from Certas Home and Auto Insurance Company under the Statutory Accident Benefits Schedule, and the insurer approved it on the basis that he could not perform the essential tasks of his job. Certas paid the benefit through June 23, 2023, then terminated it after the claimant returned to work.
The claimant then sought a continuing IRB of $400 per week from June 13, 2023, to the date of the hearing and on an ongoing basis. Certas denied the request, and the claimant applied to the Licence Appeal Tribunal to resolve the dispute.
Under section 5(1) of the Schedule, a claimant must show they were employed at the time of the accident and, within 104 weeks of the accident, suffered a substantial inability to perform the essential tasks of that job. The claimant must identify those essential tasks, specify which of them cannot be performed, and explain to what extent – with the burden of proof resting on the person seeking the benefit. The same identification requirement carries over to the tougher test for benefits sought beyond the initial 104-week period.
In his submissions, the claimant provided a brief history of the accident and pointed to clinical notes from his family physician, a disability certificate, and accounting reports. The remaining fifteen paragraphs of his submissions instead summarized case law with no bearing on an IRB dispute, addressing pain relief as a goal of rehabilitative treatment – a topic relevant to disputes over treatment and assessment plans, not the IRB entitlement question before the tribunal. The claimant did not connect any of the cited cases to the IRB issue.
Certas argued that the claimant bore the burden of proving entitlement and had failed to meet it. The tribunal agreed. As the decision put it, "The applicant has neither mentioned the essential tasks of his employment," and had not explained how he was unable to perform them. That gap, the tribunal found, was fatal to the claim under section 5(1).
Because the claimant did not meet the section 5(1) test, the tribunal found he also could not satisfy the tougher test for a post-104-week IRB under section 6(1). The application was dismissed in full. The decision, issued by Vice-Chair Julian DiBattista following written submissions, was released on July 24, 2026.
