An Ontario tribunal handed Certas a win, ruling a chiropractic claim filed more than five years after a 2018 crash arrived too late.
The Licence Appeal Tribunal dismissed Andrew McLaughlin's application against Certas Home and Auto Insurance Company in McLaughlin v Certas Home and Auto Insurance Company, 2026 CanLII 56661 (ON LAT), a decision released June 11, 2026 that turned entirely on timing.
McLaughlin was hurt in an automobile accident on December 13, 2018 and sought statutory accident benefits under the Schedule. Certas denied the benefits, and he asked the tribunal to resolve the dispute.
At issue was a treatment plan, an OCF-18, dated February 20, 2024 and proposing $2,400 for a chiropractic assessment by Markham Chiropractic Centre. The plan was submitted on February 23, 2024 and denied on March 5, 2024.
The problem for McLaughlin was the calendar. Under section 20(1) of the Schedule, no medical, rehabilitation and attendant care benefit is payable for expenses incurred more than 260 weeks - five years - after an accident, for an insured person who was at least 18 at the time. Adjudicator Robert Fleming found the last day McLaughlin could have submitted a treatment plan for this accident was December 7, 2023. The February 2024 plan missed that window.
Certas argued the plan came in past the 260-week mark, so McLaughlin was precluded from claiming it. He countered that section 20 should be read in light of the legislation's remedial purpose - ensuring access to reasonable and necessary treatment - and that the limit was improper.
Fleming was not persuaded. He accepted that the Schedule is remedial and consumer protection legislation, but found that does not mean the express time limits can be ignored. He pointed to the 2016 amendment that cut the application window from 10 years to five years, which he said showed "the limit is intended to be firm."
The exceptions in section 20(2), which lift the time limits for catastrophic impairment or certain optional benefits, did not apply. There was no catastrophic impairment determination, and it was not in issue, nor any evidence McLaughlin had purchased optional benefits.
That finding collapsed the rest of the case. McLaughlin had also asked the tribunal to find his injuries were not predominantly minor and therefore outside the $3,500 Minor Injury Guideline limit. But with the only treatment plan barred, no benefit remained tied to that question.
Citing its own decisions, the tribunal reaffirmed that the Minor Injury Guideline cannot be heard as a standalone issue when no medical or rehabilitation benefit is in dispute. McLaughlin filed no reply to Certas's arguments or case law on that point.
With no benefits payable, no interest was owing. The application was dismissed.
For claims professionals, the decision is a reminder that the 260-week limit under section 20(1) is firm, and that a Minor Injury Guideline dispute cannot survive on its own once the underlying treatment plan falls away.
