Ontario's Licence Appeal Tribunal has upheld a denial of catastrophic impairment benefits against Certas, reinforcing how surveillance and counsel statements shape accident benefits disputes.
The May 20, 2026 reconsideration decision in Almohamad v. Certas Home and Auto Insurance Company dismissed a self-represented applicant's bid to reopen a January 27, 2026 ruling that found him not catastrophically impaired and not entitled to attendant care, a physiotherapy treatment plan, or interest. The underlying claim stemmed from a September 15, 2021 accident under the Statutory Accident Benefits Schedule.
Vice-Chair Craig Mazerolle's reasons offer claims professionals a useful map of how the Tribunal treats common reconsideration arguments under Rule 18.2.
The applicant, Hamed Almohamad, argued that his former counsel had withdrawn six treatment plans and an award request at the start of the hearing without his informed consent. He pointed to a moment in the transcript where the adjudicator allowed the Arabic-language interpreter to stand down while counsel walked through the withdrawn issues. The Vice-Chair found the Tribunal was entitled to rely on counsel's statements, noting that lawyers and paralegals are "officers of the court" whose representations about client instructions are presumed truthful. The adjudicator herself had said she was confident counsel had walked the client through the withdrawals thoroughly.
For insurers, the ruling underscores that withdrawals made through counsel at hearing will generally stick, even when the insured later disputes them.
The applicant also submitted two invoices on reconsideration - one for psychological treatment, one for physiotherapy - arguing they could have changed the outcome. The Tribunal disagreed. None of the disputed issues related to psychological treatment, and the physiotherapy plan had already been found not reasonable and necessary on the medical evidence, making the question of whether the services had been incurred immaterial.
The surveillance evidence drew particular attention. Certas relied on video taken on 18 different days. According to the decision, the applicant was observed driving a car and an e-bicycle with his child as a passenger, sometimes for a period of 20 minutes or more, taking a bus, placing an order at Tim Hortons, banking, taking an SUV for a test drive at a dealership, and exchanging money with a tow truck driver in what appeared to be the sale of a vehicle. The applicant confirmed in his testimony that he was in the process of selling his van. On January 14, 2025, he was filmed running errands and installing a camera on the outside of his home. The Tribunal found these activities demonstrated persistence, pace and concentration inconsistent with the applicant's claimed impairments.
The applicant argued the Tribunal had placed too much weight on the surveillance. The Vice-Chair rejected that framing, noting that reconsideration is not a venue to re-weigh evidence already considered, and that adjudicators may weigh different parts of the record as they see fit absent legal or factual error.
On impairment ratings, the decision cited Paesano v. Coseco Insurance Co., 2025 ONSC 3245, confirming that the Tribunal may diverge from both parties' assessors when its analysis is grounded in the available evidence.
Finally, the applicant raised concerns about the respondent's conduct, pointing to spending on assessments, surveillance and legal expenses compared with treatment. The Vice-Chair held that regardless of how an insurer adjusts a claim, the onus to prove entitlement remains with the insured person.
The reconsideration request was dismissed.
