An Ontario auto insurer drew a special award after brushing aside its own examiner's reasoned findings in favour of treating doctors' checkbox forms.
The Ontario Licence Appeal Tribunal released its decision on July 13, 2026, ordering The Commonwell Mutual Insurance Group to pay the award after it kept an accident claimant inside the Minor Injury Guideline longer than it should have.
The claimant was hurt in an automobile accident on April 19, 2024, and sought benefits under the Statutory Accident Benefits Schedule. Commonwell denied the benefits, capping treatment at the $3,500 minor injury limit, and the claimant applied to the Tribunal.
At issue was whether the claimant's injuries were predominantly minor. Section 18(1) of the Schedule limits medical and rehabilitation benefits to $3,500 where impairments are predominantly minor, while section 18(2) allows removal where an insured has a documented pre-existing condition plus compelling medical evidence that the condition precludes recovery within the guideline.
The evidence that mattered came from the insurer's own corner. Commonwell's section 44 examining physiatrist found the claimant had pre-existing chronic pain in his feet from peripheral neuropathy and right hip osteoarthritis, and opined those conditions would prevent maximum recovery if he stayed within the $3,500 limit. An addendum report did not change that view.
Against this, Commonwell pointed to the claimant's treating providers. The family physician had checked a box on an OCF-3 stating the claimant had no pre-existing condition affecting his abilities, and the treating physiotherapist certified the same on an OCF-23 and OCF-18. Neither explained the reasoning behind the boxes.
Adjudicator Rachel Levitsky preferred the physiatrist's opinion. The examiner had assessed the claimant, reviewed his records, and explained his conclusions, while the treating providers had simply checked boxes. She removed the claimant from the guideline.
The costlier finding for the insurer was the special award. Under section 10 of Regulation 664, the Tribunal may order up to 50 per cent of benefits payable where an insurer unreasonably withholds or delays payment. Levitsky found Commonwell unreasonably withheld benefits when it ignored its own examiner's opinion on the guideline, relying instead on the treating providers' checked boxes in a December 12, 2025 letter.
That conduct, she wrote, was "imprudent, stubborn, inflexible, and unyielding." She noted the insurer did not have to accept its examiner's view, but here it had stubbornly set aside a reasoned assessment in favour of checkmarks. She awarded $440, or 10 per cent of the treatment plans the claimant was entitled to, plus interest.
The claimant did not win everything. Levitsky granted a $2,200 in-home occupational therapy assessment and a $2,200 psychological assessment, both plus interest, finding each reasonable and necessary. She denied $256.76 for further physiotherapy and $2,745.32 for social work and psychological services, ruling the claimant had not met his burden on those plans.
She also declined the claimant's request for costs, finding the insurer's two procedural motions did not amount to misconduct.
For claims professionals, the decision underscores a point rooted in the ruling itself: when an insurer commissions a section 44 assessment and its examiner delivers a reasoned opinion, disregarding that opinion in favour of unexplained checkbox forms can expose the insurer to a special award.
