An Ontario tribunal rejected an insurer's bid to block a benefits claim after its own examiner ended a session early.
The applicant was injured in a car accident on September 25, 2024, and applied for statutory accident benefits after The Commonwell Mutual Insurance Group denied her claims. She took the dispute to Ontario's Licence Appeal Tribunal, seeking an income replacement benefit, treatment funding, and a ruling on whether her injuries were minor under the province's Minor Injury Guideline.
Before the substantive dispute could be heard, Commonwell argued the applicant should be barred entirely. It pointed to an insurer's examination with a psychologist on January 29, 2025, that ended after 15 minutes. The examiner's notice of cancellation described the applicant as hostile toward the assessment process and untrusting of the assessor's neutrality, said her speech was short and curt, and stated she was unwilling to provide the information the assessment required.
The applicant testified that she was frustrated the examiner was late but was willing to proceed, signed the consent forms, and was willing to answer questions and complete testing, though she was confused by a document that already bore a signature on her behalf and frustrated by the examiner's request for further signatures. Adjudicator Tami Cogan found her testimony persuasive, noting she was forthcoming about challenging the need for the signatures and her doubts about the process's neutrality.
Cogan gave the examiner's letter less weight than the applicant's testimony, noting it described her posture and manner but did not detail any actual refusal to provide information, answer questions, or complete questionnaires.
Cogan found the applicant had attended and participated in the examination, and that the standard under the Schedule does not demand total compliance. As she put it, "participation does not require unquestioning submittance to the examination." The applicant was therefore not barred from proceeding to a hearing on her income replacement benefit.
On the merits, Cogan found the applicant's injuries fell outside the Minor Injury Guideline because she had sustained a concussion, giving more weight to a neurophysiatrist's objective testing than to Commonwell's orthopaedic assessment, which had not addressed her reported post-concussion symptoms. The applicant was awarded an income replacement benefit of $182.72 per week from November 19, 2024, ongoing, along with $1,927.00 for physiotherapy, and $2,486.00 each for a psychological assessment and a neurological assessment, plus interest on the overdue amounts.
Cogan declined to order a special award against Commonwell under section 10 of Regulation 664, finding the applicant raised the issue too late in the hearing for the insurer to respond to meaningfully. The decision was released August 5, 2026.
