An Ontario tribunal has handed Co-operators a win, rejecting a catastrophic impairment claim after finding the applicant's severe impairments pre-dated his 2022 crash.
The Licence Appeal Tribunal dismissed the application in a decision released June 23, 2026, ending a statutory accident benefits dispute stemming from a September 23, 2022 automobile accident. The self-represented applicant had sought a catastrophic impairment designation, attendant care benefits of $10,328.00 per month, and payment for numerous treatment plans and expense claims. All were denied.
For insurers and claims professionals, the ruling turns on causation - specifically, whether an accident actually caused the impairments a claimant relies on. Co-operators argued the applicant was already seriously impaired before the crash and had not worsened afterward. The adjudicator agreed.
The applicant and his spouse testified that he was high functioning before the accident, working in computer repair and independent with self-care, and that he could no longer do those things. But the adjudicator found this testimony inconsistent with medical records showing his mental health had declined sharply after 2020. He gave more weight to the contemporaneous records, noting they were completed by doctors who examined the applicant before the accident.
The applicant's family doctor documented "anger/temper outbursts due to brain injury" in a report completed 15 days before the accident. A Disability Tax Credit Certificate from January 2022 - nine months before the crash - described psychosis, a need for reminders, and an inability to work.
On that record, the adjudicator found the applicant already had a Class 4 Marked impairment in activities of daily living and in social functioning before the accident. Because his functioning did not change afterward, neither area produced a ratable, accident-related impairment. He also found no Extreme impairment in concentration, persistence and pace, or in adaptation. A traumatic brain injury claim failed for lack of imaging showing intracranial pathology and any physician rating.
The methodology matters. Rather than adopting the apportionment approach used by the insurer's psychiatric assessor, the adjudicator compared the applicant's actual functioning before and after the accident to isolate what the crash caused.
Attendant care met the same fate. Although an occupational therapist recommended extensive supervisory care, the adjudicator found those needs rooted in pre-existing conditions, including poor judgement and hallucinations, rather than an accident-related injury.
The treatment plans and expense claims were denied because the applicant did not identify treatment goals, how they would be met, or whether costs were reasonable. With no benefits overdue, there was no interest, and with no benefits owing, the applicant's request for an award of up to 50 per cent under Regulation 664 collapsed.
A preliminary privacy complaint - the applicant's medical records were emailed to the wrong recipient because of a typographical error - fell outside the tribunal's jurisdiction. The recipient deleted the email, and the respondent apologised.
The application was dismissed in full.
