Co-operators dodged a punitive award after Ontario's accident benefits tribunal ruled its denials, though partly reversed, rested on solid medical evidence.
The decision released June 18, 2026, gives claims professionals a clear map of what survives scrutiny at the Licence Appeal Tribunal - and what does not.
The applicant was injured in an automobile accident on July 14, 2017, and pursued statutory accident benefits under the Schedule. After Co-operators denied or reduced several benefits, she applied to the Tribunal's Automobile Accident Benefits Service. Catastrophic impairment was no longer in dispute by the time Vice-Chair Robert Maich decided the remaining issues in a written hearing.
The result split sharply. The applicant secured attendant care benefits of $420.30 per month from July 26, 2023, occupational therapy of $798.00, assistive devices of $5,628.84, medical services of $3,264.57, and $4,000.00 toward a catastrophic impairment assessment. She lost claims for higher attendant care, two social worker counselling plans, social rehabilitation counselling of $21,223.66, and mileage reimbursement of $2,740.00.
For insurers, the most instructive ruling concerned the applicant's bid for a special award under section 10 of Regulation 664, which lets the Tribunal penalize an insurer that unreasonably withholds or delays benefits. Maich refused. He found Co-operators had medical evidence supporting each denial and concluded that "an insurer is not held to a standard of perfection." Even where the Tribunal later disagreed with some denials, the insurer's reasoned, documented approach kept it clear of any penalty.
The Tribunal also drew a firm line on travel costs. The applicant, who lives in a remote area, sought thousands in provider travel time. Maich rejected charges he viewed as wildly disproportionate to the treatment value, pointing in one instance to $11,250.00 in travel tied to $1,500.00 in counselling services. A remote location, he held, could not justify travel expenses so far out of proportion to the services delivered.
Several other findings reinforced common insurer positions. The Tribunal accepted Co-operators' reduction of attendant care to exclude an emotional support component, following established case law. It upheld the insurer's reliance on the FSCO Guideline rate of $91.43 per hour for social work over the $150.00 claimed, and found one-hour sessions sufficient absent evidence that longer ones were necessary. It also confirmed that catastrophic impairment assessments are capped at $2,000.00 each under section 25 of the Schedule, trimming an $18,233.00 claim to $4,000.00.
Not every insurer argument landed. Maich rejected Co-operators' challenge to a medical cannabis treatment plan, which had questioned whether the cost belonged to OHIP. He held that regulatory compliance disputes between a physician and a governing body are not a route for an insurer to avoid liability, and that the insurer produced no evidence the prescription was payable by OHIP.
The applicant was awarded interest on overdue benefits. The decision is a final order of the Tribunal, released June 18, 2026.
