An Ontario tribunal dismissed an entire accident benefits claim against Definity Insurance, even though the insurer never conducted a medical examination of the claimant's physical injuries.
The decision, released July 10, 2026, by the Licence Appeal Tribunal, is a reminder to claims professionals that the burden of proof rests squarely on the applicant - not the insurer.
The claimant was injured in an automobile accident on September 9, 2022, and sought statutory accident benefits. Definity denied the benefits, and the dispute went before the Tribunal's Automobile Accident Benefits Service, decided on written submissions.
At the heart of the case was whether the claimant's injuries were predominantly minor and therefore capped at the $3,500 Minor Injury Guideline (MIG) limit. The claimant argued he should be removed from the MIG, pointing to both accident-related injuries and a pre-existing back condition.
To support the pre-existing condition, he relied on a single clinical note referencing degenerative disk disease dating to 1997. The adjudicator found this fell short. One decades-old note, he ruled, was not the "compelling medical evidence" required to establish that a pre-existing condition would preclude recovery within the MIG.
The claimant also listed physical injuries - including a rotator cuff tear, torn ankle ligaments, and shoulder tenosynovitis - and argued that Definity's failure to conduct a section 44 examination of those injuries counted against the insurer.
The adjudicator disagreed. The onus, he emphasized, was on the applicant to prove entitlement, regardless of whether the insurer ordered its own examination. Hospital x-rays showed no fractures, and the treating physician characterized the ultrasound findings as soft tissue trauma to be managed with physiotherapy and pain medication. Sporadic follow-up visits, the adjudicator found, did not substantiate injuries falling outside the minor injury definition.
A parallel fight played out over income replacement benefits. The claimant, who co-owned a printing business, sought $400 per week from October 14, 2022, onward. He said the accident forced him to take a few months off and hire help before returning in January 2023 to a modified administrative role.
Definity countered with accounting evidence. Its financial reports calculated the claimant's income-based entitlement at zero dollars, noting the business kept operating during his absence. The claimant, meanwhile, never identified the essential tasks of his job that he could no longer perform - a core element of the test.
The adjudicator accepted the insurer's accounting calculation. Even assuming the claimant was off work for a few months, he found, the amount owing would still be zero. The post-104-week claim failed as well, as the claimant offered no submissions to support it.
With the claimant remaining within the MIG and no benefits owing, the adjudicator ruled that no interest applied. The application was dismissed in full.
For insurers and claims handlers, the ruling reinforces familiar ground: strong accounting evidence can neutralize a self-employment income claim, an aging clinical note rarely clears the MIG threshold, and the absence of an insurer examination does not shift the burden away from the applicant.
