Definity Insurance sidestepped a $27,716 dental claim after a tribunal found the driver's tooth damage existed before his 2022 crash.
The Licence Appeal Tribunal decision, released August 7, 2026, addressed nine issues in dispute stemming from a September 24, 2022 collision. The applicant sought funding for physiotherapy, psychological treatment, a chronic pain assessment, and dental work after Definity denied several of his treatment plans.
The largest item in dispute was a $27,716 dental treatment plan proposed by the applicant's dentist, covering root canals, fillings, crowns, extractions and implants. In support, the applicant pointed to clinical notes from a second dentist who examined him on November 8, 2022 and found fractures in four teeth attributed to the accident, along with photographs taken before and after the collision.
Definity countered with a section 44 examination from its own dentist, dated April 30, 2025, which found deep decay on three teeth that predated the accident and required extraction regardless of the collision. Definity invoked the but-for causation standard set out in Sabadash v. State Farm et al, 2019 ONSC 1121, which requires an accident to be a necessary, though not sole, cause of an impairment. Weighing the competing dental evidence, adjudicator Leo Demarce sided with the insurer's expert. "I give more weight to the expert evidence produced by the respondent," Demarce wrote, finding the applicant had not proven the accident caused the need for the dental work.
Physiotherapy funding split largely in the applicant's favour. Two of three disputed treatment plans, worth an additional $1,838 and $2,117 on top of amounts already approved, were awarded after a neurological assessment described his post-concussive symptoms as still unresolved. A third plan for $2,200 was denied because the applicant never provided a copy of it or evidence that it had been submitted to the insurer at all. A $2,486 chronic pain assessment was also approved, with Demarce citing additional medical evidence pointing to instability in his condition.
The psychological treatment dispute turned on billing, not need. Definity did not challenge the reasonableness of counselling for the applicant's diagnosed major depressive disorder and chronic pain, only the length and hourly rate of sessions. The tribunal denied the $1,496.04 difference between twelve 1.5-hour sessions and twelve 1-hour sessions, finding the applicant offered no evidence justifying the longer, costlier format.
A separate $431 claim covering an ambulance fee and dental expenses was denied, with the tribunal noting the $45 ambulance fee had already been reimbursed and finding the remaining $386 in dental costs were incurred before a treatment plan was submitted, contrary to section 38(2) of the Schedule.
A special award under section 10 of Regulation 664 proved out of reach as well. Demarce noted the applicant himself had acknowledged Definity did not act with malicious intent, a concession the tribunal found decisive against the award. Interest on the approved amounts was ordered under section 51 of the Schedule.
