Definity Insurance failed to overturn a $1,300 award after Ontario's Licence Appeal Tribunal found it ignored its own assessment supporting a denied treatment plan.
The reconsideration decision released on June 15, 2026, is a pointed reminder to claims teams of their duty to continue adjusting a file as new evidence comes in.
The dispute stemmed from an April 1, 2022 accident. The applicant sought benefits under the Statutory Accident Benefits Schedule, and the parties ran a written hearing. In the original decision, released April 8, 2026, the Tribunal found the applicant entitled to a chiropractic services treatment plan plus interest, granted an award based on that plan, and dismissed her request for a non-earner benefit.
On April 28, 2026, Definity asked the Tribunal to reconsider - but only the award. Relying on Rule 18.2(b) of the Licence Appeal Tribunal Rules, 2023, the insurer wanted that portion of the decision set aside.
The award was $1,300.00, representing 50% of the amount withheld. Under section 10 of Regulation 664, the Tribunal can order up to 50% of withheld amounts where an insurer unreasonably withheld or delayed a benefit. The conduct must reach a high bar - excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
What sank Definity was its own evidence. The insurer commissioned the assessment that supported the chiropractic plan, and the Tribunal found that report sat within the insurer's knowledge and control throughout. The Tribunal held the insurer is deemed to know the contents of its section 44 reports and must adjust accordingly on an ongoing basis. An occupational therapy report dated July 12, 2024 noted pain relief from chiropractic treatment. The Tribunal concluded the insurer neglected its duty to continually adjust the file on a good faith basis.
Definity raised two grounds. First, it argued the Tribunal misread the occupational therapist's findings, saying the assessor only reported the claimant's subjective belief in symptom relief, and that this report was just one input its own assessor used to conclude the plan was not reasonable and necessary. Vice-Chair Craig Mazerolle rejected this as a request to re-weigh the evidence, observing that the decision had already characterized the pain relief as "noted," not opined upon.
Second, Definity contended that disagreement with an insurer's adjusting choices is not enough to justify an award. The Vice-Chair again found this was a dispute with the Tribunal's weighing of the evidence, not a reviewable error. He emphasized that awards are highly discretionary remedies and that adjudicators are entitled to deference when they use them.
The insurer also argued no reasons were given for the maximum 50% quantum. The Vice-Chair disagreed, finding the reasons - read alongside the entitlement analysis - adequately explained both the award and its size.
The request for reconsideration was dismissed.
