What happened: A tribunal ordered Definity to pay accident benefits plus a 10% penalty for withholding coverage during its own appeal.
Who's involved: Definity Insurance Company (the insurer); the Ontario Licence Appeal Tribunal, which issued the ruling.
What's at stake: $2,000 and $2,159.15 in disputed treatment plans, plus monthly attendant care benefits and a 10% award.
Why it matters: Insurers can't treat their own pending appeal as licence to keep denying benefits without seeking a stay.
Where it stands: Decided by the tribunal; Definity's appeal of the underlying coverage finding is still pending.
A light rail train pinned a 16-year-old to the pavement - and his own insurer argued that somehow wasn't a car accident. Definity Insurance Company refused to pay statutory accident benefits, insisting that an ION light rail train in Waterloo Region, Ontario, isn't an automobile under the province's no-fault rules.
The teen broke his hip, leg and ribs, lost consciousness, and needed intubation before a string of surgeries and a long hospital stay. Ontario's Licence Appeal Tribunal had already settled the coverage question in an October 2025 preliminary ruling: yes, getting struck by the train counted as an accident. Definity never argued the injuries weren't serious - just that they weren't its problem.
This latest ruling settles what Definity actually owes. Two treatment plans, worth $2,000 and $2,159.15, cover an occupational therapy and attendant care assessment plus follow-up therapy. Add monthly attendant care benefits on top: $3,000 from March through May 2023, then $1,571.50 a month through the end of 2024.
Definity agreed all of it was reasonable and necessary. It just didn't want to pay until the family had actually spent the money - and until its own coverage appeal was sorted out. Reasonable and necessary. Just not payable yet, in Definity's view.
Definity also pointed to the family's own conduct as a reason to doubt the urgency. The family had raised more than $10,000 through an online crowdfunding campaign and waited nearly two years before disputing the benefit denial, the insurer said - suggesting there was no real financial hardship. And it argued the coverage question was reasonable to keep fighting, since whether a light rail train counts as an accident was, in its telling, unprecedented and novel.
The tribunal wasn't buying either argument. The crowdfunding total, it said, had nothing to do with whether benefits were owed. And novelty stopped being an excuse the moment the tribunal itself ruled on the coverage question in the preliminary decision. As for the attendant care benefits, the tribunal said the family didn't need to pay out of pocket first for those to count as owed - Definity had to cover them regardless.
Then came the penalty: a financial award equal to 10% of every benefit in dispute, plus interest. That wasn't punishment for appealing - insurers get to challenge tribunal rulings, the tribunal said. It was punishment for refusing to pay while the appeal was pending, without ever asking anyone for a stay.
As the tribunal put it, a conditional approval of benefits is "akin to an ongoing denial of benefits."
Definity's appeal on the coverage question is still sitting with the Divisional Court, with no hearing date yet on record. Until that court rules, the benefits ordered here - and the 10% penalty - stand. For now, the meter keeps running.
Appealing a coverage ruling is one thing. Sitting on the benefits while you do it, without asking for a stay, is another - and now it comes with a built-in 10% surcharge.
