Definity Insurance Company beat back accident benefit claims worth thousands after the applicant skipped a neurological exam and ignored months of follow-up emails.
The Ontario License Appeal Tribunal, in a decision released May 6, 2026, sided with the insurer in a dispute over statutory accident benefits stemming from a car accident on October 2, 2022. Vice-Chair Robert Maich ruled that the applicant, Pathuraj Thamarajah, could not push most of his treatment plans through to a hearing because he failed to attend an insurer's examination - a procedural misstep that, under Ontario's auto insurance regime, can stop a claim cold.
The neurological assessment was first scheduled for July 15, 2024, then rescheduled to September 10, 2024. Thamarajah did not attend, and Definity sent a denial letter on September 27, 2024, then tried repeatedly to get him back to the table. The insurer issued an amended notice of assessment on March 18, 2025, and followed up by email on March 17, March 26, April 7, April 21, April 30, and May 20, 2025. None of it drew a response.
Under section 44 of the Statutory Accident Benefits Schedule, insurers can require an insured person to be examined by a regulated health professional to confirm entitlement to benefits. Section 44(9) demands cooperation. Section 55(1) goes a step further - if an insured ignores a valid IE request without a reasonable explanation, they can't bring the dispute to the Tribunal at all.
Maich found Definity's notices were valid and sufficient and that the neurological exam was reasonably necessary, particularly in light of earlier psychological and physiatry assessments completed on June 4, 2024. With no reasonable explanation offered for the no-show, the Tribunal declined to use its discretionary power under section 55(2) to let the claim through.
That ruling knocked out five disputed chiropractic treatment plans proposed by Midland Wellness Centre between January and October 2023, totaling roughly $12,600. Two remaining plans - a $255.60 chiropractic balance and a $2,144.93 psychological services plan - failed for a different reason. Thamarajah made no submissions on whether either plan was reasonable and necessary, and the Tribunal noted it cannot build a case for a party that hasn't built one for itself.
The applicant also raised serious allegations against his former legal representative, claiming an improper relationship with the treatment clinic and misleading advice that he had been bumped out of the Minor Injury Guideline with access to up to $65,000 in treatment. Maich found those concerns sit well outside the Tribunal's reach and likely belong with regulators such as the Law Society of Ontario, the College of Chiropractors of Ontario, or the Financial Services Regulatory Authority of Ontario.
Thamarajah remains subject to the $3,500 MIG cap. The parties had agreed at case conference that just $25.60 of that funding remained.
