An Ontario tribunal ordered Economical Insurance Company to pay a $2,913.08 special award over its handling of prescription expense claims.
The Licence Appeal Tribunal ruling resolved a long-running statutory accident benefits dispute stemming from a motor vehicle accident on December 3, 2019. An earlier 2023 decision dismissing the applicant's claims was quashed by the Divisional Court in November 2025 for a fairness breach and sent back for a rehearing before a different adjudicator, Vice-Chair Rebecca Hines.
The applicant had sought a wide range of accident benefits, including occupational therapy, physiotherapy, chiropractic care, vision and voice therapy, and dozens of prescription expense claims for medical cannabis, Botox injections and other medications. Hines found the applicant entitled to an in-home occupational therapy assessment, further occupational therapy services, a new mattress and pillows recommended for sleep problems, and vision therapy and glasses, worth a combined $13,825.79. She also allowed a portion of the prescription expense claims: medical cannabis, Botox and related migraine medications, and various anti-anxiety, antidepressant and pain prescriptions, totalling $5,826.16. Case management services, three physiotherapy and massage treatment plans, chiropractic treatment, voice therapy and the remaining prescription expenses were denied.
The special award turned on how Economical handled the prescription expense claims, most submitted under $250 each. The insurer repeatedly denied them on the basis that the applicant first needed to submit a separate treatment plan, and it scheduled medical examinations to test whether the expenses were reasonable and necessary. Hines found this position inconsistent with established tribunal and Divisional Court authority, which holds that prescriptions under $250 recommended by a regulated health practitioner need no treatment plan and fall outside an insurer's power to order an examination. She found Economical maintained the incorrect position for years despite repeated correspondence flagging the error, describing the conduct as "stubborn, inflexible, unyielding or immoderate," and ordered a 50 per cent award of $2,913.08 on the amounts found payable, plus interest.
The applicant separately alleged that Economical, its examination vendor and the examining physician violated the Ontario Human Rights Code by directing a discriminatory medical examination that excluded her psychological and post-concussion symptoms from consideration. Hines found the applicant had a disability protected under the Code but failed to establish the other elements of a discrimination claim, including that the assessor's conduct amounted to an adverse impact linked to her disability. All Code allegations against the insurer, its vendor and the examining physician were dismissed.
Hines also awarded interest on the benefits found payable and noted the file had been open for 1,518 days by the time of the rehearing.
