Co-operators General Insurance Company defeated most claims by the estate of a 94-year-old pedestrian struck by a vehicle, with the Ontario License Appeal Tribunal denying death, funeral and attendant care benefits.
The Tribunal released its decision in Fehringer v Co-operators General Insurance Company on May 13, 2026, awarding the estate just $530 plus interest - a fraction of what was sought. The award covered two wheelchair rentals and a Superpole transfer device used to help Fehringer move from bed to chair.
Frederick Fehringer was 94 and walking with his walker when he was struck by a motor vehicle on June 8, 2017. He spent approximately 10 weeks at Scarborough General Hospital before transferring to Providence Healthcare for rehabilitation on August 15, 2017, then to Cedarbrook Lodge Residence, an assisted living facility, in September 2017. He died on February 9, 2018, after contracting C. Difficile.
The estate sought reimbursement for more than $18,000 in lodging expenses at Cedarbrook Lodge, attendant care benefits, a $20,000 death benefit, $4,108.25 in funeral expenses, and various wheelchair-related costs.
Adjudicator Nadia Mauro found Fehringer was removed from the Minor Injury Guideline on November 30, 2017, when Co-operators sent letter correspondence stating "your injuries no longer fall within the Minor Injury Guideline." Before that date, the Tribunal accepted the self-represented applicant understood himself to be within the MIG.
The Form 1 question proved decisive for the attendant care benefits analysis. Section 42(5) of the Schedule bars an insurer from paying attendant care expenses incurred before a Form 1 is prepared and submitted by an occupational therapist or registered nurse. An OCF-18 for an occupational therapy assessment was not submitted until January 31, 2018 - nine days before Fehringer died. The Form 1 itself was never completed.
The Tribunal found the applicant failed to establish why a Form 1 was not completed immediately after he learned of potential ACB entitlement. The decision distinguished Botbyl v. Heartland Farm Mutual Inc. on the basis that Fehringer had been advised of his benefits from the outset, with adjuster log notes confirming a hospital visit on August 3, 2017 where the family was advised of $65,000 in medical, rehabilitation and attendant care coverage.
Lodging expenses were denied because the estate did not break down what services, if any, the charges covered. The receipts itemized items including room charges, care services, cable and phone, and lab work, but the estate made no submissions on the specifics.
The funeral benefit claim turned on the "but for" causation test. The estate argued Fehringer would not have contracted C. Difficile but for the accident forcing him into institutional care. The Tribunal disagreed, finding the submissions speculative. No medical opinion linked the infection to the accident or to his pre-accident conditions, which included anemia, probable myelodysplastic syndrome and dementia.
The Tribunal also rejected the death benefit claim, ruling that under section 26 of the Schedule the deceased applicant's estate is not eligible because the benefit attaches to spouses, dependants or other persons entitled to claim - not to the deceased.
The estate's request for an award under section 10 of Regulation 664 also failed. The Tribunal characterized the early MIG classification as wrong adjusting rather than conduct substantiating an award. Co-operators was not liable for costs, with the alleged unreasonable conduct relating to claims handling rather than Tribunal proceedings.
