A claimant who skipped her insurer's exams stayed barred from accident benefits - even after Ontario's tribunal admitted a lapse in its own reasons.
The Licence Appeal Tribunal released its reconsideration decision on July 17, 2026, in a dispute over statutory accident benefits. The outcome is a useful reminder for claims professionals: a procedural win for a claimant does not always change the result.
The applicant was involved in an automobile accident on September 28, 2023, and sought benefits under Ontario's Statutory Accident Benefits Schedule. Intact Insurance Company arranged several insurer's examinations. When the applicant did not attend, an adjudicator ruled she was barred from proceeding with every substantive issue in dispute under section 55(1)2 of the Schedule. Those issues included whether her injuries fell within the Minor Injury Guideline, two treatment plans, an award, and interest. That decision was released February 9, 2026.
On February 25, 2026, the applicant asked the Tribunal to reconsider. She argued the original adjudicator had erred and breached procedural fairness by finding she had pointed to no evidence that the missed examinations were not reasonably necessary. She also suggested the approach showed bias, and said the adjudicator had never addressed her alternative argument under section 55(3) of the Schedule.
Intact urged the Tribunal to dismiss the request, submitting that the reasons were sufficient and that an adjudicator has no obligation to refer to every piece of evidence.
Vice-Chair Craig Mazerolle rejected most of the applicant's position. He found the original adjudicator had considered her explanation for missing the examinations and saw no sign of bias. The failure to mention case law she had cited was not material, he added, because tribunal decisions are not binding and each section 44 dispute is highly fact-specific.
One argument, though, changed the analysis. The applicant's alternative submission relied on section 55(3), a remedial provision that lets the Tribunal permit a non-compliant applicant to continue. The original decision never engaged it. There was "no reference to this alternative submission in the decision," the Vice-Chair wrote. Because section 55(3) was not a minor or tertiary point, that silence amounted to a material breach of procedural fairness, and the request for reconsideration was granted.
The victory was short-lived. Turning to the remedy, the Vice-Chair confirmed the original outcome. Section 55(3) gives the Tribunal discretion, but the party seeking to rely on it carries the onus of showing that discretion should be used. The applicant, he found, had offered no argument in support - she had simply asked the Tribunal to exercise the power. On that record, there was no basis to disturb the original findings.
For insurers and claims teams, the decision reinforces how much weight attaches to attendance at insurer's examinations, and how a non-compliance bar under section 55 can end a claim before its merits are heard. It also shows that identifying a procedural gap is only half the task; a claimant must still make the substantive case for the relief sought.
