A denial letter that never named the benefit briefly cost Jevco Insurance Company weeks of benefits, even after it won the bigger fight.

The dispute reached Ontario's Licence Appeal Tribunal after a person hurt in a May 2023 car accident asked Jevco for a non-earner benefit of $185 per week, four treatment plans, and interest.

That earlier benefit hinged on a July 2023 denial letter that never said which benefit was being refused. It read, in part, "you are not entitled to the ENTER Benefit." The tribunal ruled the letter didn't meet Ontario's accident benefit notice rules, since it gave no real medical reasons for the denial.

Because the letter fell short, the tribunal ordered Jevco to pay the benefit, plus interest, from June 30 to October 19, 2023, when a second, properly worded letter took over. Outside that window, the applicant wasn't entitled to the benefit: the paperwork triggering it hadn't been received before June 30, and the October letter closed off any further liability.

From there, Jevco prevailed on nearly everything else. The tribunal found the applicant's injuries were predominantly minor, keeping his treatment within the Minor Injury Guideline's $3,500 cap. He argued that pre-existing neck, back, knee and shoulder pain, plus chronic pain, a possible brain injury and psychological symptoms, should have pushed him past that cap, leaning partly on a chronic pain specialist's report.

His family doctors told a different story. Records from two physicians made no mention of the accident across more than a year of visits, so the tribunal gave the chronic pain report limited weight. That report leaned on a recognized six-factor clinical test, of which three factors are needed to support a chronic pain diagnosis; the tribunal found the applicant met only one. A physiotherapist's notes describing anxiety and a sleep disorder didn't count either, since that diagnosis fell outside a physiotherapist's training. A claim of a possible brain injury fared no better, resting on the applicant's own account rather than independent medical findings.

Since he remained inside the guideline, the tribunal didn't need to weigh whether the four disputed physiotherapy and assessment claims were reasonable, so none were paid out. Interest applied only to the non-earner benefit period tied to that one flawed letter.

The final order holds Jevco to the non-earner benefit and interest for June 30 to October 19, 2023, and clears it of the four disputed treatment plans and everything else the applicant sought.