What happened: Jevco must pay non-earner benefits after a denial letter failed to name the benefit it was refusing.
Who's involved: Jevco Insurance Company and a claimant hurt in a May 2023 Ontario car accident.
What's at stake: Non-earner benefits of $185 a week from June 30 to October 18, 2023, plus interest.
Why it matters: Going to insurer's exams doesn't stop a claimant from challenging a vague denial later.
Where it stands: Decided by Ontario's Licence Appeal Tribunal on September 23, 2026.
The letter told her she wasn't entitled to "the ENTER Benefit." Now Jevco has to pay the benefit anyway.
It's the second recent decision in which an Ontario tribunal has faulted a Jevco denial letter containing that same wording. Insurance Business reported on the first, involving a different claimant, on September 18, 2026.
This time, in a September 23 decision, Ontario's Licence Appeal Tribunal ordered Jevco Insurance Company to pay non-earner benefits of $185 a week from June 30 to October 18, 2023, plus interest. The rest of the claim went the insurer's way.
The claimant was hurt in a car crash on May 26, 2023, and applied for non-earner benefits. These cover people who can't carry on a normal life after an accident.
Ontario's rules give insurers 10 business days after receiving the paperwork to pay, explain their medical reasons for saying no, or ask for more information. Miss that, and the insurer must keep paying until a proper notice goes out.
Jevco's July 10, 2023 letter said it had "reviewed all information in your file" and booked insurer's exams. It didn't say much else.
The tribunal found the letter didn't clearly name the benefit, gave no details about her condition, and didn't say what information was missing. It wasn't clear enough "to allow an unsophisticated person to make an informed decision," the tribunal said.
Then came Jevco's fallback. The claimant went to both exams without objecting, it argued, so she couldn't complain about the letter now.
The tribunal disagreed. Jevco hadn't pointed to "a single section of the Schedule or caselaw" backing that idea, it said.
Accepting it would leave claimants with a bad choice. Skip the exams and lose benefits right away, or attend and give up the right to challenge a flawed notice later.
A second letter, dated October 18, 2023, got it right. It relied on exams by an occupational therapist and a physician, who found she appeared to have "uncomplicated soft tissue injuries." That date closed the payment window.
Outside that window, Jevco won. The claimant also wanted non-earner benefits through May 26, 2025, three physiotherapy and massage plans, and a $2,486 chronic pain assessment.
The tribunal accepted she had sprains and strains to her neck, back and shoulders from the crash. Chronic pain was another matter.
Records from her family doctors, covering visits from June 2023 into 2025, never mentioned the accident. Her rheumatologist, who had treated her knees and lower back since 2021, never linked her ongoing pain to it either.
She said language barriers explained the silence. The tribunal found no notes of communication trouble in those records, and her husband came along to several visits.
She also missed out on the first three weeks she claimed. Benefits start when the insurer receives the disability certificate, not the date written on it, and the tribunal found Jevco received hers on June 30.
On the treatment plans, the tribunal spelled out who carries the load: "It is not this Tribunal's role to search through the evidence and make the argument on behalf of the applicant."
A denial letter needs the benefit named and real, claim-specific medical reasons, because section 36(6) keeps the payments running until it has both, exams or no exams.
The decision doesn't say whether either side plans to seek reconsideration or appeal.
