Ontario's Licence Appeal Tribunal has reopened a barred catastrophic impairment claim against Intact Insurance, ruling its own earlier decision skipped two key arguments.
Adjudicator Nathan Prince granted the applicant's request to reconsider a February 23, 2026 decision that had shut the door on her second bid for catastrophic impairment benefits. The reconsideration decision was released June 17, 2026.
The dispute traces back to a May 3, 2012 accident. The applicant first sought a catastrophic impairment determination under Criterion 8 of the Statutory Accident Benefits Schedule. After a hearing held January 8 to 12, 2024, the Tribunal found she was not catastrophically impaired, and upheld that finding on reconsideration.
The applicant then filed a second application based on a subsequent OCF-19, again seeking a catastrophic impairment determination under Criterion 8. Intact responded with a preliminary objection, arguing res judicata barred her from a hearing. Following a one-day videoconference on January 26, 2026, the Tribunal agreed, applied the doctrine, and dismissed the application.
That is the ruling now cancelled. The parties did not dispute that the preconditions for res judicata were met - the earlier decision was final, the parties were the same, and the CAT issue had already been determined. But because res judicata is discretionary, Prince found the Tribunal had to explain whether to apply it here, and had failed to do so on two central points.
The first was the applicant's reliance on Roy v. Primmum Insurance, 2020 ONSC 3886. She argued that on receiving a new OCF-19, an insurer must engage its statutory obligations under the Schedule, including a duty to reassess, and that Intact instead relied on res judicata to avoid the merits. Intact countered that Roy was decided under an earlier version of the Schedule that required insurer examinations on receipt of an OCF-19, a requirement the current version drops, and that any non-compliance would not bar res judicata in any event.
Prince noted the original decision had expressly referenced Roy but never analyzed whether it applied. Treating the argument as central to the applicant's case, he found the omission a material breach of procedural fairness.
The second gap concerned fairness. The applicant's submissions on that waiver were, in the original decision's words, "heavily focused" on an alleged error of law in the prior ruling. Prince found the decision did not meaningfully weigh the discretionary factors, again breaching procedural fairness.
Rather than order a fresh hearing and prolong an already lengthy dispute, Prince directed that a different adjudicator review the existing record - the transcript, recording, and exhibits - and decide the res judicata question anew. The party that brought the court reporter to the initial hearing must supply the recording or transcript within 30 days.
For accident benefits insurers, the point sits in the reasons: a preliminary res judicata win can be undone where the tribunal does not show its discretionary analysis.
