In Cardoso v Definity Insurance Company, 2026 CanLII 53768 (ON LAT), Ontario's Licence Appeal Tribunal upheld Definity Insurance Company's denial of catastrophic impairment benefits, rejecting an applicant's bid to reopen findings backed by surveillance evidence.
In a reconsideration decision released May 29, 2026, Vice-Chair Craig Mazerolle dismissed Elsie Cardoso's request to reopen findings from a January 21, 2026 decision following a November 27, 2019 accident. The original ruling, made after a five-day videoconference hearing, found Cardoso failed to establish catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule and dismissed her claims for additional attendant care, housekeeping, medical/rehabilitation benefits, and interest.
Cardoso pursued reconsideration under Rule 18.2(b), arguing the Tribunal made errors of law or fact that would likely have changed the result. Her challenge focused on the catastrophic impairment finding and the attendant care benefit (ACB) denial.
On the catastrophic question, Cardoso argued the Tribunal misinterpreted her psychiatric assessor Dr. Shrenik Parekh's diagnosis of Somatic Symptom Disorder by treating it as a "purely subjective or behavioural condition" rather than one supported by objective signs of neuropathic pain. She also argued the Tribunal improperly relied on surveillance to counter expert opinion.
Mazerolle disagreed. He noted both parties' assessors agreed Cardoso suffered an accident-related mental or behavioural disorder, so the operative question was whether she demonstrated marked impairment in three of four domains under the AMA Guides. The Tribunal had weighed surveillance - which on February 1, 2024 showed Cardoso running multiple errands, driving to a bakery, attending RBC Bank, shopping at Sobeys, going through a Tim Hortons drive-thru and later driving her parents to hospital - alongside other evidence, and found Dr. Parekh's account of her functioning was at odds with the overall evidentiary record. Disagreement with that weighing, Mazerolle held, is not an error under Rule 18.2(b).
The ACB challenge fared no better. Cardoso argued she had filed an account summary from her care provider showing services had been incurred. The Tribunal had found she did not refute Definity's submission that she had not incurred the monthly ACB of $851.74 since it was approved in July 2023. Mazerolle noted reconsideration is not a venue for raising arguments that could have been reasonably raised at first instance.
Cardoso also argued the Tribunal conflated approval with payment, pointing to balances owing to her service provider as proof services had been incurred. Mazerolle rejected that reading, finding the Tribunal had accepted Definity's position that only part of the approved amount had been incurred.
A further argument that the Tribunal had failed to factor in Cardoso's optional benefits - which lift the standard 260-week post-accident time limit on ACB payments - also failed. Mazerolle noted the Tribunal explicitly recognized at paragraph 84 that the 260-week mark, which fell on November 20, 2024, did not apply, and the hearing began November 3, 2025. Entitlement was considered past the limit. Optional benefits, he said, did not address whether services were reasonable, necessary or incurred.
The reconsideration request was dismissed in full.
