A catastrophically injured driver lost every disputed benefit at Ontario's Licence Appeal Tribunal after failing to file the plans, letters and records his claims needed.
The applicant was struck by a vehicle on March 11, 2022, while attaching another car to his tow truck, pinning him between the two vehicles. He suffered a fractured tibia requiring internal fixation, a traumatic brain injury, and psychiatric conditions including major depressive disorder, post-traumatic stress disorder and somatic symptom disorder, along with significant memory loss. Nordic Insurance Company of Canada took over adjusting his claim after May 31, 2023, and accepted his catastrophic impairment status in February 2025.
Nine separate disputes reached the Tribunal, including a $10,149.65-per-month attendant care claim, a catastrophic impairment assessment fee, rehabilitation support work, occupational therapy, chiropractic treatment, assistive devices and prescription medication expenses. Vice-Chair Brian Norris dismissed every one.
Norris found the applicant had not submitted the treatment plans, denial letters, invoices or medical records underlying any of his claims. Without that record, he could not assess whether Nordic's responses were untimely, insufficient or unreasonable, or whether the disputed goods and services were reasonable and necessary as a result of the accident. As Norris put it, "Submissions are not evidence."
On the attendant care dispute, the applicant argued Nordic bore the burden of disproving his entitlement rather than the reverse. Norris rejected that framing, restating that the onus falls on the claimant to prove a benefit is reasonable, necessary and, where applicable, actually incurred. He noted the applicant produced no invoices or receipts, only letters from his prior insurer setting out the monthly amounts available - none of which established entitlement to any further payment.
The catastrophic impairment assessment fee failed on a separate ground. Norris observed that Nordic had already accepted the applicant's catastrophic impairment status in February 2025, making any further assessment aimed at establishing that same status unnecessary regardless of the missing evidence.
On the one claim where the applicant argued Nordic's denial letter failed to properly explain its reasoning - a request for extended rehabilitation support hours - Norris looked to an Ontario Court of Appeal ruling rather than an earlier tribunal decision on the same question. That precedent holds an insurer cannot invent a medical reason for a denial that does not exist. Nordic's letter, which approved one-hour sessions and questioned why three-hour sessions were needed alongside separate occupational therapy already being provided, met that standard, Norris found.
With no benefits found payable, Norris denied both interest and a special award under the regulation covering unreasonably withheld or delayed payments. The application was dismissed in its entirety on August 10, 2026.
