What happened: A tribunal found the driver's injuries were minor, but a confusing denial letter still cost the insurer money.
Who's involved: Security National Insurance Company and a driver injured in a 2024 crash, identified only as the claimant.
What's at stake: $844.93 plus interest ordered paid; a separate $2,804.12 claim was denied.
Why it matters: Mixing up numbers in a denial letter can force an insurer to pay, no matter how the medical dispute turns out.
Where it stands: Decided - Ontario Licence Appeal Tribunal ruling released September 16, 2026; no appeal noted in the record.
An insurer's own denial letter cited two dollar figures for one treatment plan - and that mix-up decided the case. The dispute traces back to a June 2024 car accident, after which Security National Insurance Company said the claimant's injuries were minor.
The claimant took his case to Ontario's Licence Appeal Tribunal after Security National capped his medical and rehabilitation coverage at $3,500. That's the ceiling under the province's Minor Injury Guideline - it kicks in unless a claimant can show his injuries fall outside a list that includes sprains, strains and similar soft-tissue conditions. He didn't try to make that argument.
Instead, he went after the insurer's paperwork, calling its reasoning “mere conjecture to which the applicant can not respond effectively.” One plan was a psychological assessment worth $2,144.93. The other was psychological services worth $2,804.12.
Only one of those arguments worked.
Insurers get ten business days to spell out, in writing, what they'll pay for and what they won't - and why. Security National's August 13, 2024 letter said it had approved $1,300 toward the psychological assessment. But its own reasons then pointed to a plan from the same provider, dated the very same day - this time for the full $2,144.93 - and said none of it would be paid.
The tribunal found that explanation unclear on whether one plan was being partly funded or two separate plans were in play. It ruled the letter didn't give “clear and unequivocal medical and all other reasons,” the standard the Schedule sets. Because Security National fell short, it now owes the outstanding $844.93, plus interest.
The letter, not the medicine, made the difference.
Even the tribunal's own file briefly got the date wrong. A case-conference report a year earlier listed the same plan as dated August 1, 2024, rather than the actual July 16 - a small mix-up the tribunal sorted out before it got to the real question.
The second disputed plan, for $2,804.12 in psychological services, went the insurer's way. That first denial letter, notably, is missing from the file entirely - neither side produced a copy. So the insurer scheduled independent examinations, and its final letter, dated April 3, 2025, leaned on what those exams found.
The tribunal found that letter compliant. It also agreed with both insurer-retained examiners - a psychologist and a general practitioner - that the claimant's injuries were minor overall, since he never argued otherwise.
A request for a delay penalty went nowhere too - the problem was clarity, not stalling.
In the end, this case wasn't decided by medicine at all - it came down to whether an ordinary reader could follow the math in one confusing letter.
