An Ontario appeal court has backed an auto insurer's right to recover accident-benefit overpayments from a claimant who stayed silent about returning to work.
The Divisional Court of the Ontario Superior Court of Justice released its decision on June 30, 2026, dismissing the appeal.
The dispute began after the claimant, then an international student, was struck by a car while cycling in November 2019. He suffered a fractured hip that required surgery and an 11-day hospital stay. Coseco Insurance Company, the auto insurer for the vehicle's owner, paid income replacement benefits and covered medical costs up to the policy's $65,000 limit for non-catastrophic injuries.
The claimant returned to work on April 6, 2020, but did not tell the insurer until July 29, 2021, more than a year later. Coseco then recalculated the benefits, found it had overpaid, and sought repayment.
A Licence Appeal Tribunal adjudicator sided with the insurer. In a decision dated September 12, 2024, later upheld on reconsideration in March 2025, the tribunal found the claimant had committed wilful misrepresentation by failing to disclose his return to work and his post-accident earnings. It ordered him to repay $10,513.56 in income replacement benefits, plus interest, and ruled he was not entitled to further payments. It also found the $65,000 medical and rehabilitation limit had been exhausted.
On appeal, the claimant argued the adjudicator misstated the legal test for wilful misrepresentation by treating silence alone as enough. The Divisional Court agreed the test had not been stated correctly. Under the case law, silence or a failure to report can amount to wilful misrepresentation only where the required intent is established.
But the court held the error made no difference. A mistake of law only warrants intervention if it is material to the result. Here, the panel found the adjudicator had examined the evidence and concluded the claimant withheld his employment information because it would hurt his claim. The misstatement did not cause a substantial wrong, so the appeal failed on that ground.
The court also rejected the claimant's argument that Coseco broke the rules by paying a $53,700 hospital bill without first receiving a treatment plan or giving notice. Those requirements apply to future expenses, the court said, and nothing bars an insurer from paying a reasonable expense that has already been incurred.
For insurers and their claims teams, the ruling is a practical marker. It confirms that a claimant's non-disclosure of a return to work can support a repayment demand, and that a flawed statement of the legal test will not sink an otherwise sound decision. The court ordered the claimant to pay the insurer $7,500 in costs and the tribunal $250.
