An Ontario tribunal ordered Certas Home and Auto Insurance to pay a 25% award for years of unreasonable claims handling on a 2018 auto accident.
The Licence Appeal Tribunal released its reconsideration decision on May 15, 2026, in Vivekanantham v Certas Home and Auto Insurance Company, 2026 CanLII 48382 (ON LAT). The matter returned to the Tribunal after the Divisional Court found procedural fairness problems with the original 2023 hearing.
Kavitha Vivekanantham was injured in an automobile accident on June 1, 2018. She sought catastrophic impairment status, attendant care benefits, and an award under section 10 of Regulation 664 for the insurer's claims handling.
Adjudicators Gurleen Thethi and Caley Howard rejected the catastrophic claim and the attendant care benefits. But they found Certas's handling of both treatment plans and income replacement benefits crossed the line.
On treatment plans: Certas removed the applicant from the Minor Injury Guideline in September 2022, right before the case conference. Yet the insurer continued to deny treatment plans up to the original March 2023 hearing, despite available entitlement within the non-CAT, non-MIG limit of $65,000. The adjuster acknowledged at the original hearing that the plans had not been paid and that there was no reason for the continued non-payment.
The tribunal called this conduct "stubborn, inflexible, and immoderate" - the language of the section 10 test.
On income replacement benefits: The insurer terminated IRBs in May 2019 based on section 44 reports. The respondent reinstated IRBs in January 2023 and paid arrears for May 29, 2019, to February 14, 2023. The tribunal noted the insurer's own internal log notes had acknowledged that the original termination was unclear, and that the reinstatement appeared to follow advice of counsel rather than any new medical information.
The tribunal observed that late-stage reversals without clear explanation can support an inference that earlier decisions were not reasonably maintained.
The applicant led evidence of significant financial hardship - reliance on social assistance, borrowing money, accumulating debt, and difficulty meeting basic household expenses.
The applicant asked for a 50% award. The tribunal chose 25%, citing mitigating factors: Certas initially relied on medical evidence, eventually paid the benefits with interest, and the panel did not find bad faith or deliberate misconduct.
The order: 25% of $61,000 for treatment plans and 25% of $159,000 for IRBs, with interest under section 51 of the Schedule and compound interest under section 10 of Regulation 664.
For claims professionals, the decision flags the gap between removing an insured from the MIG and actually reassessing previously denied treatment plans. The Tribunal also signaled that reinstating benefits without contemporaneous documentation - especially after long delays - can suggest earlier denials were not properly maintained. The adjuster's testimony that there was no reason for continued non-payment after MIG removal was a significant factor in the panel's findings.
This was the rehearing ordered by the Divisional Court in November 2024.
