An Ontario tribunal has ordered a rehearing after finding it may have overstepped its jurisdiction in barring an accident benefits claim.
The Licence Appeal Tribunal granted a reconsideration in Umbargalsigamany v. Primmum Insurance Company, 2026 ONLAT 25-005668/AABS-R, cancelling its earlier decision that had shut the applicant out of statutory accident benefits under the Schedule. The decision was released on April 29, 2026.
The original ruling, dated December 12, 2025, found that applicant Chandrahasan Umbargalsigamany was barred from claiming accident benefits under section 61(1) of the Statutory Accident Benefits Schedule. That provision relieves an insurer of the obligation to pay accident benefits when the claimant is entitled to receive benefits under the Workplace Safety and Insurance Act (WSIA).
On reconsideration, the applicant - now with new counsel - argued the Tribunal had no business determining whether he was entitled to WSIA benefits. He pointed to sections 31 and 118 of the WSIA, which vest exclusive jurisdiction over entitlement questions in the Workplace Safety and Insurance Board (WSIB) and the Workplace Safety and Insurance Appeals Tribunal (WSIAT).
He also produced a WSIB letter dated December 23, 2025, showing his WSIB claim had been denied - not on the merits, but because he had not provided enough information about his injuries and the circumstances of the accident. That letter reframed the entire dispute. If WSIA entitlement was never actually established, the section 61 bar may have been applied prematurely.
Primmum Insurance Company pushed back, arguing the applicant had taken the opposite position at the original hearing - claiming section 61 did not apply because he was an independent contractor not entitled to WSIB benefits. The insurer argued he had essentially invited the Tribunal to rule on the issue and could not now reverse course after losing.
Adjudicator Ulana Pahuta acknowledged the inconsistency but held that jurisdictional challenges can be raised at any stage, including for the first time on reconsideration. If a decision-maker lacks jurisdiction over a matter, she wrote, it simply cannot proceed - regardless of timing.
The adjudicator also cited the consumer protection purpose of the Schedule, referencing Clouthier v. Co-Operators General Insurance, 2025 ONSC 6798. She found it would run counter to that mandate to deny accident benefits without fully examining whether the claimant was actually entitled to WSIA benefits or whether a proceeding before the WSIB remained pending.
The original decision was cancelled and a rehearing before a different adjudicator was ordered. A case conference was to be scheduled within 30 days.
For Ontario auto insurers and claims teams, the takeaway is pointed. Relying on section 61 to deny accident benefits demands clarity around WSIA entitlement. Where that question remains open - whether because a WSIB claim is pending, denied for procedural reasons, or simply unresolved - the denial is vulnerable. And jurisdictional arguments, even those raised late in the game with new counsel, can reopen files insurers thought were closed.
