An Ontario tribunal partially reversed itself against Peel Mutual, ordering a rehearing of six denied treatment plans worth more than $34,000 in an auto accident benefits dispute.
The Licence Appeal Tribunal released its reconsideration decision on May 8, 2026, in Grewal v Peel Mutual Insurance Company, 2026 CanLII 45609 (ON LAT). Vice-Chair Craig Mazerolle granted the applicant's request in part, cancelling the denial of six treatment plans and sending them to a written rehearing before a different adjudicator.
The dispute traces back to a motor vehicle accident on November 7, 2016. The applicant sought catastrophic impairment status under Criterion 8 and a series of medical and rehabilitation benefits under the Statutory Accident Benefits Schedule. In its earlier decision released October 17, 2025, the Tribunal denied catastrophic impairment but approved some benefits, including treatment plans for catastrophic impairment assessments, occupational therapy services, assistive devices, and a psychological assessment.
On reconsideration, the central issue for insurers was the Tribunal's reliance on section 20(1)(a) of the 2016 Schedule, which caps medical and rehabilitation funding at 260 weeks for non-catastrophic claims. Mazerolle accepted that this cap was applied incorrectly. The reason came down to a letter the insurer itself wrote.
In an August 19, 2024 letter, Peel Mutual told the applicant that because her policy was renewed before the June 1, 2016 amendments, her claim was not subject to those regulatory changes. The letter said medical and rehabilitation benefits "are payable for up to 10 years after the accident," with a $50,000 cap for non-catastrophic, non-minor injuries.
That letter went missing during the original hearing. The applicant's representative referenced it but could not produce a copy. The Tribunal then denied four Okell Rehabilitation plans and two Anchor Rehabilitation Support Services plans on the basis of the 260-week limit.
Once the letter resurfaced on reconsideration, Mazerolle concluded the denial could not stand. Since the insurer authored the document, he found the information was already within its knowledge prior to the hearing. The six plans, ranging from $4,487.57 to $8,420.80, will be reheard along with related interest and award claims.
The applicant did not succeed on every front. Her Notice of Constitutional Question, which argued that the Schedule's evidentiary framework discriminates against people with psychiatric impairments under section 15(1) of the Charter, was dismissed. Mazerolle found the Tribunal had applied the legal test for causation, not an approach skewed toward physical injuries, and noted that certain physical conditions can also surface unexpectedly long after an accident.
The Tribunal also upheld the denial of an OCF-6 for an inpatient stay at Homewood, finding the strict pre-authorization requirement under section 38(2) of the Schedule applied. Mazerolle observed, however, that section 34's remedial authority over time limits may provide a path forward for insureds in similar circumstances.
For claims professionals, the takeaway is direct. Letters confirming coverage terms can return as evidence even after a hearing closes, and statutory bars cannot fix a misapplied limitation period.
