Pembridge Insurance has defeated an accident benefits claim in full after the applicant pursued a two-day tribunal hearing without medical or financial evidence.
Ontario's Licence Appeal Tribunal released its decision on July 14, 2026, following a videoconference hearing held June 9 and 10, 2026. Adjudicator Tami Cogan ruled that the applicant's injuries were predominantly minor and denied every benefit in dispute.
The claim stemmed from an automobile accident on October 19, 2020. The applicant, who owns a hair salon, sought statutory accident benefits from Pembridge and, after being denied, applied to the tribunal to escape the Minor Injury Guideline and its $3,500 treatment limit. She also sought an income replacement benefit of $400 per week, $5,443.97 for psychological services, and $4,052.95 for physiotherapy.
The outcome turned on evidence, or the lack of it. The applicant filed no document brief and was the only witness at the hearing. She produced nothing to corroborate her testimony. The only medical evidence before the tribunal came from the insurer's own examination reports.
The insurer's examining physiatrist, in a report dated May 11, 2021, concluded that the applicant's accident-related injuries were uncomplicated soft-tissue injuries falling within the guideline. Cogan found the report persuasive, citing its detailed objective findings. The applicant argued she had a psychological impairment, but the insurer's psychologist, in a report dated May 11, 2021 and an addendum dated March 31, 2023, found no basis for a diagnosis and flagged concerns about symptom magnification on testing. The tribunal placed little weight on the applicant's contrary testimony, finding it inconsistent with her own reporting to the assessor.
For claims professionals, the income replacement analysis is instructive. The applicant returned to her salon one week after the accident and continued to run it. Cogan found she still performed the essential tasks of her employment and could not quantify any reduction in her activities, so she had not shown a substantial inability to work.
The decision also underscores the reach of section 33. Pembridge suspended benefits effective December 10, 2020, after the applicant failed to provide requested financial documentation. Cogan found the applicant had not produced a single document since 2020, and that under section 33(6) the insurer was not liable to pay while she remained non-compliant.
On costs, Pembridge sought $2,000, pointing to a two-day hearing run without evidence and to a $250 cost order from an earlier proceeding between the same parties that remained unpaid. Cogan found the applicant had shown "an unreasonable pattern of disregard for the Tribunal's procedures, Rules, and Orders" and that proceeding without evidence was frivolous. Even so, she declined to order costs, citing the applicant's language barrier, her dependence on her legal representative, and her right to be heard.
The result is a clean sweep for the insurer, across the guideline question, income replacement, both treatment plans, interest, and costs.
