Ontario's Licence Appeal Tribunal has dismissed a driver's bid for three treatment plans, an award and costs against Royal & Sun Alliance.

Adjudicator Laura Goulet ruled the claimant, hurt in a January 27, 2021 car accident, failed to prove that an orthopaedic assessment plan worth $2,460 and two occupational therapy assessment plans totalling $2,911.62 were reasonable and necessary under Ontario's Statutory Accident Benefits Schedule. She also found Royal & Sun Alliance had not unreasonably withheld or delayed payment, so the claimant was not entitled to an award. He had also sought interest and costs.

Goulet rejected the orthopaedic assessment plan, proposed in November 2022, after finding the claimant had already been examined by an orthopaedic surgeon five times between April 2022 and April 2023, including cortisone injections and referrals for further imaging. The claimant argued the assessment would clarify a diagnosis and guide treatment, pointing to a disc protrusion identified on a June 2022 MRI. Goulet was not persuaded. She wrote that "assessments, by their nature, are investigative," and found the claimant had not shown a second orthopaedic opinion was warranted or explained why the plan's costs were reasonable.

The first occupational therapy plan, dated February 6, 2022, ran into a similar problem. Goulet placed little weight on the resulting assessment report because it conflicted with the claimant's family doctor's notes from days after the assessment. The claimant told the assessor his condition was incompatible with his work as a commercial pilot, but his doctor indicated around the same time that he had no restrictions and was ready to return to work full time. Goulet also noted the claimant's absence from work traced partly to a pre-existing diabetes diagnosis rather than the accident.

A second occupational therapy reassessment, proposed in May 2024, fared no better. Goulet gave it little weight because the assessor was not a medical doctor, did not review records from the claimant's treating physicians, and made no mention of his diabetes despite its effect on his return to work. The claimant did not point to any treating doctor recommending the assessment.

Royal & Sun Alliance had also sought to exclude a January 2023 orthopaedic report from the case file, arguing it was filed late. Goulet rejected that request, finding the report had been served on the insurer and that excluding it would prejudice the claimant more than admitting it would prejudice Royal & Sun Alliance. The report ultimately did not change the outcome.

The claimant also sought costs, arguing Royal & Sun Alliance's handling of the file was unreasonable and had forced him into litigation. Goulet allowed the issue to proceed despite the insurer's objection that it was raised too late in submissions, but found no evidence of unreasonable, frivolous or bad-faith conduct by the insurer. Because no benefits were found owing, she also declined to order interest.

The application was dismissed in full in a decision released September 3, 2026.