An Ontario tribunal ordered Security National Insurance Company to pay a special award after finding it unreasonably denied a crash victim's psychological assessment.
The Licence Appeal Tribunal released its decision on June 17, 2026, granting the applicant's claim and penalizing the insurer for how it handled the file.
The dispute began with a March 15, 2023 collision. The applicant, the seat belted driver of an SUV, was rear-ended by a stolen vehicle during a high-speed police chase. Her vehicle sustained over $18,000 in damage and was written off.
The applicant sought benefits under the Statutory Accident Benefits Schedule. Security National denied them, treating her injuries as predominantly minor and capping coverage within the $3,500 Minor Injury Guideline limit. She applied to the Tribunal to challenge that classification and to obtain $2,200 for a psychological assessment proposed by Prime Health Care Inc. The treatment plan was submitted June 15, 2023, and denied June 27, 2023.
Adjudicator Sofia Ahmad found the applicant's impairments were not minor. Her psychological symptoms were first noted on June 7, 2023, during a screening interview with a psychologist. Her family physician prescribed trazodone for sleep disturbances on October 12, 2023, and later diagnosed her with Generalized Anxiety Disorder, prescribing Cipralex. During a mental health visit, the applicant reported a panic attack while driving and said she had not driven since. The adjudicator noted the applicant was taking no prescription medication before the accident.
A key point for claims professionals: the decision confirmed that a psychological impairment alone justifies removal from the Minor Injury Guideline. There is no requirement, the adjudicator held, that the impairment carry a functional limitation - a position the insurer had argued and the Tribunal found was not legally correct.
With the guideline no longer applicable, the adjudicator found the proposed psychological assessment reasonable and necessary, ordering payment of the $2,200 plus interest under s. 51 of the Schedule.
The sharper outcome for insurers came under s. 10 of Reg. 664, which lets the Tribunal award up to 50 per cent of benefits payable when an insurer unreasonably withholds or delays them. The adjudicator awarded 25 per cent of the treatment plan as a special award, with interest.
In doing so, she found the insurer had failed to properly adjust the claim. "The insurer carries blameworthiness in this case," she wrote. The applicant was in a vulnerable position, and by delaying examination of her psychological issues, the insurer caused harm or potential harm. The adjudicator described the conduct as inflexible, imprudent and unyielding, and pointed to a need for deterrence.
The application was granted.
