What happened: An Ontario tribunal rejected a $3,042.64 psychological treatment claim caught by the 260-week benefits cutoff
Who's involved: TD General Insurance Company and a motorist who sought accident benefits from it
What's at stake: $3,042.64 in treatment, interest, and a $7,000 costs request from the insurer
Why it matters: Claimants must prove expenses were incurred before week 260; insurers need specifics to win costs
Where it stands: Decided September 24, 2026; application dismissed, costs denied
The tribunal never got to the medical file. The calendar settled things first.
A motorist hurt in a February 6, 2020 crash wanted TD General Insurance Company to pay for $3,042.64 in psychological treatment. Her treatment plan was dated November 6, 2024, and TD said no on January 22, 2025.
She took the dispute to Ontario's Licence Appeal Tribunal. In a decision released September 24, 2026, the tribunal sided with TD - then turned down the insurer's own request for $7,000 in costs.
Ontario's accident benefits rules put a time limit on medical and rehab coverage. For anyone 18 or older at the time of the crash, expenses incurred more than 260 weeks later - roughly five years - aren't payable.
There are two ways around that limit. The person has to be catastrophically impaired, or have optional benefits.
TD said her 260-week window closed on January 30, 2025. She didn't dispute that date.
What she didn't do was show the treatment costs were incurred before it. In her view, that question was irrelevant to the hearing.
The tribunal saw it differently. It found the "clear wording" of the rule only covers expenses incurred inside the window, and that proving it was up to her.
Neither way around the limit applied. There was no evidence of a catastrophic impairment finding, or that she had optional benefits.
She had one more argument. She asked the tribunal to assess the plan now, so it could be funded "if or when the applicant is deemed to have sustained a catastrophic injury in the future."
The tribunal said the rules don't support that. No benefit owing meant no interest either.
So the medical evidence never came into play. That included a nine-page medical summary filed alongside her submissions, which TD wanted excluded for going over a six-page limit. The tribunal said that side fight was moot.
TD then asked for $7,000 in costs. It pointed to this application and to three earlier ones in which she sought a catastrophic impairment finding, then withdrew.
According to TD, each was withdrawn "on the eve of the hearing." The insurer said it had prepared to examine "17 witnesses for the applicant and review over 3,000 pages of medical records," and called the pattern "an abuse of process" driven by "vexatious and frivolous actions."
She pushed back. A crash more than six years old, she said, "inevitably" led to several applications and hearings, and her own counsel had also prepared witnesses and reviewed thousands of pages of records.
This round went to her. The tribunal described costs as an exceptional remedy with a high bar, capped at $1,000 for each full day of attendance at a motion, case conference or hearing.
The closed files were off the table, since the rules only allow costs for the current application and TD cited no authority saying otherwise. On this application, TD gave no specifics of improper conduct, didn't address any harm to the process or to itself, and listed no attendance days to claim for.
Request denied.
For adjusters reviewing files near the 260-week mark, the first question is simple: when was the expense actually incurred? Insurers frustrated by repeat withdrawals, meanwhile, will need to build any costs request around the application in front of the tribunal, not the ones already closed.
The decision does not say whether either party plans to seek reconsideration or appeal.
