TD General Insurance was ordered to pay a special award after waiting two months to remove a claimant from the Minor Injury Guideline.
The claimant was injured in an automobile accident on October 27, 2022, and sought statutory accident benefits from TD General Insurance. The insurer determined the injuries fell within the Minor Injury Guideline and capped funding at $3,500, denying several treatment plans.
TD had earlier scheduled insurer's examinations in July, August and September 2023, which the claimant failed to attend. At a case conference on July 31, 2025, the parties agreed he would attend any rescheduled examinations. Multidisciplinary examination reports arrived on November 7, 2025, with TD's own psychological assessor recommending removal from the guideline - but TD did not act on that recommendation for two months.
Only on January 8, 2026 - one day after the claimant filed his written hearing submissions - did TD send a letter removing him from the guideline. Four days later, it approved all three previously denied treatment plans, covering a psychological assessment, a chronic pain assessment and physiotherapy. By January 14, 2026, TD told the tribunal a related preliminary issue over the claimant's earlier non-attendance was now moot, and withdrew it.
Adjudicator Ulana Pahuta found TD's delay unreasonable, rejecting the insurer's explanation that the gap was due to the holiday period. TD also delayed in rescheduling the examinations after the July 2025 case conference, not replying to the claimant's counsel until September 30, 2025. Pahuta wrote that the delay in releasing the examination report and revisiting the Minor Injury Guideline decision was "excessive, imprudent, unyielding, and immoderate."
Section 10 of Regulation 664 allows the tribunal to order an award of up to 50% of benefits an insurer unreasonably withheld or delayed. The claimant sought a 50% special award on the psychological assessment and 35% on the chronic pain and physiotherapy plans, citing a prior tribunal decision involving a two-month delay. Pahuta found that case involved a longer period of unreasonable conduct, and instead ordered a 15% special award on the three treatment plans, plus interest under the regulation.
Pahuta also ordered TD to pay $1,000 in costs, finding the claimant would not have incurred hearing-preparation expenses had TD acted on the examination findings before he filed his submissions. The tribunal separately resolved a dispute over settlement-privileged material in the claimant's reply submissions, excluding some portions while allowing others to stand.
The decision was released on September 1, 2026.
