A dispute over $5,560 in CAT assessment fees has reinforced Ontario's per-assessment funding cap - and exposed a subtle interest trap for insurers.
In Liu v TD General Insurance Company, decided April 23, 2026, by the Licence Appeal Tribunal, Adjudicator Melanie Malach sided with the insurer on the central billing question but ordered interest on three treatment plans TD had denied and later approved.
The case was filed November 26, 2024. It arose from a January 2, 2020 motor vehicle accident involving Bao Qi Liu, who sought statutory accident benefits from TD. Among the disputed items was a multi-disciplinary catastrophic impairment assessment proposed by Somatic Assessments and Treatment Clinic, totalling $14,750.81. TD approved $9,190.81 but denied $5,560 in additional charges, including a separate occupational therapy summary report, two clinic file reviews, and HST.
TD's position was straightforward: the Statutory Accident Benefits Schedule caps fees at $2,000 per assessment under section 25(5)(a), and the denied items either fell within that cap or were not payable. The adjudicator agreed.
Section 25(5)(a) states that an insurer shall not pay more than $2,000 plus applicable taxes for conducting any one assessment or examination and preparing reports in connection with it. Malach held that file reviews are part of an assessment and cannot be billed separately on top of the $2,000 ceiling. She adopted the reasoning the Tribunal applied in Zhang v. The Co-Operators (2022) and Chen v. Certas (2025) - part of a line of decisions on the issue that also includes Marcijus v. Co-Operators (2024).
The summary report got the same treatment. An analysis and summary, Malach found, should be part of the assessment report itself - not carved out for additional payment.
The adjudicator also rejected the argument that TD's denial was deficient because it lacked a medical opinion. Where a denial is grounded in the Schedule and the Professional Services Guidelines rather than a clinical assessment, she held, no medical rationale is required.
On HST, the respondent pointed to the Professional Services Guidelines, which note that the Canada Revenue Agency exempts services by physicians, occupational therapists, and psychologists. The applicant did not meaningfully contest the point, and the Tribunal found the burden had not been met.
But the case did not go entirely TD's way. Three other treatment plans - a physiotherapy plan ($4,229.56) and the balance of two psychological services plans ($280 each) - had been denied and then approved by TD on April 15, 2025, after the applicant was deemed catastrophically impaired. Malach found those approvals amounted to a settlement under section 51(4) of the Schedule, triggering mandatory interest at the prejudgment rate from the filing date to the date of approval.
Claims teams should take note: approving previously denied benefits during an active Tribunal proceeding does not wipe the slate clean. Interest runs from the moment the application is filed.
The applicant also sought a special award under section 10 of Ontario Regulation 664, alleging TD acted unreasonably. The Tribunal declined. TD's denial of the physiotherapy plan was based on an Insurer's Examination report, and the psychological services denials rested on a Schedule provision restricting certain transportation expenses for non-catastrophically impaired claimants. Once the CAT determination was made, TD approved the benefits. The Tribunal found nothing excessive, imprudent, stubborn, inflexible, unyielding, or immoderate in that approach.
