TD General Insurance lost a bid to bar an accident benefits claim after Ontario's tribunal ruled a consent form clause demanding assessor independence was reasonable.
In a decision released July 23, 2026, Vice-Chair Trina Morissette of the Licence Appeal Tribunal found that a claimant had a reasonable explanation for not attending seven insurer examinations scheduled to assess her post-104-week income replacement benefit entitlement.
The dispute arose from an August 23, 2023 automobile accident. TD General Insurance approved the applicant's pre-104 income replacement benefits but required her to attend insurer examinations under section 44 of the Statutory Accident Benefits Schedule to determine ongoing entitlement.
On June 24, 2025, the insurer issued a Notice of Examination requiring attendance at seven assessments - neurology, ophthalmology, functional abilities, neurocognitive, psychology, orthopaedic and vocational - between August and September 2025. The applicant did not dispute the validity of the notice or the need for the examinations.
The dispute centred on two clauses in a consent form the applicant proposed for each assessment. The first clause required that assessors preserve their notes, emails and draft reports and produce them on request. The second required that the retained expert - not the assessment company - personally review the applicant's medical records, conduct the examination and prepare the report without outside influence.
The parties negotiated the terms through August and September 2025 but reached an impasse. The assessors' position was that no assessment could proceed without a signed consent form. On October 27, 2025, TD declared the applicant in non-compliance with section 44 and discontinued her income replacement benefits effective November 21, 2025.
Morissette found the first clause unreasonable. The tribunal's own rules already provide a mechanism for ordering third-party document production, and the applicant had not used that process. Requiring production commitments inside a consent form was not a reasonable basis for refusing to attend the examinations.
The second clause, however, was found reasonable. Morissette described a medical assessment as "a personal and intrusive process" and held that an insured person has the right to expect the retained expert to review their records, conduct the assessment and prepare the report without outside influence from the assessment company. Morissette noted that TD refused the clause without offering a persuasive explanation.
Because the insurer rejected a clause the tribunal found reasonable, Morissette ruled the applicant had satisfied her onus of providing a reasonable explanation for non-attendance. The parties were ordered to proceed to a hearing on the substantive issues as scheduled.
The ruling draws on a 2016 Ontario Superior Court decision that established IE consent forms can be negotiated between the parties and that disputes over their content should be resolved on a standard of reasonableness, case by case. That same decision recognized that health professionals could reasonably require written consent before performing medical-legal examinations.
