An Ontario driver's bid for catastrophic impairment benefits collapsed after The Personal Insurance Company leaned on surveillance and a strict "incurred" rule.
In a decision released July 14, 2026, the Licence Appeal Tribunal ruled that the applicant did not meet the test for a catastrophic impairment designation following a January 30, 2021 rear-end collision, and dismissed his related claims for attendant care, housekeeping, an award and interest.
The claimant was stopped at a traffic signal when another vehicle struck him from behind. He declined emergency services and drove home, seeking medical attention from his family physician the next day. He had also been injured in a July 19, 2018 accident, when he rolled a delivery truck and lost consciousness. The insurer for that earlier accident was not involved in this dispute. By the hearing, the respondent said it had paid more than $40,000 in accident benefits for the 2021 accident.
The central fight was whether the applicant was catastrophically impaired under Criterion 8 of the American Medical Association's Guides, which turns on mental or behavioural impairment across four domains of function. To qualify, he needed marked (Class 4) impairment in three of the four domains. Neither side argued an extreme (Class 5) impairment.
It came down to a battle of experts. The applicant's psychiatrist and occupational therapist rated him marked in activities of daily living, concentration and adaptation. The insurer's assessors rated those domains far lower. The applicant also tried to discredit the insurer's psychiatrist, arguing his undated draft reports showed pre-set ratings. Adjudicator Bernard Trottier disagreed, accepting that provisional ratings subject to later input were a normal part of multidisciplinary assessment.
Surveillance proved decisive on concentration. Over six days, video showed the applicant transporting his children to school, fuelling his vehicle, using a drive-through, and visiting a medical office and a pharmacy. On one day he drove Highway 401 through mid-day Toronto traffic. Trottier found that "driving safely is a complex task that requires planning, concentration," inconsistent with marked impairment.
In the end, the adjudicator found one mild and three moderate impairments - short of the three marked ratings needed. Causation did not need to be decided.
The attendant care claim failed on a different point. The applicant sought $1,227.58 per month; the insurer's assessor put the figure at $613.79 and agreed it was reasonable and necessary, but argued it was never incurred. With no invoices or receipts in evidence, and no proof the insurer unreasonably withheld payment, the Tribunal declined to deem the expense incurred. More than 260 weeks had passed since the accident, and without a catastrophic designation, the benefit was unavailable.
Housekeeping benefits, an award and interest all fell away once the catastrophic claim failed.
