An Ontario tribunal handed Intact Insurance Company a split outcome on May 7, 2026, in a dispute that turned less on medicine than on a missed calendar deadline.
The case, Phull v. Intact Insurance Company, 2026 CanLII 42195 (ON LAT), arose from a December 5, 2022 collision in which the applicant's vehicle flipped onto its roof. Manraj Phull went to the emergency room with a head laceration that needed stitches, but the ER record was clear: no loss of consciousness, no nausea, no vomiting, and no other symptoms of head injury. He sought to be removed from the $3,500 Minor Injury Guideline cap, arguing he had sustained a concussion and a psychological impairment from the crash.
Vice-Chair Rebecca Hines was not persuaded. She gave more weight to the ER record than to the applicant's later self-reports of lost consciousness, which she found inconsistent with the day-of documentation. The family doctor's notes referencing post-concussion symptoms, she wrote, were based on those same unreliable self-reports, and no diagnostic testing had been recommended. Speculation about the mechanics of the rollover, she added, was not a medical opinion.
The psychological claim fared no better. A report from a psychologist diagnosing adjustment disorder with mixed anxiety and depressed mood, features of PTSD, and situational phobia was given little weight. Hines flagged internal inconsistencies - the applicant reported severe depression and anxiety, but psychometric testing showed only mild symptoms, and the report did not reconcile the gap. The applicant also reported driving anxiety while his licence was under suspension. By contrast, the insurer examination by a psychologist for Intact aligned with its own testing and found no diagnosable impairment. Six treatment plans submitted by Prime Health Care Inc. - covering physiotherapy, psychology, and chiropractic services and totalling more than $15,000 - were all denied because only $40.82 remained inside the MIG.
So far, a clean win for the insurer. Then came section 36(4).
The applicant submitted his OCF-3 disability certificate on February 27, 2023. Intact did not respond until April 14, 2023, when it requested an insurer examination based on pre-accident medical records. The Schedule requires insurers to either pay, deny with reasons, or request information within 10 business days of receiving a completed OCF-3. Intact missed that window, and the consequence under s. 36(6) is automatic: the insurer must pay the benefit from the day it received the application until the day it eventually responds.
That triggered an order for income replacement benefits of $400 per week from February 27 to April 14, 2023, plus interest under s. 51 of the Schedule - even though Hines separately found the applicant had not proven substantive entitlement to the benefit. His submissions, she noted, did not even set out the essential tasks of his employment.
The bid for a special award under s. 10 of Reg. 664, which allows up to 50 percent of benefits payable where an insurer has unreasonably withheld or delayed payment, was rejected. Hines found no unreasonable delay on the record before her.
The takeaway for claims teams is straightforward. Substantive defences can hold up under tribunal scrutiny, but they will not rescue a file from the procedural meter once a 10-day clock has run out.
