Intact Insurance must pay a special award after an Ontario tribunal found it unreasonably withheld accident benefits, leaning on speculative credibility concerns.
The Licence Appeal Tribunal ordered the insurer to fund a series of disputed chiropractic and psychological plans and added penalties for how the file was handled.
The applicant was involved in an automobile accident on December 5, 2022, and sought benefits under the Statutory Accident Benefits Schedule. Intact denied the claims, and he applied to the Tribunal's Automobile Accident Benefits Service.
The dispute spanned three chiropractic plans totalling $4,923.25 and four psychological plans, including an assessment, totalling $11,768.38. Intact had relied on a section 44 insurer examination to argue the chiropractic treatment was not reasonable and necessary. Adjudicator Amar Mohammed gave that report less weight, finding it did not consider the broader context of the applicant's accident-related symptoms or his diagnosed accident-related chronic pain.
Intact also argued the applicant was not credible. The adjudicator was not persuaded, finding the insurer pointed to "selective and minor inconsistencies" that did not undermine the consistency of his reported symptoms. He added that a claimant inquiring about compensation or documenting symptoms does not erode credibility.
Two findings carry weight for claims handling. Intact had cut a psychotherapist's hourly rate from $149.61 to $58.19, applying the Professional Services Guideline cap. The adjudicator found that cap does not apply to a registered psychotherapist performing the same controlled act as a psychologist, and restored the higher rate. He also rejected Intact's move to convert a $200.00 block fee for form completion into an hourly charge, finding the block fee consistent with the Guideline.
On a later psychological plan, the adjudicator noted Intact denied benefits citing a need for a medical opinion and a forthcoming Notice of Examination - but no such notice was issued and no insurer examination took place.
The sharpest finding went to the special award. Under section 10 of Regulation 664, the Tribunal can order up to 50 per cent of benefits payable where an insurer unreasonably withheld or delayed payment. Mohammed found the denial of the psychological assessment especially unreasonable, because it was rejected despite consistent opinions from both section 25 and section 44 assessors.
He set the award at 10 per cent of the psychological assessment and services ($1,176.84) and 5 per cent of the chiropractic services ($246.16), for a total of $1,423.00 before interest. He cited the modest amounts in dispute, Intact's eventual funding of the chiropractic plans, and the absence of systemic withholding as mitigating factors.
Interest is payable under section 51 of the Schedule and section 10 of Regulation 664. The decision was released June 16, 2026.
