In Lopez v TD General Insurance Company, 2026 CanLII 53761 (ON LAT), an Ontario tribunal hit TD General Insurance with a 35% award after finding it ignored a claimant's psychological injuries and stalled her benefits.
Adjudicator Timothy Porter ordered the insurer to pay a 35% award on all overdue benefits and interest. Section 10 of Regulation 664 lets the tribunal award up to 50% of benefits payable when an insurer unreasonably withholds or delays payment.
Laura Lopez was injured in an automobile accident on December 23, 2022, and sought statutory accident benefits. TD denied her claims, and she applied to the Licence Appeal Tribunal.
The case turned on two issues: how TD handled her psychological injuries, and how it handled her income replacement benefit.
On the psychological side, Porter found the insurer kept Lopez inside the $3,500 Minor Injury Guideline despite mounting evidence she did not belong there. From her first call to TD, she reported panic attacks tied to the accident. A preferred service provider of the insurer flagged concussion-related symptoms and anxiety at her first treatment visit. She was admitted to North York General Hospital twice within a year, with a staff psychiatrist diagnosing panic disorder. Yet a new adjuster recorded that the panic attacks were unrelated to the accident. Porter found the adjuster's testimony about that misread of the file unconvincing.
TD conceded days before the hearing that Lopez's injuries were not minor, but limited the removal to psychological treatment, a position Porter said the Schedule did not support.
On the income replacement benefit, Lopez submitted her disability certificate on December 11, 2024. TD did not respond until February 10, 2026, more than a year later. Under section 36(4), an insurer must respond within 10 days; section 36(6) requires it to pay the benefit through the period of non-compliance. Porter ordered the benefit from December 11, 2024, to February 10, 2026, but declined to extend it past the 104-week mark, finding no evidence Lopez could not work at all.
When TD finally approved the benefit ahead of the hearing, it did not pay; it asked for more documentation. Porter found no further information was needed to calculate or pay it. The adjuster testified TD was waiting for the hearing result before paying.
Porter assigned 20% for holding Lopez in the guideline and 15% for the income replacement handling, finding TD acted in an "imprudent, inflexible, unyielding and immoderate" way.
Lopez won three of four disputed treatment and assessment plans: a $3,428.30 physiotherapy plan, a $2,700 psychological assessment from Complex Care, and a $2,567.16 chronic pain assessment. A duplicate psychological assessment from Healthmax and a partially approved invoice were denied. She was awarded interest on all overdue payments, and her request for costs was refused.
The decision was released June 4, 2026.
