An Ontario tribunal ordered McKillop Mutual to fund nearly all of a catastrophically injured driver's disputed treatment, faulting the insurer's assessor for downplaying her injuries.
The Licence Appeal Tribunal released its decision on July 10, 2026, resolving a dispute over statutory accident benefits stemming from a December 7, 2020 collision. The applicant was driving through an intersection when a transport truck struck the side of her vehicle, moving it roughly 40 feet from the point of impact. She was hospitalized for eleven days.
Her injuries included fractures to her lower left leg and ribs, a neck hematoma, and a concussion, along with regular urinary incontinence and psychological conditions featuring post-traumatic stress disorder, generalized anxiety, adjustment disorder, and somatic symptom disorder. In October 2023, McKillop Mutual deemed her impairments catastrophic.
That designation was not in issue. What the parties fought over was whether the disputed treatment plans were reasonable and necessary - a burden that fell on the applicant.
She largely succeeded. Vice-Chair Brian Norris awarded funding for occupational therapy, an in-home assessment and Form 1, two case manager plans, a speech-language pathology assessment and treatment, and physiotherapy, plus interest on the overdue amounts. Only one plan was refused.
Much of the decision turned on competing expert reports, and the tribunal repeatedly preferred the applicant's treating occupational therapist over the insurer's independent examination assessor. Norris reasoned that the treating therapist had observed the applicant throughout her recovery and was better placed to judge her needs, and that her recommendations matched the catastrophic impairment findings.
The insurer's assessor drew sharper criticism. Norris noted the assessor offered no recommendations for extra laundering or hygiene care despite the applicant's daily incontinence, and set aside reported balance and pain complaints on thin grounds. The assessor's "reluctance to recognize the Applicant's catastrophic injuries undermines the persuasiveness of the report," he wrote.
McKillop Mutual had argued that the applicant leaned on self-reports without contemporaneous clinical records, and that her reported decline lacked support. It also pointed to failed validity testing during one assessment, suggesting she overreported symptoms. Those arguments did not carry the treatment plans.
The insurer did secure one win. Norris refused the rehabilitation assistant plan, worth $5,014.77, finding the applicant had not shown how eight two-hour sessions would meet the plan's goals. Because the approved occupational therapy already addressed independence and community participation, he found the rehabilitation assistant services duplicative, and therefore not reasonable and necessary.
For accident benefits insurers, the reasons carry a familiar lesson. An examination report that appears to discount an accepted catastrophic designation risks losing weight against a treating provider - yet a focused duplication argument can still defeat an individual plan on its own terms.
