An Ontario tribunal excluded TD General's addendum medical reports for lack of proper notice, then ordered it to fund a claimant's $2,000 catastrophic-impairment summary.
The mixed ruling released on June 15, 2026, offers claims professionals a pointed reminder that procedure cuts both ways before the Licence Appeal Tribunal.
The applicant was injured in an automobile accident on September 17, 2022, and sought statutory accident benefits from TD General Insurance Company. After TD denied her, she applied to the Tribunal. The hearing ran by videoconference on February 17 and 18, 2026, before Vice-Chair Brian Norris.
The first day was consumed by motions. The most consequential for insurers concerned TD's addendum insurer's examination reports. The claimant argued the addendum reports were obtained without notice and without a chance for her to provide additional information, contrary to section 44(9) of the Schedule. TD countered that its initial notice was sufficient and that the addendum reports simply continued the original assessment process.
Norris sided with the claimant. He found the addendum reports were obtained improperly because she received no notice of them and no opportunity to contribute information, and he excluded them from the record. The initial examination reports, obtained with proper notice, stayed in.
On the central benefit, Norris ruled that an executive summary tied to a catastrophic-impairment assessment is a separate, reasonable and necessary assessment, not a mere recap of other reports. Section 25 of the Schedule entitles a claimant to reasonable assessment fees, capped at $2,000 for any one examination and its reports. He preferred the reasoning in Kandeepan and D.M. over the contrary view in ZJ, and ordered TD to fund the summary prepared through a plan dated August 7, 2024, plus interest.
The claimant fared less well on her bid for extra money. She sought an award under section 10 of Regulation 664, which lets the Tribunal grant up to 50 percent of benefits payable when an insurer unreasonably withholds or delays payment. Norris found she had not met that onus. Nothing in the Schedule, he wrote, stops an insurer from conducting examinations that mirror the very benefits it later denies, and no binding authority made the executive summary separately fundable.
Her good-faith claim, framed as an award of $1,500,000 or, alternatively, a 50 percent lump sum against the $1,000,000 catastrophic-impairment funding limit, also failed. Because she had withdrawn her catastrophic-impairment claim, Norris found there was no withheld benefit on which an award could rest.
TD, meanwhile, recovered costs. Norris found the claimant acted frivolously or vexatiously by serving contempt motion materials over an adjuster's absence, then declining to pursue the motion - her counsel said it was "not on the table." He awarded TD $250, well short of the $500 it sought.
The decision is final.
