An Ontario tribunal has ordered Intact Insurance to pay a 25% special award after finding it relied on speculation and a misread cost column to deny accident benefits.
The decision in Alleyne v. Intact Insurance Company, released April 28, 2026, by Licence Appeal Tribunal adjudicator Amar Mohammed, is a sharp reminder that how an insurer writes a denial letter can matter just as much as what it decides to pay.
The case began with a car accident on May 11, 2024. The applicant, Lathaniel Alleyne, applied for statutory accident benefits and ran into a wall of partial and full denials from Intact across a string of treatment plans - occupational therapy, physiotherapy, medical services, chiropractic care, an orthopaedic assessment and a psychological assessment.
At the heart of the dispute was a question that comes up constantly in Ontario auto claims: when a provider proposes a flat block fee for an assessment or an OCF-18 form, can the insurer quietly convert it into an hourly-rate calculation and pay less?
Mohammed's answer was no. He ruled that a section 25(5)(a) assessment is capped at $2,000 and form completion under section 25(1)3 is capped at $200, and both can be billed as a reasonable block fee on a per-procedure basis. Intact's approach - demanding a breakdown of components, hours and an hourly rate before approving the full amount - had no grounding in the Schedule or the Superintendent's Guideline No. 03/14, he found. He pointed to the Court of Appeal's line in Tomec v. Economical Mutual that the accident benefits regime is consumer protection legislation that "is supposed to maximize benefits."
The orthopaedic assessment denial fared even worse. Intact's notice said the assessment "may be a duplication" if Alleyne was already seeing an orthopaedic surgeon through OHIP. Mohammed called that "based on speculation" and not "clear and unequivocal," and noted Intact never asked for clarification under section 33. Because the notice fell short of section 38(8), the $2,200 plan became payable under the "shall pay" provision in section 38(11), with no need to weigh whether it was reasonable.
Then there was the cost-column mix-up. Intact had denied chunks of the physiotherapy and chiropractic plans after reading the cost column as a $225.62 hourly rate - double the accepted $112.81. In correspondence on July 7 and 8, 2025, the applicant and the treating practitioner, Dr. Raphael Ahn, explained the figure reflected two-hour sessions at the accepted rate. Intact kept the denials in place anyway. The tribunal called that "unyielding."
Adding it up, Mohammed found $9,333.49 in benefits had been unreasonably withheld or delayed. Running through the Plowright factors - length of delay, blameworthiness, vulnerability, deterrence and advantage gained - he settled on a 25% special award under section 10 of Regulation 664, on top of interest under section 51 of the Schedule and compound interest under the regulation.
For claims professionals, the message is hard to miss. Speculative denials, hourly-rate scrutiny stacked onto block fees, and digging in after a provider corrects an obvious misreading are now a fast track to a special award.
