An Ontario insurer approved accident benefits in full - then tried to take them back. The Tribunal wasn't having it.
In a decision released April 27, 2026, the Licence Appeal Tribunal ordered Continental Casualty Insurance Company to pay a Quebec-resident claimant $609.10 in assistive devices it had already approved, plus the maximum penalty allowed under Ontario law for unreasonably withholding payment.
The case, Groleau vs. Continental Casualty Insurance Company (2026 ONLAT 24-012366/AABS), started with a straightforward auto claim. Alexandra Groleau was riding as a passenger when the vehicle she was in was struck at a suburban Ottawa intersection on November 12, 2022. She suffered a concussion, cervical sprain/strain, head lacerations, and other injuries.
Groleau is a Quebec resident. She does not hold a driver's licence, does not own a vehicle, and is not a named insured on any auto policy. She filed her accident benefits claim with Continental Casualty, the insurer of the vehicle she was travelling in.
Continental Casualty accepted the claim. For over a year and a half, it approved and paid benefits without issue - including a non-earner benefit, an in-home assessment, and an attendant care report. At no point during that stretch did the insurer mention that Groleau, as a Quebec resident, might be required to first apply for coverage through Quebec's Société de l'assurance automobile du Québec, or SAAQ.
On March 26, 2024, the insurer approved a treatment plan for occupational therapy services and assistive devices "in full." Then, on October 2, 2024, after receiving invoices totalling $609.10, it changed course. Continental Casualty told Groleau she needed to submit the claim to the SAAQ first.
Vice-Chair Brian Norris agreed that, as a general matter, Ontario statutory accident benefits are excess coverage under section 268(7) of the Insurance Act. Quebec residents are entitled to SAAQ benefits regardless of where their accident occurred, and Ontario insurers can deduct amounts available from that program.
But Norris found the insurer could not rely on that principle here. Under section 131(1)(b) of the Insurance Act, an insurer cannot enforce a requirement it led the claimant to believe did not apply - especially when the claimant acted on that belief to their detriment.
The insurer pointed to boilerplate language in its approval letters directing claimants to submit costs to "other medical coverage" first, citing employer or spousal group plans as examples. Norris was not persuaded. That same language had appeared in prior approvals where no SAAQ deduction was ever raised, and it made no specific mention of the SAAQ or Quebec's auto insurance regime.
Continental Casualty also cited a January 5, 2024 letter from its counsel referencing the SAAQ. The Tribunal found that letter was tied to a separate Tribunal dispute that was later withdrawn and never addressed how future claims would be handled.
Norris described Continental Casualty's conduct as "imprudent, stubborn, inflexible, unyielding, and immoderate," and awarded Groleau the maximum penalty of 50 percent of the withheld amounts under section 10 of Regulation 664, plus interest.
The decision is a practical reminder for claims teams adjusting inter-provincial auto files: when an insurer knows a claimant may have access to benefits in another province, that needs to be flagged from the start - not after benefits have already been approved without qualification.
