Ontario's Licence Appeal Tribunal hit TD General Insurance with penalty awards for delaying benefits to a brain-injured claimant.
In a decision released April 29, 2026, Adjudicator Amar Mohammed found that TD General Insurance Company unreasonably withheld enhanced accident benefits and guardianship fees owed to a catastrophically impaired applicant identified as [RR], who was injured in a December 1, 2023 automobile accident.
The applicant had suffered devastating injuries - found unconscious with a Glasgow Coma Scale score of 3, an open skull fracture, extensive intercranial hemorrhage, and a severe traumatic brain injury. A litigation guardian was required to pursue the claim.
The central issue turned on TD's response to an OCF-19 catastrophic impairment application it received on October 3, 2024. Under Ontario's Statutory Accident Benefits Schedule, sections 45(3) and 45(4) require an insurer to act within 10 business days of receiving a completed OCF-19 - either accepting or denying the catastrophic impairment designation and, in the meantime, paying attendant care benefits at the enhanced monthly limit of $6,000 rather than the standard $3,000.
TD took a different path. On October 16, 2024, the insurer informed the applicant it could not make a determination because the OCF-19 was allegedly incomplete - missing Etobicoke General Hospital records and a Glasgow Outcome Scale assessment. Mohammed rejected that position, finding the OCF-19 form did not require those documents and that TD had provided no basis for claiming otherwise.
The result was a roughly six-month stretch - from October 2024 through mid-March 2025 - during which TD continued capping attendant care at the lower $3,000 monthly limit. TD only reversed course days after a case conference held on March 14, 2025, ultimately paying out $9,591 in delayed enhanced benefits.
A separate thread involved $41,670.13 in guardianship application fees. TD had agreed in a January 23, 2024 email to fund the legal costs of appointing a guardian. An Ontario Superior Court order dated October 17, 2024 approved those costs. But when the applicant submitted the related invoice, TD denied it on December 23, 2024, claiming the Schedule did not provide coverage for guardianship fees - without acknowledging its own prior agreement. As of its October 3, 2025 submissions, TD had made no payment toward the expense.
Mohammed ordered TD to pay a penalty of 25 percent on the $9,591 in withheld attendant care benefits and 18 percent on the $41,670.13 in guardianship costs, with interest under section 51 of the Schedule and section 10 of Regulation 664.
The Tribunal's quantum analysis weighed the applicant's extreme vulnerability - a person with a GCS score of 3 requiring both a guardian and enhanced attendant care - alongside TD's failure to comply with two procedural obligations under the Schedule. Mohammed noted that deterrence was necessary, particularly for the most vulnerable claimants. Mitigating factors, including TD's eventual correction and the absence of evidence that the delays blocked the applicant from accessing care, brought the awards below the 50 percent maximum sought.
The case, [RR] v. TD General Insurance Company, 2026 ONLAT 24-014730/AABS, underscores the risks insurers face when OCF-19 compliance obligations go unmet - especially where catastrophically impaired claimants are involved.
