An Ontario tribunal hit Allstate with a $7,336.27 special award, finding the insurer unreasonably delayed benefits in a catastrophic injury claim.
On June 16, 2026, Vice-Chair Robert Maich ruled that the applicant had sustained a catastrophic impairment after a January 4, 2023 rear-end collision and ordered Allstate to pay a special award for withholding or delaying benefits.
The applicant was stopped at a red light when another vehicle struck her car from behind. She later sought statutory accident benefits, but Allstate denied them, prompting her application to the Licence Appeal Tribunal.
The central question was whether she met the test for catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule, which turns on mental or behavioural impairment across four domains of function. Maich found she sustained a class 5 extreme impairment in social function, plus class 4 marked impairments in concentration, persistence and pace, and in adaptation. He did not find a class 4 impairment in activities of daily living. Because a single class 5 finding satisfies Criterion 8, the catastrophic designation stood.
The decision turned heavily on competing expert evidence, and the Tribunal's treatment of the insurer's psychiatrist will interest claims teams. Maich assigned little weight to the respondent's catastrophic assessor, noting that under cross-examination the assessor could not recall the foundations of several findings. The decision also records that, immediately upon being sworn in and before any questions, the assessor demanded $1,800 for his afternoon attendance and asked which party would pay him; he later said he received $700 for his report.
On benefits, Maich rejected the claimed attendant care benefit of $6,424.02 per month from May 1, 2023, finding the supporting assessment unsupported, but awarded $785.25 per month from November 20, 2024 onward. He noted the maximum non-catastrophic attendant care benefit was $3,000 per month plus tax. Several treatment plans were approved and others denied, often where claimed mileage, transportation, or assessment fees exceeded what the Schedule allows. Maich noted section 25(5) caps assessment fees at $2,000.
The sharpest findings concerned the insurer's conduct. Maich found Allstate denied an early physiotherapy plan for reasons the vice-chair found plainly invalid, breaching its duty to adjust in good faith, and described its conduct as "reprehensible conduct that is most certainly immovable and stubborn." He was similarly critical of its refusal of a gym membership and pet therapy plan, which Allstate had rejected as experimental.
Under section 10 of Regulation 664, the Tribunal may grant up to 50 per cent of benefits payable where an insurer unreasonably withholds or delays payment. Maich applied a 50 per cent award to three plans, totalling $7,336.27, and awarded interest on overdue benefits.
