In Ng v. TD General Insurance Company, 2026 CanLII 42203 (ON LAT), TD General Insurance Company won at Ontario's Licence Appeal Tribunal after an applicant challenged the sufficiency of two denial letters for accident benefits.
The decision, released May 7, 2026, offers claims professionals a clear look at what an adjudicator considers a compliant denial under section 38(8) of the Statutory Accident Benefits Schedule.
Kwan Ho Ng was involved in an automobile accident on January 4, 2024 and sought benefits. TD denied two treatment plans: a $5,023.90 plan for chiropractic services proposed by Total Recovery Rehab Centre on April 16, 2024, and a $3,102.48 plan for an in-home assessment proposed by Somatic Assessments and Treatment Clinic on January 17, 2025.
Ng did not argue the treatment plans were reasonable and necessary. He focused entirely on whether the insurer's denial letters - dated November 27, 2024 and January 28, 2025 - complied with section 38(8). That section requires an insurer to respond to a treatment plan within 10 days, identifying what it will and will not pay for, and to set out the medical reasons and all other reasons for considering proposed treatments not reasonable or necessary.
For the chiropractic denial, TD relied on an insurer examination by Dr. Seung-Jun Lee, who opined the plan was "neither reasonable nor necessary" because he did not identify ongoing accident-related musculoskeletal impairments. Ng argued the report failed to properly analyse his injuries against those listed in the treatment plan, leaning on the Divisional Court's decision in Hedley v. Aviva Insurance Company of Canada.
Adjudicator Caley Howard disagreed. The denial letter set out the specifics of the applicant's condition - the lack of ongoing accident-related musculoskeletal impairments - and made clear the decision rested on Dr. Lee's assessment. That, the tribunal held, was enough to let the applicant decide whether to dispute the decision.
Howard also drew a clear line: any issues with the substance of Dr. Lee's report might matter to whether the plan was reasonable and necessary, but not to whether the denial letter itself was sufficient under section 38(8).
The in-home assessment denial listed five specific reasons. Ng had reported to Dr. Lee and to psychologist Dr. Cindy Goodfield that he was independent with his self-care. He continued to drive. The treatment plan itself indicated no barrier to recovery. One year had passed since the accident with no worsening of his physical condition. And no new compelling medical information had been received.
That letter, too, was found compliant. Ng argued the insurer should have invited him to submit a Form 1 for attendant care benefits after he was removed from the Minor Injury Guideline, citing sections 25(1)4 and 32(2)(c) of the Schedule. The tribunal noted that section 38(11) only triggers mandatory payment when section 38(8) is breached, and the applicant had not shown how non-compliance with other sections would entitle him to payment.
Ng provided no medical documents beyond the disputed treatment plans themselves and made no submissions on whether they were reasonable and necessary. TD was cleared of liability for an award under section 10 of Regulation 664, and no interest was owed.
