What happened: A Licence Appeal Tribunal found Jevco failed to properly respond to two treatment plans for a crash victim.
Who's involved: A claimant pursuing accident benefits; Jevco Insurance Company, respondent; Gore Mutual Insurance Company, the prior insurer.
What's at stake: $3,829.09 for physiotherapy, $3,430.27 for counselling, plus a 40 percent special award and interest.
Why it matters: A claim-number mix-up during a priority dispute cost the insurer a special award two years later.
Where it stands: Decided - the Licence Appeal Tribunal released its order on September 21, 2026.
A $3,829 physiotherapy bill fell through the cracks between two insurers for more than two years - even after one of them tracked it down. By the time anyone fixed it, the clock had already run out.
A crash victim sought accident benefits from Jevco Insurance Company after a car accident in April 2022. The Licence Appeal Tribunal has now sorted through a stack of disputed treatment plans covering physiotherapy, chiropractic care and psychological counselling. Jevco ended up on the hook for the physiotherapy bill and part of the counselling costs, plus a penalty for how it handled one of the files.
The physiotherapy plan is where things get interesting. HealthMax submitted the $3,829.09 bill in December 2023, but it used the claim number of Gore Mutual Insurance Company - the insurer that held priority on the file before Jevco stepped in.
Jevco took over priority from Gore sometime in early 2023 - though the two insurers couldn't even agree on whether that happened in February or March. Either way, nobody at Jevco connected the dots in time. The plan sat marked denied in a file that never properly made the move, and no notice explaining why ever reached the claimant.
Ontario's accident-benefits rules give an insurer ten business days to say whether it'll pay for proposed treatment, and why not if it won't. Miss that window without a compliant letter, and the insurer owes the treatment anyway - whether or not it was actually reasonable or necessary. That's exactly what tripped up Jevco here.
Even once the mix-up came to light, Jevco didn't exactly rush to fix it. Its own file notes show it had tracked down the missing plan by August 2025 - more than a year and a half after it was filed - and knew by then that Gore had never paid out either. Seven more months ticked by before the written hearing wrapped up in March 2026, and Jevco still hadn't sent a proper response.
By then, the delay was all Jevco's.
The tribunal called that pattern “imprudent, stubborn, inflexible, and unyielding” - the bar for deciding whether a special award is warranted under Ontario's accident-benefits rules. It settled on a 40 percent penalty, just shy of the 50 percent cap the regulation allows.
A second dispute centred on a psychological-counselling plan worth $4,959.75, submitted by a clinic in November 2024. Jevco partially approved it - paying $1,529.48 and denying $3,430.27 - but the letter explaining the denial left its approved hourly rate as “$___ per hour,” blank space and all.
That gap, plus no breakdown of the math, meant the letter didn't do its job. The claimant couldn't tell which services were approved, which were cut, or why - he'd have had to reverse-engineer it himself. That counted as a second notice failure, triggering the same pay-up consequence as the HealthMax plan.
Two months later, the same clinic submitted a near-identical plan for a second block of counselling, again worth $4,959.75. This time Jevco's denial letter broke down every line item, named the dollar figure tied to each one, and explained the fee cut - even though it still left the hourly rate blank. The tribunal was satisfied with that version.
With the notice question settled, the fight moved to the rate itself. The clinic billed a social worker's hours at $149.61 - the Professional Services Guideline rate for psychologists, a profession the guideline actually prices, unlike social workers, whose rates are left to negotiation. The claimant didn't offer evidence showing why that higher rate fit his particular provider, and the tribunal sided with Jevco.
A third claim, for chiropractic and physiotherapy services from a different clinic, fared no better. Those providers' rates are capped under the same guideline, and there was no basis offered for paying above the ceiling. The tribunal threw that portion out.
Jevco now has to pay the HealthMax bill and the rest of the November 2024 counselling plan, both with interest, plus the 40 percent special award on the physiotherapy claim. The psychological-rate dispute and the physiotherapy-fee dispute both went the insurer's way. The tribunal released its decision on September 21, 2026.
The lesson is in the contrast: spell out the math and a denial letter holds up; leave a line blank and it doesn't - and that gap can be the difference between paying a claim once and paying it twice, penalty included.
This piece is based on a Licence Appeal Tribunal decision.
