What happened: A claimant sought an award after Definity approved his disputed treatment plans weeks before the hearing.
Who's involved: Definity Insurance Company, Ontario's Licence Appeal Tribunal and a self-represented claimant.
What's at stake: Up to 50 per cent of the total benefits payable, under section 10 of Regulation 664.
Why it matters: The tribunal noted the timing, but an award still takes evidence of unreasonable conduct.
Where it stands: Decided September 16, 2026. The tribunal dismissed the award claim.
A claimant wanted to ask the adjuster on his file why the insurer changed its mind weeks before his hearing.
The tribunal said no. It also turned down his bid for an award against Definity Insurance Company.
It started with a 2021 auto accident. The claimant sought accident benefits, Definity denied them, and he took the dispute to Ontario's Licence Appeal Tribunal.
By the June 9, 2026, videoconference hearing, most of the issues had been resolved. Definity said it had removed him from the Minor Injury Guideline and approved both disputed treatment plans in full, with any interest payable on incurred amounts.
What remained was a claim for an award. Under section 10 of Regulation 664, a tribunal can order one of up to 50 per cent of the total benefits payable if an insurer unreasonably withheld or delayed payment.
Unreasonable, in tribunal terms, means conduct that is "excessive, imprudent, stubborn, inflexible, unyielding or immoderate." The claimant had to prove it.
His argument was about timing. His treatment plans dated to 2023, he said, and he had produced no new medical evidence since a November 2025 case conference that would justify changing the claim. He alleged Definity delayed approving his benefits on purpose to limit its financial exposure before his claim period expires.
Definity said it did not know the details of his argument about its conduct until after the hearing began, because he had not provided any. It said that put it at a disadvantage, and it noted that every other issue from the case conference had been resolved in his favour.
The claimant asked to put questions to the adjuster about how his claim was handled, so that answers would be "on the record." Definity objected. The only witness expected at the case conference was the claimant himself.
The tribunal agreed with Definity. He had not filed a witness list despite clear written instructions to do so. He had also not told Definity he planned to call the adjuster, or why, even in the most basic terms.
He said he only learned of the change on May 15, 2026. The tribunal saw that as enough time to give a heads-up, and it did not accept that being self-represented excused the gap.
Both sides agreed the adjuster's log notes had already been produced. They cover the claim only up to December 2025, several months before the reversal. The claimant could have asked for updated notes after May 15, 2026.
He didn't.
The tribunal found he filed no evidence to back the award claim and did not rely on any part of the log notes. His testimony, it said, "did little more than convey his bewilderment" about what led to the reversal.
He had also agreed to spell out the details of his award claim within 30 days of receiving the log notes, but none came before the hearing. The tribunal gave his testimony less weight as a result.
The tribunal did acknowledge "an eyebrow-raising situation" weeks before the hearing, and said it was sympathetic to his testimony that he may now be unable to fully realize value from his recently approved treatments. Still, it found he had not shown Definity unreasonably withheld or delayed payments. Giving his award testimony full weight, given how it was presented, would have been unfair to Definity, it said.
The treatments are approved in full. By his account, his claim period ends in October 2026.
A reversal weeks before a hearing drew a remark from the bench but no award, since the tribunal found the claimant had not proven unreasonable conduct.
This report is based on the tribunal's written decision, released September 16, 2026, which does not explain why Definity changed its position.
