What happened: An Ontario tribunal ordered Intact to cover therapy and glasses, plus a special award for slow payment.
Who's involved: Intact Insurance Company and a claimant hurt in a February 2020 car accident.
What's at stake: $1,546.68 for occupational therapy, $964.00 for glasses and a $203.73 award, plus interest.
Why it matters: The tribunal said claimants must submit treatment claims within 260 weeks, not pay for them first.
Where it stands: Decided October 6, 2026. Intact won on a separate $680.33 claim filed too late.
Intact had paid a claimant's lodging and mileage before without asking for a treatment plan. In February 2025, it turned down the same kind of costs because she didn't have one.
Just over a year later, Intact changed its mind and approved most of the travel costs. It didn't say why.
In an October 6, 2026 ruling, Ontario's Licence Appeal Tribunal found Intact had unreasonably delayed those payments. It added a special award of 25 per cent on top.
The claimant was hurt in a car accident on February 12, 2020. By early 2025, she was travelling to Winnipeg for medical appointments, a 692 km trip each time, and claiming the mileage and lodging from Intact.
Intact said no to two of those claims in February 2025. One was refused because there was no treatment plan. The other was refused because Intact said it fell after the 260-week cutoff, roughly five years after the accident.
That second claim listed costs from January 26 and 27, 2025. The cutoff was February 12, 2025. The invoices were included.
On February 23, 2026, after the claimant had made her written arguments to the tribunal, Intact approved $413.31 on one claim and $401.60 on the other. The tribunal found Intact didn't explain what changed its mind, what new information it had looked at, or why it wasn't paying interest.
It also noted that it took Intact "over a year to realize" the expenses fell inside the window.
Intact argued that special awards are for extreme cases, like payments held up for a very long time or a catastrophically impaired claimant whose accessible housing options weren't considered. The tribunal disagreed. Any unreasonable delay can qualify, it said, and "there is no requirement for a significant delay."
Intact also said the claimant hadn't pointed to any adjuster log notes. The tribunal said it was unclear how she could have, since the payments came after the hearing ended.
In the end, the tribunal found Intact's conduct met the legal test for a special award, describing it as "excessive, imprudent, stubborn, inflexible, unyielding, or immoderate."
Awards can reach 50 per cent of the benefits and interest owed, and the claimant asked for the full amount. The tribunal landed on 25 per cent, or $203.73, plus interest. It said the delay gave Intact a money advantage and that this kind of conduct should be deterred.
The bigger fight was over what the 260-week cutoff actually requires. Intact said a $1,546.68 occupational therapy plan, submitted January 31, 2025, wasn't payable because the claimant hadn't actually run up the cost of the therapy inside the window. It said the same about $964.00 in migraine glasses.
The tribunal read the rule differently. A claimant only has to submit the plan within 260 weeks, it said, and if the plan is found payable, the treatment can happen after that.
Intact pointed to two earlier tribunal rulings that went its way on this exact point. This tribunal said it wasn't bound by them and didn't agree with them. Making injured people pay up front just to prove they need treatment, it said, would create the very power imbalance the accident benefits rules are meant to prevent.
Other adjudicators see it the other way. In a September 24, 2026 ruling involving TD General Insurance, a different adjudicator found the rule only covers expenses incurred inside the window.
On the medical side, Intact pointed to clinic notes showing the claimant was managing daily life on her own, driving and using an exercise bike. The tribunal wasn't swayed. All four assessors, including both of Intact's own, accepted that she'd had a concussion.
One of Intact's assessors went further, warning that her attention and speed problems were likely to be permanent if left untreated.
As for the glasses, Intact had already approved a new pair. The optometrist who examined her later recommended a special coating to help with migraines, because she was still struggling with depth perception. Intact didn't offer any medical opinion to the contrary.
Where Intact came out ahead
Intact did win some rounds. A $680.33 claim from November 2022, for travel, lodging and a recumbent bike, came too late. The tribunal found Intact's December 2022 denial letter was clear, and according to Intact, the claimant didn't bring the dispute to the tribunal until April 2025, about four months past the two-year deadline.
She didn't make the case for extending that deadline, so the tribunal didn't. She also hadn't justified the last $20 left unpaid on each of the two travel claims.
Then there was the $100. The claimant asked for that in costs over the year-long delay. The tribunal said no, because costs cover how a party behaves during a tribunal case, not how an insurer handles its file.
A reversal with no reasons and no interest was enough to trigger a special award here, and the tribunal made clear the delay doesn't have to be dramatic for that to happen.
The decision doesn't say whether either side plans to challenge it.
