Citation: Yuan v. Co-operators General Insurance Company, 2026 ONLAT 24-008720/AABS

Licence Appeal Tribunal File Number: 24-008720/AABS

In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.

Between:

Yong Yu Lisa Yuan

Applicant

and

Co-operators General Insurance Company

Respondent

DECISION

ADJUDICATOR:

Nadia Mauro

APPEARANCES:

For the Applicant:

Sareena Samra, Counsel

For the Respondent:

Jonathon Kahane-Rapport, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Yong Yu Lisa Yuan, the applicant, was involved in an automobile accident on November 15, 2018, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Co-operators General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The issue in dispute is:

1. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

3The applicant states, in her reply submissions, that the respondent sent email correspondence on July 23, 2025, confirming that it had made payment for issues 1-7 as listed on the Case Conference Report and Order, dated December 13, 2024 (“CCRO”). The applicant confirms in her reply submissions that the only issue left in dispute is as listed above.

RESULT

4The applicant is not entitled to an award.

ANALYSIS

Award

5I find that the applicant is not entitled to an award.

6The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. The Tribunal has determined that an award is justified where the delay or withholding of benefits by the insurer is unreasonable conduct, meaning “behaviour, which is excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.” The onus is on the applicant to prove, on a balance of probabilities, that the respondent’s conduct meets this criteria.

7The applicant relies on the Tribunal decision in 17-006575 v. Aviva Insurance Company, 2018 CanLII 81949 (ON LAT), where it was held that the policy objective is consumer protection. The applicant further relies on the factors set out in Liberty Mutual Insurance Company v Persofksy, 2003 ONFSCDRS 9, in that the respondent categorically ignored the medical records of the applicant; the applicant is vulnerable and she sustained serious injuries as a result of the accident; the weekly benefit was never paid; the Tribunal needs to set precedents to ensure deterrence to insurers; and the insurer acted in a high handed manner.

8The respondent submits that on July 22, 2025, Somatic Assessments & Treatment Clinic emailed adjuster, Janet Healey, advising that amounts were outstanding. The respondent submits that the adjuster handling the matter was off work for about 3 months when the expenses were originally submitted. Another adjuster, unfamiliar with the matter, accidentally did not flag the expenses for the adjuster handling the file causing the expenses to be inadvertently missed. The respondent submits that when brought to adjuster Janet Healey’s attention on July 22, 2025, the expenses were immediately paid on July 23, 2025. The respondent submits that the amount for attendant care benefits (“ACB”) from November 1, 2023 to November 30, 2023, was paid with interest on July 23, 2025. The respondent also submits that all other expenses that have been submitted on this claim have been paid, subject to the maximum claimable amount under the Schedule.

9Moreover, the respondent submits the applicant failed to produce the documents set out in the CCRO, and as such, the insurer had not been provided with the records and documentation it required to properly adjust the claim. The respondent submits that with respect to the March 2024 invoices for attendant care and the housekeeping expenses for February 2024, the supporting documentation was not provided to the insurer until July 22, 2025, and these expenses were thereafter paid upon receipt.

10The applicant, in her reply submissions, submits that the respondent acted in a frivolous and vexatious manner. The applicant submits that there was no delay in providing the information required by the respondent, but the respondent withheld payment. The applicant submits that another adjuster unfamiliar with the file not flagging the expenses, given that it is a catastrophic file, is not acceptable. The applicant states that the lack of ACBs meant her condition further deteriorated.

11I find that the evidence supports the November 2023, December 2023, January 2024 service breakdowns were provided to the respondent via fax on February 14, 2024. The evidence also supports that the services breakdown for March 2024 were provided to the respondent via fax on July 22, 2025. On July 22, 2025, Bernadine Gouveia of Somatic Assessments & Treatment Clinic Inc., sent email correspondence to adjuster Janet Healey, following up with the outstanding ACB and Housekeeping invoices. Bernadine Gouveia provided a copy of the invoices via email correspondence on July 23, 2025. On July 23, 2025, Janet Healy sent email correspondence to Bernadine Gouveia confirming that she was now in receipt of all invoices and breakdowns of the outstanding expenses. A second email from Janet Healey, on July 23, 2025, confirms payment had been requested for the outstanding invoices, and interest for the period between March 18, 2024, to July 23, 2025.

12The applicant has not pointed me to evidence that would support the respondent purposefully delayed payment. It is not clear from the parties’ evidence or submissions if the applicant followed up with the respondent for payment of the outstanding invoices prior to July 22, 2025. The evidence supports that upon receipt of all the invoices and services breakdowns, the adjuster issued payment within 24 hours. In this respect, I find it more probable than not that the respondent made a clerical error resulting in the delayed payment and immediately corrected it upon notice of the outstanding balances. In my view, this sort of clerical error is not the sort of behaviour that rises to a level that would substantiate an award. Moreover, submissions are not evidence. While the applicant has stated that the lack of ACBs meant her condition further deteriorated, the applicant has not directed me to evidence that would support this assertion.

13In sum, I am not persuaded that the respondent’s conduct was the “excessive, imprudent, stubborn, inflexible, unyielding, or immoderate” conduct that I would deem to warrant an award. Therefore, the applicant is not entitled to an award.

ORDER

14I find that:

1. The respondent is not liable to pay an award; and

2. The application is dismissed.