Licence Appeal Tribunal File Number: 24-010948/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:
Rajaratnam Menaha
Applicant
and
TD General Insurance Company
Respondent
DECISION
VICE-CHAIR:
Julian DiBattista
APPEARANCES:
For the Applicant:
Jono Schneider, Counsel
For the Respondent:
Karen Klaiman, Counsel
HEARD: In Writing
OVERVIEW
1Rajaratnam Menaha, the applicant, was involved in an automobile accident on October 3, 2023, 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, TD General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to income replacement benefit (“IRB”) in the amount of $400.00 per month from October 10, 2023, to date and ongoing?
ii. Is the applicant entitled to payment of $100.00 of costs for filing a motion at the Tribunal on October 17, 2024?
iii. Is the respondent entitled to $250.00 of costs for drafting submissions for this written hearing?
iv. Is the respondent liable to pay an award under s.10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The respondent has paid the IRB and interest for the period in dispute to July 29, 2025. The respondent subsequently terminated the benefit in a denial letter dated July 29, 2026. However, I find that this denial is not in dispute before me.
4Neither party is entitled to costs.
5The applicant is not entitled to an award under s.10 of Reg 664.
6No interest is payable.
ANALYSIS
The dispute over IRB has been resolved prior to this hearing
7Although the applicant has not withdrawn this issue, the respondent has paid all amounts owing to the date of the denial letter of July 29, 2025. I therefore find that the quantum of the IRB is no longer in dispute.
8To receive payment for an IRB under s. 5(1) of the Schedule, the applicant must be employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffer a substantial inability to perform the essential tasks of that employment. The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them. The applicant bears the burden of proving, on a balance of probabilities, that they meet the test.
9The applicant and the respondent agree in submissions that, at the time of the dispute, the applicant was substantially unable to perform the essential tasks of her employment. The parties’ dispute over IRBs was solely based on the quantum of the IRBs.
10The applicant submits an accounting report from Clarity CPA. This report calculated past IRBs to February 8, 2025 in the amount of $7,111.10 plus $660.31 interest on unpaid amounts. The going forward IRB payable was calculated at $24.25 per week.
11The respondent submits an accounting report from Pricewaterhouse Coopers (“PwC”). This report has calculated the past IRBs to January 11, 2025 at $7,506.11. The respondent has calculated outstanding interest due on past amounts to be $394.11. The weekly benefit payable on January 11, 2025 was calculated at $25.47 per week.
12The respondent states in submissions that all amounts in arrears have been paid with weekly payments continuing at $25.47 per week to the July 29, 2025 denial letter. This is supported in an explanation of benefits provided to the applicant dated June 17, 2025.
13The respondent further submits that it discontinued benefits for medical reasons on July 29, 2025, as evidenced by an explanation of benefits dated July 29, 2025.
14The July 29, 2025 termination of IRBs was highlighted in the respondent's submissions. The applicant was given an opportunity to make reply submissions but did not. This was confirmed by the Tribunal in correspondence dated March 30, 2026.
15Applicant’s counsel, in correspondence, noted that he did not file reply submissions as he contends that the respondent’s submissions were never properly served.
16I note that the respondent filed a certificate of service with the Tribunal certifying that the respondent’s submissions were served on the applicant on August 13, 2025.
17The respondent has included copies of e-mail correspondence showing service on the applicant, and the applicant’s counsel has confirmed he received the email.
18There is no evidence before me that the applicant raised the issue of not receiving the respondent’s submissions prior to the Tribunal seeking clarification on March 27, 2026.
19In response to the Tribunal’s correspondence, the applicant did not make a request, or file a motion to allow for an extended deadline to file reply submissions.
20The applicant at no point sought to introduce the July 29, 2025 denial as an issue in dispute.
21I therefore find that applicant had sufficient opportunity to address the July 29, 2025 denial and did not do so.
22As there is no indication that the denial letter of July 29, 2025 is in dispute, I find that the applicant’s entitlement to IRBs after July 29, 2025 is not properly before me in this hearing. Should the applicant wish to contest the adjusting decision of the respondent, they can avail themselves of the dispute resolution mechanisms provided by the Schedule. For greater clarity, I am not making a finding with respect to the applicant’s entitlement to IRBs after July 29, 2025.
23As the amounts owing have been paid, and the respondent paid the benefit to the denial letter of July 29, 2025, I find that this issue is no longer in dispute.
Costs
24Rule 19.2 of the Licence Appeal Tribunal Rules, 2023 (the “Rules”) allows a party to make a written request for costs at a hearing or at any time before a decision is released. Therefore, the applicant’s requests for costs is properly before me.
25Rule 19.1 states that costs may be sought if a party believes that another party has acted unreasonably, frivolously, vexatiously, or in bad faith.
26Rule 19.5 states that in deciding whether to order costs and the amount of costs to be ordered, the Tribunal shall consider all relevant factors including: the seriousness of the misconduct; whether the conduct was in breach of a direction or order issued by the Tribunal, whether or not a party's behaviour interfered with the Tribunal's ability to carry out a fair, efficient, and effective process; prejudice to other parties; and the potential impact an order for costs would have on individuals accessing the Tribunal system.
The applicant is not entitled to costs for filing a notice of motion
27I find that the applicant is not entitled to costs.
28In its submissions, the applicant requests costs in the amount of $100.00 against the respondent given that the applicant brought a motion to the LAT asking for an Order to produce the complete accident benefits file (“AB file”).
29The applicant submits that they have requested the AB file on seven separate occasions between May 17, 2024 and October 17, 2024 and that the respondent’s refusal to produce the file in response to these requests was unreasonable, forcing them to file a motion with the Tribunal requiring production of the AB file.
30The respondent submits that it served the completed AB file within two business days of the receipt of the applicant’s motion and that they have not acted in an unreasonable manner.
31When analyzing the factors under Rule 19.5, I note that the motion was filed 44 days after the application was filed with the Tribunal and 14 days after the Tribunal issued a Notice of Telephone Case Conference.
32I find that respondent did not breach an order or direction issued by the Tribunal. In fact, this motion was filed prior to the scheduled case conference, which Rule 14.2(b) indicates is the proper venue for requesting production orders.
33The applicant has not made submissions about whether or not the respondent’s behavior interfered with the Tribunal’s ability to carry out a fair, efficient and effective process. As I have previously stated, the Tribunal’s process is that productions are requested at the case conference (Rule 14.2(b)).
34I have not been able to ascertain how the applicant was prejudiced when a case conference, which is the proper venue for a production order, had already been scheduled.
35Therefore, I find that the applicant has not satisfied me that an award for costs is justified based on the factors outlined in Rule 19.4.
The respondent is not entitled to costs because it approved the IRB
36I also find that the respondent is not entitled to costs.
37In its submissions, the respondent requests costs in the amount of $250.00 against the applicant given that the issue of IRB quantum was resolved in the period between the applicant’s initial submissions and the respondent’s submissions due date, which it argues should have removed the need for the respondent to file written submissions for this hearing.
38I disagree with the respondent’s position as there are still issues in dispute despite the respondent agreeing to pay the IRB.
39Section 280 of the Insurance Act is conveniently titled “Resolution of disputes,” with subsection (1) stating that the section applies: “with respect to the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled.”
40Further, in Vivekananthan v. Certas Direct Insurance Company, 2024 ONSC 6198 the Court found that s. 10 of Regulation 664 grants the LAT the authority to order ‘stand-alone’ awards, clarifying the meaning of the section, and particularly the words “may award a lump sum of up to 50 per cent of the amount to which the person was entitled at the time of the award”.
41The Court endorsed the interpretation of s. 10 adopted in some LAT jurisprudence, which generally states that an insurer cannot escape liability for an award by resolving claims on the eve of a hearing. Although the Court does not use the term ‘stand-alone award’, the decision holds that an award is always available where there is evidence of unreasonable withholding or delay of benefits.
42The Court married the plain wording of s. 10 with a large and liberal interpretation of the legislation. They did so by anchoring entitlement to an award in the right to receive a benefit was unreasonably withheld or delayed, a right that spans the pre-hearing phase of a dispute, and the time a decision is rendered. The Court further noted, “The fact that those benefits may have been paid by the insurer does not detract from the fact that at the time of the award the insured had a right to receive those benefits.”
43The respondent has calculated an IRB quantum and made a payment of arrears and interest based on its calculation. However, there appears to be no resolution of the applicant’s claim for an award under s. 10 of Reg 664 and the applicant’s claim for costs related to the motion for a production order.
44As there are still live issues in dispute which necessitate this written hearing, I decline to award the respondent costs for drafting their submissions.
Interest
45Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
46As no benefits are owing, no interest is payable.
Award
47The 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.
48The applicant submits that the insurer had the material information to quantify the wage loss benefit at all times. Specifically, the applicant submits that the insurer’s request for the complete Employment Insurance file was unreasonable when the applicant provided screenshots of her bank account activity showing Employment Insurance payments.
49The respondent submits that as soon as it was in receipt of the report from PwC outlining the quantum of benefits owing, it made a full payment, including interest.
50From the evidence submitted it appears that the applicant provided the screenshots in an email sent on August 28, 2024. The applicant submits that these screenshots are a substitute for the complete Employment Insurance file.
51The respondent responded in a letter dated September 10, 2024 that the screenshots were not acceptable proof of income for Employment Insurance payments and this request remains outstanding.
52I note in these screenshots several payments are referenced solely as “Deposit Canada”. There is no indication or confirmation that these payments are Employment Insurance payments. Also, these are net payments, there is no detail on the gross amount of Employment Insurance benefits that the applicant was receiving.
53Section 4.1 of the Schedule states that Employment Insurance benefits received form part of the gross employment income calculation and therefore evidence showing net payments is not sufficient to calculate IRB quantum.
54Given that the applicant had not provided particulars of the Employment Insurance benefits received, it was reasonable for the respondent to withhold the benefit.
55The Employment Insurance file was provided to the respondent on January 17, 2025.
56PwC sent a letter to the applicant’s counsel on February 4, 2025 requesting further information.
57This letter is evidence that the respondent engaged PwC within 18 days of receipt of the Employment Insurance file. The exact timeframe of the engagement is not clear, but at most it was within 18 days of receiving the Employment Insurance file. As evidenced by the date of the letter to the applicant’s counsel from PwC. This is not an unreasonable timeframe.
58The report from PwC was completed on June 13, 2025 and the respondent advised the applicant on June 17, 2025 that the benefit will be paid. This occurred within 4 days, which is not unreasonable.
59Therefore, for the reasons above, I find that the respondent did not unreasonably withhold benefits, and the applicant is not entitled to an award under s. 10 of Reg 664.
ORDER
60For the reasons above I find that:
i. The respondent has paid the IRB and interest for the period in dispute to July 29, 2025;
ii. The denial of the IRB dated July 29, 2025 is not in dispute before me;
iii. Neither party is entitled to costs;
iv. The applicant is not entitled to an award under s. 10 of Reg 664; and
v. No interest is payable.
61This application is dismissed.
Released: April 17, 2026
Julian DiBattista
Vice-Chair