Licence Appeal Tribunal File Number: 25-006469/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:
Arjan Singh
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
VICE-CHAIR: Brian Norris
APPEARANCES:
For the Applicant: Imtiaz Hosein, Counsel Christos Kakaletris, Counsel
For the Respondent: Joanne R. Witt, Counsel
Heard by Videoconference on January 28, 2026, followed by written submissions
OVERVIEW
1Arjan Singh (“the Applicant”) was involved in an automobile accident on July 1, 2015, and sought benefits from Aviva General Insurance Company (“the Respondent”) pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”). The Applicant was denied medical benefits and a catastrophic impairment determination by the Respondent 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 Respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the Applicant?
ii. Is either party entitled to costs?
RESULT
3I find that the Applicant is not entitled to an award.
4The Applicant is entitled to costs in the amount of $500.00.
5The Respondent is not entitled to costs.
BACKGROUND
6The Applicant applied to the Respondent for a determination that he sustained a catastrophic impairment as a result of the subject accident. The Respondent denied that application and sought insurer’s examinations (“IEs”) to assist it in determination whether the Applicant’s injuries were at the catastrophic level. Following the IEs, the Respondent concluded that the Applicant did not sustain a catastrophic impairment as a result of the accident.
7The Applicant disagreed and applied to the Tribunal for resolution of the dispute, and the parties participated in a case conference with respect to the Applicant’s application.
8At the case conference, the Respondent advised that it had changed its position and concluded that the Applicant sustained a catastrophic impairment as a result of the accident. The parties, however, were unable to resolve the issue of entitlement to an award pursuant to section 10 of Regulation 664, with respect to the Applicant’s catastrophic impairment determination. This is the issue before me now.
PRELIMINARY MOTIONS
9The Respondent filed a motion prior to the start of the hearing seeking the following forms of relief:
i. An order excluding the Applicant’s witness, the claims advisor of the Respondent, for failing to serve and file a witness list;
ii. An order excluding the Applicant’s particulars of the award claim because the particulars were not produced in compliance with the Case Conference Report and Order (“CCRO”);
iii. An order denying permission to the Applicant to rely on any productions listed in the CCRO and/or the Applicant’s hearing brief, such as the Applicant’s neuropsychologist’s clinical notes and records (“CNRs”), which the Respondent submits were not served in accordance with the CCRO;
iv. An order dismissing the award claim due to a failure to provide particulars;
v. An order vacating the hearing; and
vi. An order for costs of the motion and the entire proceeding.
10The crux of the Respondent’s argument in the motion is that the Applicant failed to provide particulars of his award claim following the case conference; he failed to file his witness list on time; was late to file an Oral Hearing Requirement Form; and failed to produce the complete file of a neuropsychologist together with their contemporaneous records and raw test data from their assessment with the Applicant.
11The Respondent claims prejudice due to the Applicant’s inaction or late compliance. The Respondent submits that the Applicant has violated the principles of procedural fairness. It claims that it should be afforded the means to present its case fully and fairly and have a decision made in a fair, impartial, and open process. It submits that the Applicant should not be able to advance his claim for an award because he failed to provide the particulars of the award claim, as ordered in the CCRO.
12The Applicant submits that the hearing must proceed in order for him to understand the reasons why the Respondent deemed him to have sustained a catastrophic impairment and when the determination is made. I understand this to be the root of the Applicant’s claim for an award. He submits that the adjuster’s log notes do not provide the information for him to understand the Respondent’s decision to deem him to be catastrophically impaired and requires a hearing with testimony from the adjuster to determine this information. To him, no further award particulars are required other than what has been provided in his Case Conference Summary, which was disclosed prior to the case conference.
13The Applicant submits that the witness list is a formality, and no change or update was made to adjust his witness list, provided at the case conference. He further submits that no further particulars of his award claim are required because the parties are to issue written submissions following the hearing and that gives the Respondent 14 days to address his claim for an award. The Applicant questions relevance of the neuropsychologist’s CNRs but submits that the records are nevertheless captured in the disclosure of certain hospital records.
14For the following reasons, I dismissed the Respondent’s motion and advised that I would address costs at the conclusion of the hearing.
15I acknowledge that the Applicant failed to comply with the CCRO by not producing a witness list more than 45 days prior to the hearing. However, I find no prejudice or violation of procedural fairness as a result. To me, there are no changes or surprises to the witness list that would cause any procedural unfairness. Since the case conference, the Applicant has maintained an intention to call the claims adjuster from the Respondent as his one and only witness.
16Excluding the witness would prejudice the Applicant in advancing his claim for an award. This is because the witness is the adjuster on the Applicant’s claim at the time the catastrophic impairment determination was made, and the log notes do not address the reasons why the Respondent reversed its decision. Thus, the adjuster is the only source of information regarding the decision to deem the Applicant catastrophically impaired.
17I dismissed the Respondent’s motion to exclude the Applicant’s evidence because it has not demonstrated any prejudice to it, or violation of procedural fairness.
Given that the issue at this hearing is entitlement to an award, and that the Respondent has agreed that the Applicant sustained a catastrophic impairment, the records from the neuropsychologist hold virtually no probative value as they do not address whether the Respondent’s adjusting of the Applicant’s claim warrants an award. Further, the Respondent’s reply submissions do not refute that the neuropsychologist’s CNRs are included in the hospital records.
18I find no violation of procedural fairness or prejudice to the Respondent in dismissing its motion to strike the Applicant’s claim for an award. I find that the Applicant provided the particulars of his claim for an award with his case conference documents. While the particulars appear to be boilerplate, I am satisfied that the Respondent had sufficient information of the case to be met – whether the Applicant is entitled to an award based on the Respondent’s decision to deem him catastrophically impaired after initially denying his claim. Moreover, I agree with the Applicant that the format of this hearing, which allows for written submissions following oral testimony, provides the Respondent with sufficient time to respond to the case brought by the Applicant.
19I dismissed the Respondent’s motion to vacate the hearing. To me, there is no violation of procedural fairness or prejudice to the Respondent in proceeding with the hearing because it is aware of the case before it. That is, whether the Applicant is entitled to an award based on the adjusting of his catastrophic impairment claim. Likewise, there is no violation of procedural fairness or prejudice to the Respondent in allowing the Applicant to call his only witness because the Respondent has been aware of the Applicant’s intention to call the witness since the case conference.
20Overall, I dismissed the Respondent’s motion on all grounds and concluded that the hearing should proceed because the Respondent has not demonstrated that the Applicant has violated procedural fairness or caused prejudice to the Respondent due to a failure to file a witness list, provide further particulars of his award claim, and CNRs from his neuropsychologist that are isolated from the hospital records. Costs are addressed at the end of this decision.
ANALYSIS
No award is payable
21I find that the Applicant is not entitled to an award because he has not met his onus on a balance of probabilities to demonstrate that the Respondent acted in a manner which is excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
22The Applicant seeks an award under section 10 of Regulation 664. Under section 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. To be entitled to an award, the Applicant must demonstrate that the Respondent acted in a manner which is excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
23The Applicant claims entitlement to an award on the basis that the Respondent did not approve his catastrophic impairment determination until after he filed an application with the Tribunal. The Applicant submits that the delay and unreasonable withholding of his catastrophic impairment designation came to light after the insurer approved his catastrophic determination at the case conference without providing any medical reasons. He submits that the evidence suggests that the Respondent was aware of his catastrophic impairment determination well before the case conference.
24The Applicant submits that an award is necessary to address and deter poor behaviour by insurers and respond to insurer misconduct. To him, it is standard practice of the Tribunal to find an award payable where an insurer reverses a denial and issues an approval only after an application is filed with the Tribunal and is unable to provide an explanation for the delay in issuing that approval.
25The Applicant highlights the following conduct by the Respondent that he considers to be behaviour which should be deterred:
In testimony, the adjuster agreed that the Respondent had a duty of good faith, a duty to fairly adjust the Applicant’s claim, a duty to comply with the Schedule, and a duty to provide clear and intelligible reasons when it approves or denies a benefit;
The Respondent provided no reasons for the decision to deem the Applicant catastrophically impaired, and in particular included no reason for the decision the log notes;
The Respondent does not have a policy requiring certain log note recording, including “key decisions” like finding a person catastrophically impaired, but that as a matter of good faith it usually provides reasons when it changes status from denied to approved;
The letter confirming the approval of the Applicant’s catastrophic impairment determination include no relied-upon medical report, no medical reasons, and no medical explanation for the reversal;
The Respondent admitted that the Applicant’s catastrophic impairment determination had no medical basis and was not based on any new medical evidence to drive the reversal, and that the decision was tied to privileged discussions with counsel;
In testimony, the adjuster agreed that failing to communicate reasons for approval or denial of benefits, even during litigation, would breach its responsibilities under the Schedule; and
The adjuster admitted in testimony that counsel for the Respondent represented at the case conference that the log notes would show the basis for the approval, but the produced log notes do not.
26The Respondent submits that a catastrophic impairment determination is not a benefit and does not entitle the Applicant to anything other than increased limits being available if he is able to substantiate that he is entitled to the benefit pursuant to the Schedule. To the Respondent, a catastrophic impairment determination is a procedural issue and not a benefit, therefore it cannot be the basis for an award.
27The Respondent further submits that the Applicant has not provided any persuasive evidence to demonstrate that the Respondent acted in a manner which is excessive, imprudent, stubborn, inflexible, unyielding or immoderate. It further submits that the Applicant has not identified the precise insurer conduct, such as what it did, when it occurred, who made the decision, the information available to the Respondent at the time of the decisions, and the consequences to the Applicant as a result of its actions. Lastly, it submits that the Applicant has not demonstrated that the action taken by the Respondent was more than an error, disagreement with the Applicant’s reports, or reliance on the insurer’s examinations (“IEs”).
28The Respondent is critical of the Applicant’s allegations in support of his claim for an award. It submits that the basis for the Applicant’s claim is that the reasons for reconsidering the catastrophic impairment designation were not included in the letter dated September 11, 2025, which confirmed the reversal, or in the log notes provided on October 16, 2025. It submits that allegations are not reflected in the particulars provided by the Applicant at the case conference.
29The Respondent submits that the Applicant knew, or ought to have known the basis for its award claim on or before October 16, 2025, when the log notes were produced. To the Respondent, this substantiates its position that the hearing is unnecessary and waste of the Tribunal’s resources.
30The Respondent submits that there was no misrepresentation at the case conference or on any other occasion. Instead, it submits, the reasons for the reconsideration of the catastrophic impairment determination fall under litigation and solicitor-client privilege, and that this does not equate to reasons not being present in the log notes.
31The testimony of the adjuster was that there is no policy as to what is to be included in the log notes. To the Respondent, there is no nefarious purpose regarding what is recorded in the log notes and the Applicant has not provided any evidence to the contrary, as such evidence does not exist.
32The Respondent submits that no benefits were denied based on the Applicant not being designated as catastrophically impaired as he had not yet exhausted the non-catastrophic impairment funding available to him.
33I agree with the Respondent and find that disagreeing with the Applicant’s catastrophic impairment assessment reports is not stubbornness, reliance on the IEs is not imprudent, denial of a designation is not inflexibility, and that good faith reliance on expert opinion is not the kind of conduct an award was designed to repudiate. The Schedule includes sections which address how insurer may respond to an application for a catastrophic impairment designation, which includes seeking their own assessments. In this case, the Respondent exercised its right to assess the Applicant and initially agreed with the opinions of those assessors. This is conduct that the Schedule anticipates occurring and it cannot be said that following that process is grounds for an award.
34I find that the Schedule does not require the Respondent to provide medical and other reasons for approving a benefit or designation. Section 45(3)(a) of the Schedule provides no indication that an approval of an application for a catastrophic impairment requires medical and other reasons. Medical and other reasons are required pursuant to section 45(3)(b), when an insurer determines that the impairment is not catastrophic.
35To me, the Schedule is consistent in that medical and other reasons are not required to be provided when benefits are approved. For example, section 38(8) of the Schedule, does not require medical or other reasons for the approval of a treatment plan. The requirement for an approval is that the Respondent must give notice identifying all the goods and services it agrees to pay for. The latter part of section 38(8) provides the requirement for medical and other reasons for the denial of a benefit.
Similarly, insurers are not required to provide medical and other reasons for the approval or a specified benefit, or for concluding that an insured’s injuries are no longer subject to the minor injury guideline. I see no difference in finding that a person sustained a catastrophic impairment as a result of the accident.
36I find that the timing of the Respondent’s decision to reverse its position on whether the Applicant sustained a catastrophic impairment does not automatically attract an award. The Applicant has not demonstrated that the Respondent reversed its decision “well before” the reversal was relayed to him. The Applicant points to the CCRO and testimony from the adjuster to support his position that the Respondent knew of its reversal well before it was relayed to him at the case conference. To me, the CCRO is silent on when the determination was made. Similarly, none of the adjuster’s testimony indicated that the decision to deem the Applicant catastrophically impaired occurred “well before” the case conference, or that the Respondent withheld its reversal from the Applicant for any material time.
37I find that the Applicant has not demonstrated that it is standard practice to find an award payable where an insurer reverses a denial and issues an approval after an application is filed with the Tribunal and is unable to provide an explanation for the reversal. Up front, I am not bound by the decisions of my peers at the Tribunal, and I nevertheless find the cases submitted by the Applicant to be distinguishable from the case at hand.
38M.P. v. Aviva General Insurance Company, 2019 CanLII 119736 (ON LAT) is distinguishable because it involved a situation where the insurer advised the insured that her injuries were no longer considered a minor injury, but maintained denials based on the minor injury guideline. O.M. v. Allstate Insurance, 2020 CanLII 45540 (ON LAT) is distinguishable because it involved a situation where the insurer denied funding for a psychological assessment on the basis that it was three years post-accident and because there was no evidence of a psychological injury in the insured’s medical record. The adjudicator granted an award because the timing of the plan, relative to the accident, is not part of the reasonable and necessary analysis, and because it had multiple documents indicating that the insured suffered a psychological injury as a result of the accident. S.V. v. Aviva Insurance, 2020 CanLII 57406 (ON LAT) is distinguishable because it involved a situation where the insurer maintained a non-compliant denial for nearly a year and only approved the benefit about a month prior to a hearing on the issue.
39I find Stewart v. Travelers Insurance Company of Canada, 2022 CanLII 92733 (ON LAT), Ziv v. Allstate Insurance Company of Canada, 2025 CanLII 20833 (ON LAT), and Dimitropoulos v. Unifund, 2025 CanLII 92264 (ON LAT) to be distinguishable from the present case because they all involve a situation where the insurer approved a treatment plan during the hearing, and after the insured inevitably incurred the time and expense of tendering written submissions.
40I further find that the remaining cases are distinguishable or unhelpful in determining whether the Applicant is entitled to an award because the Respondent reversed its decision without medical or other reasons. The award in Driscoll v. Allstate Insurance Company of Canada, 2025 CanLII 35966 (ON LAT) was granted because the insurer ignored rebuttal reports and the overall delay amounted to nearly two years, which had a profound impact on the insured due to her vulnerable financial state. Here, there are no rebuttal reports, thus it cannot be said that rebuttal reports were ignored because no rebuttal reports were issued. Additionally, the length of delay in the reversal in the Applicant’s case is approximately five months, which is significantly less than the nearly two-year delay in Driscoll.
41The award in Larmond v. Onlia Insurance Company, 2026 CanLII 358 (ON LAT) was granted because of a clear delay in relaying the reversal to the insured. In Larmond, the insurer reversed its denials after it became aware that its denials were not compliant with the Schedule, based on advice from its counsel. However, the evidence in that case demonstrated that the insurer delayed the reversal by a minimum of two months. There, the insurer retained counsel on or before July 17, the case conference occurred on September 19, and the reversal occurred on November 26. In the Applicant’s case, the Respondent reversed its denial at the case conference and there is no indication that notice of the reversal was delayed. Neither the log notes, nor the adjuster’s testimony at this hearing indicate that the notice of the reversal was delayed.
42Additionally, I find that the Applicant has not demonstrated that the Respondent’s reversal led to the unreasonable withholding or delay of benefits. As noted by the Respondent, the Applicant had access to funding for medical and rehabilitation, as well as attendant care benefits without the catastrophic impairment designation, thus there is virtually no monetary reason for him being unable to obtain goods and services which are reasonable and necessary as a result of the accident.
Similarly, he has led no evidence to suggest that his access to benefits at the catastrophic impairment level, such as a greater monthly rate for ACBs, and possible entitlement to housekeeping and home maintenance, or rehabilitation benefits, were withheld or delayed as a result of the Respondent’s actions.
43Lastly, although not raised by the parties, I highlight the remedial nature of the case conference which has a strong focus on settlement of the issues without the need of a hearing. Tribunal rule 14.4 states that the case conference is an important opportunity to discuss settlement of the issues without the need for a hearing, and that parties are expected to come to the case conference prepared to discuss settlement. To me, settlement can come in a broad range of outcomes, including the reversal of prior denials issued by an insurer, which is present in the Applicant’s case. To me, punishing the Respondent for reversing its decision at the case conference, and going against the advice of its IE assessors, would be against the leading principle for conducting a case conference.
44Having determined that the Respondent’s conduct did not lead to the delay or withholding of benefits, and that it was not excessive, imprudent, stubborn, inflexible, unyielding, or immoderate, it follows that no award would be payable. As such, I do not need to address the Respondent’s position that an award cannot flow through the unreasonable withholding or delay of a designation such as catastrophic.
Costs
45I find that the Applicant is entitled to costs in the amount of $500.00.
46Both parties sought an order for costs in the maximum amount with respect to the motions and the hearing. The Applicant seeks costs related to this hearing, pursuant to Rule 19, on the basis that the Respondent, through its employee and legal representative, misrepresented to the Tribunal at the case conference that the reasons for approving his catastrophic determination would be found in the log notes, but the adjuster confirmed that it was untrue and the information was not actually found in the log notes, making a false representation.
47The Applicant submits that the Respondent made a false representation that the log notes would reflect the reversal of its denial and that it has not retracted the misrepresentation to-date. He submits that the Respondent acknowledge the misconduct during testimony. To the Applicant, costs must be awarded against the Respondent to deter insurers’ employees from making misrepresentations at case conferences for litigation gain.
48The Respondent claims that the Applicant failed to comply with the CCRO, the Tribunal Rules, and the Schedule while insisting that the matter proceed to what it characterizes as an unnecessary hearing. It further submits that the Applicant’s counsel be cautioned to refrain from unprofessional conduct such as a failure to comply with the CCRO and uncivil communication.
49Specifically, the Respondent submits that the Applicant’s written submissions exceed the page limit outlined in the CCRO by 1 page; that he quoted the hearing transcript incompletely; that he filed a brief of 98 tabs but only relied on 5 exhibits; that he split the cross-examination of the adjuster between two counsel and without any prior notice; he made unfounded allegations about the log notes in his submissions; and that his counsel engaged in unprofessional language and communication.
50In response, the Applicant submits that an oral hearing was necessary, as demonstrated by the facts uncovered in testimony that were not included in the adjuster’s log notes. He further submits that the language and communication of his counsel is immaterial, and it is not unprofessional or an accusation to identify insurer misconduct. He further submits that the Respondent never raised an objection over splitting the cross-examination at the hearing.
51I find that the Respondent is liable to pay costs to the Applicant because it misrepresented its position at the case conference. I agree with the Applicant, and the adjuster’s testimony, that the log notes include no reasons regarding the approval of the Applicant’s catastrophic impairment designation. While I have found that the Respondent is not required to provide reasons for a reversal of its position, it cannot misrepresent to the Applicant and Tribunal that the reasons could be found in the log notes. To me, the Respondent’s misrepresentation is serious conduct which interfered with the Tribunals ability to carry out a fair, efficient and effective process. It was completely unfair to the Applicant to advise that the reasons would be in the log notes when they clearly were not.
52I find that costs of $500.00 is appropriate in the circumstances. This demonstrates that the seriousness of the Respondent’s misrepresentation but also accounts for the Applicant’s contribution to the dispute. The primary basis for this hearing is that the Applicant never received any medical or other reasons for the Respondent’s reversal of its denial that the Applicant sustained a catastrophic impairment.
Because of the Applicant’s position, I find that the hearing would have proceeded regardless of the Respondent’s comments, as he sought an award on the basis that no medical and other reasons were provided – not because the Respondent misrepresented the reasons for the reversal at the case conference.
53I decline to find costs payable by the Applicant but caution his counsel on the language used in the written submissions. I do not agree with the Respondent that the hearing was unnecessary because it was only until the hearing that the Applicant was advised that the reversal was a litigation decision and not based on medical or other factors. The Respondent has not identified any prejudice it suffered as a result of the Applicant exceeding a page limit by one page, or because he failed to file a final witness list. Similarly, the Respondent has not identified any prejudice in having received a brief of 98 documents in advance of the videoconference portion of the hearing. Likewise, the language of the Applicant’s counsel has not interfered with the Tribunal’s ability to conduct a fair, efficient, and effective process.
54I do caution the Applicant’s counsel on the language and tone of their submissions as it has no place in a civil dispute resolution process. I agree with the Respondent that zealous advocacy is important, but it cannot come at the expense of civility and the obligation to act in a professional manner. In the submissions, counsel for the Applicant accused the Respondent as acting “disgraceful” and shaming them for it. At another time, the Applicant attempts to characterize the Respondent’s actions as attempts to escape accountability, having procedures to obstruct and prohibit personal services. This type of language and these accusations are unhelpful and does nothing to assist the Applicant in advancing his claim.
55However, the language and accusations have not risen to the level that it interfered with the Tribunals ability to carry out a fair, efficient, and effective process. Accordingly, I find no costs payable by the Applicant.
Interest
56Interest applies on the payment of any overdue benefits pursuant to section 51 of the Schedule. Having found no benefits or award payable, it follows that no interest is payable.
CONCLUSION AND ORDER
57I find that the Applicant has not met his onus to demonstrate that he is entitled to an award with respect to the Respondent’s decision to accept his application for a determination that he sustained a catastrophic impairment.
58The Applicant is entitled to costs in the amount of $500.00.
59The Respondent is not entitled to costs.
Released: June 8, 2026
Brian Norris
Vice-Chair