Claimant recovers partial income benefits as tribunal limits Definity's suspension power

The insurer paused payments for missing documents - until it no longer could

A claimant recovered only a fraction of disputed benefits after Ontario's Licence Appeal Tribunal clarified when insurers may suspend income replacement payments. The dispute stemmed from a July 13, 2023 automobile accident. The claimant sought statutory accident benefits from Definity Insurance Company, which denied the claims, prompting an application to the Licence Appeal Tribunal's Automobile Accident Benefits Service.

Adjudicator Nadia Mauro decided the matter on written submissions, releasing her decision on June 29, 2026. At the centre of the ruling was the Minor Injury Guideline, which caps medical and rehabilitation benefits at $3,500 for predominantly minor injuries. The claimant argued that chronic pain and a psychological impairment should lift him out of that cap.

The adjudicator disagreed. Mauro preferred the insurer's section 44 assessment reports over the claimant's own assessments. The insurer's physiatrist and psychologist had relied on contemporaneous clinical notes and records, she found, while the claimant's assessors leaned largely on self-reported complaints without corroborating evidence.

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