One wrong word in a denial letter just cost an Ontario insurer four months of benefits on a claim it arguably did not owe.
In a decision released April 9, 2026, the Ontario Licence Appeal Tribunal ordered Co-operators General Insurance Company to pay non-earner benefits to Marvin Walker - not because Walker proved he deserved them, but because the insurer's own paperwork fell short.
Walker was hurt in a car accident on December 23, 2021, and filed for statutory accident benefits. Co-operators placed him in the Minor Injury Guideline, capping his treatment at $3,500. Walker filed his application with the Tribunal on July 16, 2024.
Vice-Chair Robert Maich's written decision zeroed in on how Co-operators handled its denial notices - and found a series of missteps that created payment obligations the insurer might otherwise have avoided.
The insurer sent Walker several denial notices for non-earner benefits between March and July 2022. The early notices came bundled with either a request for more information under section 33 of the Schedule or a notice scheduling an insurer examination. The Tribunal found that pairing a denial with an open request or pending examination does not amount to an "unequivocal" denial - meaning the two-year clock to challenge the denial never started ticking. The Tribunal pointed to the Supreme Court of Canada's direction in Pioneer Corp. v. Godfrey, 2019 SCC 42, holding that the limitation period only begins once a clean, standalone denial is delivered.
That pushed the effective denial date to August 17, 2022, and kept Walker's 2024 application within the limitation window.
Then came the paperwork error. When Co-operators sent its first request for additional information on March 2, 2022, it cited section 33 of the "policy" instead of section 33 of the "Schedule." The Tribunal called the wording "confusing and unclear" and ruled the request invalid. Because the insurer neither made a proper information request nor paid the benefit within 10 days of receiving Walker's disability claim form - faxed on January 27, 2022 - the Tribunal found Co-operators in breach of section 36(4) of the Schedule.
The result: Walker was awarded $185 per week in non-earner benefits from January 27 to May 27, 2022. The Tribunal was clear that Walker had not actually met the legal test for those benefits under Heath v. Economical. He was paid because the insurer's process failed, not because his claim succeeded.
On the broader file, the Tribunal removed Walker from the Minor Injury Guideline entirely. Medical records from his family doctor, Dr. Go, showed chronic pain with functional impairment that worsened after the accident, including limited shoulder movement and an inability to lift with his right arm. A psychiatric assessment by Dr. Papazoglou also identified somatic symptom disorder with predominant pain, which the Tribunal accepted as corroborated by Dr. Go's findings.
Walker was awarded $2,560 for psychological services, $2,360 for a neurological assessment, and $4,861.95 across three chiropractic treatment plans from Mackenzie Medical. The Tribunal declined to impose a punitive award, finding no basis to conclude that Co-operators had acted excessively or unreasonably in withholding benefits.
