A recent Ontario tribunal ruling sends a clear message to insurers: uploading a denial to HCAI is not the same as delivering it.
The Licence Appeal Tribunal's January 28, 2026 decision in Amouei v. Allstate Insurance Company of Canada should prompt claims departments across the province to take a hard look at how they handle denial notices under Ontario's accident benefits system.
At issue was a seemingly straightforward question: does posting a denial on the Health Claims for Auto Insurance platform count as giving notice to a claimant? The tribunal said no — and the reasoning has implications for every insurer processing statutory accident benefits claims.
The dispute traces back to an October 13, 2022 motor vehicle accident. Ali Amouei later submitted a treatment plan for chiropractic services, dated August 4, 2023. Allstate uploaded its denial to HCAI on August 23, 2023. On paper, that appeared to meet the 10 business day deadline set out in section 38(8) of the Statutory Accident Benefits Schedule.
But there was a problem. The claimant's representative did not actually receive an Explanation of Benefits until August 29, 2023 — 13 business days after the plan was delivered to the insurer on August 10, 2023. And under the Schedule, timing is everything.
Section 38(8) requires insurers to "give the insured person a notice" within 10 business days of receiving a treatment plan. That notice must spell out what the insurer will and will not pay for, along with the medical and other reasons behind any denial.
Miss that window, and section 38(11) kicks in. The insurer loses the right to argue the claimant falls under the Minor Injury Guideline. It also becomes liable for any treatment costs incurred during the gap — from the 11th business day until proper notice is finally delivered.
Vice-Chair Craig Mazerolle, who issued the reconsideration decision following a December 5, 2025 request, found the reasoning in an earlier case, Kemp v. Aviva General Insurance, convincing. That decision held it was not reasonable to assume that uploading a denial to a system claimants cannot access would satisfy the requirement to "give" notice. Mazerolle agreed, noting this interpretation is more in line with the consumer protection mandate.
Allstate pointed to a document dated August 24, 2023, arguing it was a fax confirmation proving earlier delivery. The tribunal was not persuaded. There was no text in the header or footer confirming when the transmission was completed. The document, Mazerolle found, was simply a cover page - not proof the denial had been sent.
The result: the $1,328.00 treatment plan was declared payable for any services incurred between August 25 and August 29, 2023.
For insurers, the lesson is practical. HCAI is a useful tool, but it is not a delivery mechanism that satisfies statutory notice requirements. Claims teams should ensure denial notices reach claimants or their representatives directly - and through means that can be verified - within the prescribed timeframe. Anything less invites exposure to mandatory payment obligations and the loss of key defences.
