Definity Insurance was hit with the maximum penalty after Ontario's Licence Appeal Tribunal found it ignored its own assessor's report when denying a treatment plan.
In a decision released April 8, 2026, Vice-Chair Robert Maich ordered the insurer to pay a $1,300 award - the full 50% permitted under section 10 of Regulation 664 - after concluding that Definity unreasonably withheld approval of a $2,600 chiropractic treatment plan submitted on behalf of applicant Sylvie Chayer-Charron.
The case, Chayer-Charron v. Definity Insurance Company, 2026 ONLAT 24-012487/AABS, arose from an automobile accident on April 1, 2022. Chayer-Charron applied for statutory accident benefits, including non-earner benefits of $185 per week and funding for a chiropractic treatment plan submitted by Rockland Family Chiropractic & Wellness Centre in September 2024. Definity denied both.
For the treatment plan denial, issued November 5, 2024, Definity relied on its physiatry assessor, Dr. Sreenivasan, who in an addendum report dated October 31, 2024 concluded the treatment was not reasonable and necessary. The reasoning: the applicant had already undergone roughly two and a half years of chiropractic therapy and achieved only 50% improvement.
But there was a wrinkle. Another assessor Definity itself had commissioned - occupational therapist Mr. Iyengar - had found in a July 12, 2024 report that rest and chiropractic therapy was noted to relieve the applicant's pain, though without sustained improvement. Vice-Chair Maich found that Mr. Iyengar's assessment linked the condition to the accident and that pain relief on its own was enough to satisfy the "reasonable and necessary" standard under sections 15 and 16 of the Schedule. He cited MHE v Aviva Insurance Canada, 2018 CanLII 13183 (ON LAT), where chiropractic funding was approved because the treatment provided some functional and symptomatic benefits despite limited improvement.
The sharper finding was on the penalty. Vice-Chair Maich wrote that an insurer "is deemed to know the contents of its s.44 reports and must adjust accordingly on an ongoing basis." He found Definity "neglected its duty to continually adjust its file on a good faith basis" and was "derelict in its duty to continuously adjust the file," calling the withholding "excessive, imprudent, stubborn, inflexible, unyielding, or immoderate." Definity made no submissions on the award.
Interest on overdue benefits was also ordered under section 51 of the Schedule.
On the non-earner benefits claim, the applicant was unsuccessful. Chayer-Charron had a significant pre-accident medical history, including chronic back pain, anxiety, and a catastrophic injury determination from a 2013 motor vehicle accident. The Tribunal found that her accounts of pre-accident activities varied across multiple assessments and her sworn affidavit, with new activities appearing that had not been reported to earlier assessors. Vice-Chair Maich found these inconsistencies precluded a clear picture of her pre-accident condition, making it impossible to apply the comparison required under the Heath v. Economical Mutual Insurance Company test.
