September 15, 2025
Wilson v. Intact Insurance Company, 2025 ONSC 5305
In this case, a combined appeal and Judicial Review of the LAT’s decision denying the Insured’s application for catastrophic impairment benefits, the Divisional Court found aspects of the decision to be unreasonable and of sufficient impact that the decision could not stand.
The errors made by the adjudicator included the following:
- Unreasonably reducing the Insured’s degree of visual impairment from the 24% assessed by her expert witness – and confirmed by other strong evidence called by the Insured – to 0% based on his own rigid interpretation of the AMA Guides, and failing to provide logical reasons why the evidence he accepted diverged from the bulk of evidence that supported a contrary finding.
- Deciding to give no weight to an impairment rating for peripheral neuropathy assessed by the Insurer’s expert (with which the Insured agreed) because the expert, in error, cited the wrong page number for the table in the AMA Guide he was referring to. Although the adjudicator noted the expert’s error in citing the wrong page number in the AMA Guide, rather than seeking clarification, he declined to find impairment because the table cited did not relate to the impairment. Moreover, when this error was identified in the Reconsideration request, the adjudicator refused to change his decision.
- Unreasonably making no assessment of an additional impairment rating for the side effects of medications on the basis that the evidence provided on this point by one expert called by the Insured was incomplete when there was further evidence supporting the assessment from a different expert. Again when this error was identified in the Reconsideration request, the adjudicator declined to change his decision.
The case was sent back to the LAT for a hearing by a new adjudicator.