Licence Appeal Tribunal says claimant failed to prove entitlement to statutory accident benefits
The Ontario Divisional Court has upheld an insurance company’s denial of statutory accident benefits sought by a claimant who fell while moving boxes out of his running car, given his failure to establish an entitlement to the requested benefits.
In Huynh v. Security National, 2026 ONSC 4759, the appellant sustained injury during this fall in January 2022. As he required surgery for a fractured elbow, he requested statutory accident benefits from the respondent insurer.
The insurer refused benefits upon deciding that the appellant did not have an accident as defined by the Statutory Accident Benefits Schedule, Reg. 34/10 (SABS).
Asserting before the Licence Appeal Tribunal that he indeed had an accident, the appellant claimed income replacement benefits, payments for services under the disputed treatment plans, interest, and an award under s. 10 of Automobile Insurance, RRO 1990, Reg 664.
An adjudicator of the Licence Appeal Tribunal denied the appellant’s claims for benefits, interest, or an award under s. 10 of Reg. 664.
Though acknowledging that the appellant had an accident, the adjudicator determined that the appellant failed to prove an entitlement to the requested benefits.
The adjudicator saw no compelling medical evidence of the accident-related impairments’ extent or duration and insufficient detail to show that the treatment plans were reasonable and necessary.
Upon a request for reconsideration, the same adjudicator held that the appellant failed to satisfy the high threshold for granting such a request and failed to explain how his arguments met the grounds for reconsideration under the tribunal’s rules.
On appeal, the appellant challenged the adjudicator’s denial of his request for reconsideration.
First, the appellant said the adjudicator erred by rejecting his uncontradicted medical evidence, even though he submitted the statutorily required form to claim benefits. The appellant added that, although the insurer argued that he did not have an accident, it did not challenge that his injuries otherwise satisfied the test for benefits under the SABS.
Second, the appellant alleged that the adjudicator breached procedural fairness by reconsidering her own decision.
The appellant also moved to introduce fresh evidence, including:
During the insurer examination, the appellant said he could not lift anything heavy.
The Divisional Court of the Ontario Superior Court of Justice dismissed both the appeal and the motion to introduce fresh evidence. The court ordered the appellant to pay the insurer $5,000 in all-inclusive costs.
The Divisional Court saw no legal error in the adjudicator’s determination that the appellant had failed to satisfy his burden of proof. The court explained that the adjudicator did not need to accept the disability certificate form (OCF-3) and other forms as sufficient evidence.
The court pointed out that the appellant’s chiropractor:
The court also noted that the appellant:
According to the court, the case conference report and order:
The Divisional Court did not consider it a breach of procedural fairness for the same adjudicator to deal with the request for reconsideration, pursuant to r. 18.1 of the tribunal’s rules.
According to the court, the adjudicator fully knew about and rejected the appellant’s argument that she needed to accept uncontradicted medical evidence.
The court noted that the adjudicator said she had “no obligation to accept at face value the findings or opinions of the medical professionals” even if there was no contradictory evidence.
The court added that the adjudicator rejected the appellant’s arguments as a request to reweigh evidence, which was not the function of a reconsideration.
The Divisional Court ruled that the proposed fresh evidence failed to satisfy the test in Palmer v. The Queen, 1979 CanLII 8 (SCC), [1980] 1 SCR 759.
The court found the proposed fresh evidence irrelevant to determining whether the adjudicator committed a legal error.
Here are some other Ontario Superior Court decisions arising from injuries from falling.
In an injury matter involving a trip-and-fall incident, the Superior Court issued a July 24 decision fixing the fee at $65,000, reduced from the proposed amount of $73,885.27 requested by counsel of the plaintiff, a person under disability.
In a case in which the plaintiff tripped and fell while trying to access a bus, the Superior Court made a June 17 decision upholding a contingency fee arrangement that imposed a proposed fee of 33 percent for tort claims and an alternate hourly rate of $900.
In an injury action alleging a concussion from an actor’s fall while filming a commercial, the Superior Court issued a May 4 decision holding that a release and waiver clearly applied and unequivocally barred her from bringing any claim in relation to an accident on set.
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