Licence Appeal Tribunal denied coverage beyond Minor Injury Guideline
In proceedings seeking benefits in connection with a May 2, 2020, automobile accident, the Ontario Divisional Court dismissed an appeal alleging errors in the Licence Appeal Tribunal’s finding that res judicata applied and its refusal to waive the doctrine.
In Muddapati v. Primmum Insurance Company, 2026 ONSC 1878, the respondent insurance company rejected the appellant’s claim for statutory accident benefits.
Before the tribunal, the appellant applied for a determination of her entitlement to benefits. In an initial decision dated Sept. 26, 2024, the tribunal denied coverage for treatment costs beyond the Minor Injury Guideline (MIG).
Next, the insurer denied the appellant’s claim for benefits for additional treatment plans. Before the tribunal, she applied for a resolution of the second dispute.
The insurer alleged that res judicata barred additional consideration of the issue of whether the MIG covered the appellant’s injuries.
The appellant wanted the adjudicator to waive res judicata. She relied on the following as new evidence:
In a preliminary issue decision dated Sept. 4, 2025, the tribunal’s adjudicator said res judicata applied because the tribunal’s initial decision had finally determined the same issue between the same parties, thus barring the appellant from proceeding with her application.
The adjudicator refused to waive res judicata. She explained that the log notes, which the appellant could have requested in time for the prior hearing, were not medical evidence that would conclusively impeach the original finding of a non-MIG injury.
The adjudicator added that the new medical report was not previously unavailable evidence that would challenge whether the original outcome was valid.
The adjudicator rejected the appellant’s argument that the insurer breached s. 38(9) of the Statutory Accident Benefits Schedule, O Reg 34/10 (SABS). The adjudicator noted that the insurer had notified the appellant that the MIG covered her injuries on Sept. 27, 2021, before the disputed treatment plans.
On appeal, the appellant alleged that the tribunal misapplied the relevant test in the circumstances, wrongly interpreted s. 38(9), and erred in failing to waive res judicata based on the new evidence.
The Ontario Divisional Court dismissed the appeal and ordered the appellant to pay the respondent insurer $7,500 in costs, as agreed.
First, the court affirmed the tribunal’s finding that res judicata applied despite the requirements of s. 38(9) of the SABS.
The court emphasized that the insurer notified the appellant of its opinion that her impairment fell within the MIG before the disputed treatment plans and confirmed this position when the appellant originally applied to the tribunal.
The court refused to interpret s. 38 of the SABS as requiring further notice from the insurer where the MIG benefits had been exhausted and the insurer had stuck to its position that the MIG covered the injuries.
Second, the court upheld the tribunal’s refusal to waive res judicata based on the proposed fresh evidence.
The court saw no error in the adjudicator’s conclusion that the log notes, which the appellant could have obtained before the original hearing, would not conclusively impeach that hearing’s outcome.
The court reiterated that the insurer notified the appellant that her injuries fell within the MIG limit, a position it pursued at the original hearing.
To explain why the log notes appeared to reflect that the injuries did not fall within the MIG, the court noted that the insurer:
The court then declined to interfere with the tribunal’s rejection of the medical report as a basis to waive res judicata. According to the court, while the medical examiner made a new diagnosis, they did not consider new, previously unavailable information.
