Intact bars most of accident benefits claim over missed insurer examinations

The insurer scheduled three exams - proving it sent all three was another matter

In a preliminary decision released July 6, 2026, Vice-Chair Trina Morissette ruled the applicant was statute-barred from disputing most of his denied benefits because he skipped two properly scheduled insurer examinations and gave no reasonable explanation for missing them. The dispute began with a February 12, 2024 automobile accident. The claimant first sought benefits from Definity/Economical Insurance Company, which denied the nine treatment plans at issue.

On July 18, 2024, Intact Insurance Company accepted priority of the claim and maintained those denials before the applicant took the fight to the tribunal. As a preliminary matter, Intact argued the claimant should be blocked from proceeding at all because he had failed to attend three insurer examinations under section 44 of the Schedule - a physician assessment set for February 17, 2026, a psychological assessment for February 27, and a neurological assessment for March 2. Section 44 lets an insurer require an insured person to be examined by regulated health professionals.

Under section 55, an insured cannot apply to the tribunal if the insurer has given proper notice of a section 44 exam and the insured has not complied. The onus sits with the claimant to explain any non-attendance. The applicant did not dispute missing the exams or the validity of the notices.

He argued instead that no exams had been scheduled when he first filed, that a clinic letter gave no explanation of the benefits being addressed, and that he never received formal notice of the March 2 neurological exam. Morissette rejected the first two arguments. She found the notices for the February 17 and 27 exams met every requirement of section 44(5): they identified the treatment plans, required the applicant's attendance, set out dates, times and locations, named the assessors and their designations, offered transportation and interpreter accommodations, and gave medical reasons tied to the Minor Injury Guideline.

With no reasonable explanation for missing them, the applicant was statute-barred from disputing whether his injuries were predominantly minor and from pursuing the related plans - five physiotherapy plans, a psychological services plan of $4,204.32, and a $2,486.00 attendant care assessment. The neurological exam was different. Intact produced a letter it said was emailed to the applicant and his representative, but no copy of the email itself.

"Without proof of service," Morissette wrote, she could not find the notice had been properly delivered. That gap let a $1,700.00 shockwave therapy plan and a $2,486.00 neurological assessment survive, alongside the claimant's claims for an award under section 10 of Regulation 664 and interest. The tribunal also noted the Minor Injury Guideline's $3,500.00 limit had not been exhausted, with $600.00 remaining as of the case conference date.

The surviving issues head to a written hearing scheduled for September 4, 2026.