In Wilson v. Intact Insurance Company (2025 ONSC 5305), the Divisional Court clarifies the boundaries of Licence Appeal Tribunal (“LAT”) adjudicators’ discretion in assessing expert evidence and the standard for providing adequate reasons that support the LAT’s truth-seeking function.
The underlying decisions
Following a motor vehicle collision on August 17, 2016, Nadine Wilson filed an application to dispute Intact Insurance Company’s denial of her claim for catastrophic impairment benefits.
During the initial 11-day hearing, Ms. Wilson tendered expert evidence to advance her claim that she was catastrophically impaired under criteria 6, 7, and 8 of the American Medical Association’s Guides to Evaluation of Permanent Impairment (“AMA Guides”).
Specifically, under Criterion 6, the applicant’s expert assessed her at 65% whole person impairment (WPI), which exceeds the 55% threshold. Additionally, the applicant’s expert rated Ms. Wilson at 78% WPI under Criterion 7 and found “marked impairments” in three (3) categories thereby supporting a finding of catastrophic impairment under Criterion 8. However, Adjudicator Harry Adamidis (the “Adjudicator”) discounted the applicant’s expert evidence and assessed Ms. Wilson at 36% WPI under Criterion 6, 48% WPI under Criterion 7, and found one (1) marked impairment under Criterion 8. Notably, the Adjudicator assigned 0% impairment for the Applicant’s reported intermittent double vision, peripheral neuropathy, and medication-related side effects. Accordingly, the Adjudicator held that Ms. Wilson did not suffer a catastrophic impairment and dismissed her application. Ms. Wilson’s subsequent request for reconsideration was denied. Ms. Wilson then sought relief under both a statutory right of appeal and judicial review.
While the Divisional Court ultimately found there was no breach of procedural fairness to warrant setting aside the Adjudicator’s decision, the Court held that the Adjudicator made unreasonable factual findings regarding Ms. Wilson’s claims of (a) double vision (diplopia), (b) peripheral neuropathy, and (c) medication-related side effects.
The Adjudicator’s unreasonable factual findings
Double vision (diplopia)
The Court held that the Adjudicator unreasonably discounted the Applicant’s optometrist expert’s finding of 24% impairment for intermittent double vision to 0%. Intact’s expert assessed the Applicant’s double vision at 0% simply because he did not observe it during the assessment. Despite other confirmatory evidence beyond the Applicant’s expert report, including the Applicant’s own testimony, the Adjudicator accepted Intact’s expert evidence. The Court acknowledged that adjudicators can prefer one expert’s evidence over another; however, where such evidence is supported by objective tests, it cannot be summarily dismissed without clear reasons. The Court held that the Adjudicator’s assessment was unreasonable because he failed to provide adequate reasons for preferring Intact’s expert evidence, particularly when the expert did not observe the issue, which was characterized as intermittent. Further, the Court noted that the Adjudicator’s interpretation of the AMA Guides was “unduly rigid.”
Peripheral Neuropathy
The Court held that it was both “unreasonable” and “untenable” for the Adjudicator to assign a 0% impairment rating for peripheral neuropathy. Both parties agreed that Ms. Wilson was to be assessed at 11%. However, Intact’s expert report cited the incorrect table and pages in the AMA Guides. The Adjudicator relied on this typographical error to discount the expert evidence entirely. The Court found that the Adjudicator’s refusal to correct this oversight, particularly during the reconsideration process, constitutes a failure to perform the LAT’s truth-seeking function.
Medication-related side effects
In the initial decision, the Adjudicator dismissed the expert’s assessment as incomplete for failing to specify whether the medications masked impairments resulting from the collision rather than causing further side effects. On reconsideration, the Adjudicator once again dismissed the expert’s evidence, this time citing counsel’s failure to direct him to it during closing submissions. The Court adamantly rejected these reasons emphasizing an adjudicator’s obligation to consider the evidence in its entirety. While the Court acknowledged that such an error is “understandable” at first instance, to make no effort to correct the oversight on reconsideration undermines the process’ purpose. The reconsideration process provides a mechanism to correct errors. However, it is fundamentally concerned with reaching a fair resolution for the parties; it is not focused critiquing adjudicators’ decisions.
Conclusion
The Court quashed the Adjudicator’s decision and ordered a new hearing before a different adjudicator. This decision underscores the scope of adjudicators’ discretion, their duty to fairly consider the entirety of the evidence, and the necessity of adequate reasons to support the LAT’s truth-seeking function. Ultimately, Wilson v Intact confirms that the pursuit of administrative efficiency must not come at the expense of reason and fairness.
Isabel Cox is the author of this blog and a member of the firm’s LAT practice group. If you have a question about this decision or a similar file, please contact Isabel at 416-777-2811 ext. 5221
