Traders General Insurance Company v. Rumball
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The Facts
Shelley Rumball was in a collision on December 28, 2014. She worked as an educational assistant and had recently started a wedding-planning business. She went back to her school job in February 2015 but stopped at the end of May, saying that she could not manage the lifting. A Licence Appeal Tribunal adjudicator awarded income replacement benefits for the first two years, to the end of December 2016, because she could not carry out the core duties of her own job. The adjudicator refused them after that point, finding she had not shown a complete inability to do any suitable work and that wedding planning was suitable. The Divisional Court dismissed her appeal. She was granted leave to appeal on one narrow question: the proper meaning of the post-104-week test in the Statutory Accident Benefits Schedule.
What the Court Decided
Justice Wilson, for the panel, dismissed the appeal. The test in the Schedule asks whether, because of the accident, the person has a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience. The Court held that this is an evidence-driven question decided on everything before the decision maker. The relevant factors include whether alternative work exists in a real, competitive setting and how it compares in nature, status and pay. The Court rejected the insured's argument that those items are separate requirements and that the insurer carries the burden on them, and it equally rejected the insurer's suggestion that they could be ignored. It also confirmed that the person claiming benefits has the burden of proving entitlement. On this record, the adjudicator had applied the right test: the medical evidence was dated, the experts had not taken a work history, no vocational expert had been called, and the finding that wedding planning was suitable was open on the evidence. The appeal was dismissed with $7,000 in costs to the insurer.
Thousands of injured workers reach the 104-week mark each year. This decision sets out in plain terms what is considered and who has to prove it, which affects how evidence should be gathered well before the deadline arrives.
“These factors are not stand-alone components of the test”— Traders General Insurance Company v. Rumball, 2025 ONCA 656, at para. 42
Does This Affect You?
- ✓You are approaching the two-year mark of income replacement benefits and your insurer says you can do some other kind of work.
- ✓Your pre-accident job was specialized or well paid, and any alternative work would be very different in status or income.
- ✓You have medical reports but no vocational or work-history evidence about what jobs you could realistically do.
Key Takeaways
- After 104 weeks the question is not whether you can return to your old job; it is whether you are completely unable to do any job you are suited for.
- Pay, status and real-world availability of alternative work must be considered, but they are factors in the overall evidence, not extra boxes to tick.
- The injured person has to prove the claim, so up-to-date medical evidence, a full work history and, where appropriate, vocational evidence can decide the outcome.