Wilson v. Intact Insurance Company
This page is a summary and commentary on a publicly available court decision, written for general informational and educational purposes only. It is not legal advice and does not create a lawyer-client relationship with Azimi Law, regardless of how specific or applicable it may seem to your situation.
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The Facts
A collision on August 17, 2016 left Nadine Wilson injured, and she claimed catastrophic impairment from Intact Insurance. After an 11-day hearing, the Tribunal decided in November 2024 that she was not catastrophically impaired, and it refused reconsideration in March 2025. Her experts had put her at 65% whole person impairment on the physical criterion (Criterion 6), 78% when mental and behavioural impairments were combined (Criterion 7), and marked impairment in three functional areas (Criterion 8). The thresholds are 55% for the first two, and three marked areas, or one extreme area, for the third. The adjudicator assessed 36%, 48% and a single marked area. Missing the designation also meant losing the attendant care, housekeeping and treatment claims that depended on it, which the Tribunal never reached. She appealed on questions of law and applied for judicial review.
What the Court Decided
Justice Molloy, for a three-judge panel, found no breach of procedural fairness and held that the reasons were generally adequate. The court nevertheless found three Criterion 6 findings unreasonable. First, double vision: her optometrist had objective test results and rated it at 24%, while the insurer's expert, who had not seen those results, rated it at nothing because it was not seen on the day. The adjudicator accepted zero without explaining why, never made a credibility finding on her own evidence, and ignored a further assessor's report; the court also called the approach to the AMA Guides unduly rigid. Second, neuropathy in the arms: both sides accepted about 11%, but the insurer's neurologist cited the wrong table in the Guides, and the adjudicator gave zero because of that slip. Third, medications: two doctors rated 2%, yet the adjudicator overlooked one doctor's testimony and, on reconsideration, declined to correct that because counsel had not pointed to it. The court held that reconsideration exists to fix such oversights. It left the equilibrium and Criterion 8 findings alone, as matters of weighing evidence, but declined to declare her catastrophically impaired itself because fact-finding and the resulting benefits belong at the Tribunal. Both decisions were quashed, the whole matter is to be heard again, and Intact was ordered to pay $7,500 in costs.
Catastrophic impairment often turns on percentage ratings assigned to individual conditions. This decision confirms that a tribunal cannot reduce a rating to zero over a technical slip in a report, or by disregarding evidence that strongly points the other way, and that a reconsideration request is meant to correct such oversights. It does not change the criteria or lower any threshold.
“A trier of fact has an obligation to consider the whole of the evidence in reaching a conclusion.”— Wilson v. Intact Insurance Company, 2025 ONSC 5305, para. 40
Does This Affect You?
- ✓You were told you are not catastrophically impaired even though your own specialists rate you above the thresholds.
- ✓An insurer's expert did not observe a symptom, such as intermittent double vision, that your treating team documented with testing.
- ✓The Tribunal gave no weight to an impairment rating because of a clerical or citation error in a medical report.
Key Takeaways
- A tribunal may prefer one expert over another, but it needs logical reasons, especially where most of the evidence points the other way.
- An intermittent symptom that is supported by objective testing and by other assessors cannot simply be discounted because one examiner did not see it.
- Point the Tribunal directly to the evidence you rely on at the hearing, and use reconsideration promptly if something was missed.