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A recent LAT decision reaffirms the insurer's obligation to provide timely benefits despite concerns over priority. Where claimants satisfy the low threshold of establishing a nexus with an insurer, that insurer must commence adjusting the claim and dispute priority later.
Wilson v Coachman Insurance Company, 2026 CanLII 4142 (ON LAT)
https://www.canlii.org/en/on/onlat/doc/2026/2026canlii4142/2026canlii4142.html
In a recent reconsideration decision, Wilson v. Coachman (2026), the Licence Appeal Tribunal reaffirmed a foundational principle of Ontario's accident benefits regime: the first insurer to receive a completed OCF-1 is responsible for paying benefits pending resolution of any dispute regarding which insurer is responsible for payment under section 268 of the Insurance Act. An insurer cannot refuse to pay a benefit simply because it believes another insurer is higher in priority.
The SABS Priority Scheme
Section 268 of the Insurance Act and Ontario Regulation 283/95 establish the legislative framework to determine which insurer bears responsibility to pay statutory accident benefits, i.e. which insurer has priority.
Section 2 of the Regulation explicitly provides that the first insurer to receive a completed application for benefits must pay benefits pending the resolution of any dispute regarding priority. An injured person must receive benefits promptly and should not be prejudiced by any dispute between insurers.
The LAT Decisions
The claimant was injured as a pedestrian and filed an application for accident benefits with the alleged insurer of the at-fault driver. The insurer took the position that the at-fault driver's policy had expired several months before the accident. As such, the insurer denied the claim on that basis.
The matter proceeded to a written hearing and the Adjudicator held that the claimant was entitled to benefits. The Adjudicator affirmed that she had jurisdiction to adjudicate entitlement to accident benefits but not priority. She found the claimant had established a clear nexus between himself and the insurer. The claimant had been advised that the at-fault driver had insurance with the insurer and there was no reason for him to question this information. The Adjudicator found that whether or not this information was proven to be incorrect was not the responsibility of the claimant. If the insurer subsequently determined that there was an issue with the policy, it was required to commence a priority dispute. In the meantime, the insurer was required to adjust the claim once it received the completed application.
On reconsideration, the insurer argued that the Adjudicator had acted outside her jurisdiction when determining the claimant's entitlement to benefits on the basis that she, in effect, decided the parties' priority dispute. However, the Vice-Chair disagreed noting that the Adjudicator had focused on the core question of entitlement to benefits, which was squarely within her jurisdiction. The evidence at the hearing established that there was a sufficient nexus between the claimant and the insurer, such that the insurer was obligated to adjust the claim and later dispute priority. The Adjudicator did not make a finding on priority. Rather, she concluded that the insurer had an obligation under the Regulation to respond to and adjust the claimant's application.
Why This Matters
This decision serves as an important reminder to insurers. The statutory accident benefits scheme and priority regulation act together to ensure that injured persons can receive timely benefits without being prejudiced by potential disputes between insurers.
The nexus test has a low threshold. An insurer's obligation to pay is triggered so long as there is some connection between a claimant and the insurer. An insurer cannot outright refuse to adjust a claim on the basis of potential higher priority insurers. An insurer who receives a completed application must commence adjusting the file and later seek to pursue priority. This holding flows in lockstep with the consumer-protection principle embedded within the SABS and the priority regulation.
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