Tribunal Overturns Intact's Catastrophic Impairment Ruling Over Unsourced Definition
A Canadian tribunal has sided with a claimant against Intact Insurance after finding that the insurer's denial of catastrophic impairment status relied on a medical definition that lacked proper attribution. The decision underscores how insurers must meet evidentiary standards when challenging or applying impairment thresholds under auto insurance policies.
What happened
A provincial tribunal has overturned Intact Insurance's determination that a claimant did not qualify for the catastrophic impairment designation under their auto policy. The ruling hinged on the insurer's reliance on a medical definition that was not properly sourced or attributed, weakening the basis for denying the enhanced benefits.
What it means for consumers
Claimants whose catastrophic impairment applications are denied should expect that insurers must now produce clearly sourced, attributable medical frameworks when disputing impairment thresholds. This decision reinforces that insurers cannot rely on unattributed or generic definitions to override a claimant's medical evidence, giving policyholders a stronger footing when appealing denials.
What it means for premiums
No direct premium change has been announced.
Coverage considerations
The catastrophic impairment designation typically unlocks significantly higher benefit limits, including enhanced medical, rehabilitation, and attendant care coverage, compared to standard accident benefits. For consumers in jurisdictions with statutory accident benefits schedules (such as Ontario's SABS), this ruling highlights that the path to qualifying for those enhanced limits depends heavily on the quality and sourcing of the medical evidence insurers use to evaluate claims. Insurers may need to tighten internal processes for how impairment definitions are documented and cited in future claim decisions.