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Forms - Evidence-Gathering Role. Huynh v. Security National [admin evidence-gathering problems]
In Huynh v. Security National (Div Ct, 2026) the Divisional Court (usefully?) considers the essential role of form 'design' and that of administrative evidence-gathering by forms, and IMHO reflects the injustice that often results in a populace not familiar with the legal culture in this (and too many other) administrative legal fields:[14] .... 4. Pursuant to this mandate, the SABS provides standardized forms for a claimant’s medical practitioner to complete to establish the claimant’s injuries and potential entitlement to benefits: SABS, s. 36.
[15] In this case, the appellant’s chiropractor filled out the Disability Certificate form, which is called an OCF-3. The form requires the health practitioner to answer various questions using “yes,” “no,” or “N/A” tick boxes, with some requests for further explanation. The form was submitted to the respondent, which denied benefits, but not because it was dissatisfied with the medical evidence. The insurer is not required to accept the information in the forms at face value, but in this case the insurer did not deny benefits because of insufficient information. The insurer instead denied the benefits because it said there was no qualifying accident. Before the Tribunal, the insurer’s position rested entirely on its submission that the appellant had not suffered an accident within the meaning of the SABS.
[16] The question, therefore, is whether the adjudicator was required to treat the appellant’s evidence as sufficient in the circumstances of this case. I conclude she was not. It is within the discretion of the adjudicator to weigh the evidence and determine whether the applicant has met his burden of proof. As Lococo J. stated in Dooman v. TD Insurance Co., 2025 ONSC 184 (Div. Ct.), at para. 36:The Tribunal was free to accept all, none, or some of the hearing evidence, including any expert evidence. While a trier of fact is obliged to consider all the evidence before it, it [is] not required to accept all of a medical expert’s evidence merely because there is no contrary expert testimony tendered on behalf of the other party. [17] Regardless of the insurer’s position, the appellant was required to demonstrate to the Tribunal that he met the legal test for receiving income replacement benefits. As the adjudicator states, that test arises from s. 5(1) of the SABS and requires the applicant to demonstrate that, within 104 weeks of the accident, they suffered a substantial inability to perform the essential tasks of their employment. At para. 37 of her initial reasons, the adjudicator states: “The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them.”
[18] Even if an adjudicator may be required, in some circumstances, to accept the OCF-3 and other forms as sufficient evidence (which I do not need to decide), she was not required to do so here. The OCF-3 was completed only by ticking boxes and without providing any extra detail in any “please explain” boxes. Although the chiropractor wrote in several places “See GP notes” or “as per GP,” no GP notes were attached. The appellant also attended an insurer’s examination where he stated he could not lift anything heavy, but he did not provide any details of the essential tasks of his employment and the degree to which he was unable to perform them. Further, with respect to the appellant’s claim for payment for specific treatment plans, he failed to submit the statutory forms (OCF-18s) to the adjudicator at all.
[19] Another way the appellant articulated the argument about his evidence was that the Tribunal breached procedural fairness by dismissing his claim for benefits, even though the insurer had not taken issue with his evidence. I do not find this submission persuasive. The Tribunal held a case conference with the parties before the in-writing hearing was scheduled. The case conference report and order specified that the hearing would include the determination of the preliminary issue as to whether the appellant was involved in an “accident,” but also the substantive issues regarding his entitlement to benefits. It listed, as issues to be decided, each of the benefits he claimed. It also provided a list of documents the appellant had to provide the respondent, which included, for example, clinical notes from all treating physicians, hospital records, his updated OHIP records, and his records from his family doctor. The appellant, therefore, was aware that, despite the insurer’s position, the adjudicator would be determining the benefit entitlement issues and expected a detailed medical record.
[20] In the end, there was no legal error in the adjudicator’s finding that the appellant had failed to meet his burden of proof. This ground of appeal is dismissed.
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