Case snapshot
At a glance
- Case
- Can an Insurer Deny Accident Benefits Because of WSIB in Ontario?
- Court / Tribunal
- ONLAT
- Citation
- 2026 CanLII 94500 ↗
- Date
- September 10, 2026
- Area of law
- Motor Vehicle Accident
- Key issue
- Whether an insurer can bar an injured person from claiming statutory accident benefits by asserting that the person is entitled to WSIB benefits, without a WSIB determination confirming that entitlement.
- Outcome
- The Licence Appeal Tribunal found the insurer had not met its burden of proving WSIB entitlement, and the injured person was permitted to proceed with his accident benefits application.
- Why it matters
- If you were hurt in a car accident while working, your insurer may try to redirect you to WSIB — but this decision confirms the insurer bears the burden of proving that WSIB actually applies before it can cut off your accident benefits.
Legal principle
The rule from this case
Under section 61(1) of the Statutory Accident Benefits Schedule, an insurer is not required to pay accident benefits to someone who is entitled to receive WSIB benefits. The key word is 'entitled' — the insurer must actually prove that entitlement exists. It is not enough for the insurer to raise the possibility that a person might be a worker covered by the WSIA. In this decision, the Tribunal confirmed that the burden of proof sits with the insurer, not the injured person. If the insurer cannot show, on a balance of probabilities, that the person was an employee of a Schedule 1 or Schedule 2 employer at the time of the accident, the section 61 bar does not apply. A letter from the alleged employer denying an employment relationship, combined with the absence of any formal WSIB determination, was enough to defeat the insurer's position.
Important limits
What this does not mean
This decision does not mean that working at the time of an accident automatically entitles someone to both WSIB and accident benefits. If an insurer can produce clear evidence — such as a WSIB decision confirming coverage — the section 61 bar may well apply and prevent an accident benefits claim from proceeding at the LAT. The ruling also does not resolve the question of whether the injured person was legally an employee or an independent contractor. The Tribunal was explicit that determining employment status is outside its jurisdiction — that question belongs to the Workplace Safety and Insurance Appeals Tribunal. This decision only establishes that the insurer failed to meet its evidentiary burden on the preliminary issue; the underlying employment question remains open in other forums.
Can an Insurer Force You to Claim WSIB Instead of Accident Benefits?
No — not without proof. An insurer can only redirect you to WSIB if it can demonstrate, on a balance of probabilities, that you are actually entitled to WSIB benefits. Simply asserting that you might have been working at the time of the accident is not enough.
This is the core finding in Aldiabat v. Co-operators General Insurance Company, 2026 CanLII 94500 (ON LAT) — a Licence Appeal Tribunal decision released in September 2026 that clarifies who carries the burden when an insurer invokes the WSIB bar under Ontario’s accident benefits rules.
What Is the Section 61 Bar and How Does It Work?
Section 61(1) of the Statutory Accident Benefits Schedule says an insurer does not have to pay accident benefits to someone who is entitled to WSIB benefits. The idea is that injured workers in covered industries receive no-fault compensation through WSIB in exchange for giving up the right to sue their employers.
But the bar only applies when WSIB entitlement actually exists. The Tribunal in this case confirmed that the onus falls on the insurer — not the injured person — to establish that entitlement. If the insurer cannot meet that burden, the accident benefits claim moves forward.
What Happened in This Case?
The injured person was struck by a vehicle while on foot in May 2025. He applied for accident benefits through his insurer. The insurer denied benefits, arguing he was working for a landscaping company at the time and should instead claim through WSIB.
The landscaping company’s owner provided written confirmation that the injured person was not an employee. The injured person described himself as an independent contractor who negotiated job prices for cash and used the company’s truck and workers to complete contracts. A WSIB records search later showed no application on file. Despite all of this, the insurer continued to deny accident benefits.
The Tribunal found the insurer had not established, on a balance of probabilities, that an employment relationship existed. Without that foundation, the WSIB bar under section 61 could not apply.
Does Working at the Time of an Accident Automatically Trigger WSIB?
No. Being on a job when an accident happens does not automatically mean WSIB applies and accident benefits are unavailable. Several conditions must be met: the person must be a worker, employed by a Schedule 1 or Schedule 2 employer under the WSIA, and injured in circumstances that give rise to WSIB entitlement.
Independent contractors are generally not covered by WSIB in the same way employees are. The distinction matters enormously. In this case, the evidence pointed away from an employment relationship, and the insurer could not fill that evidentiary gap.
What If There Is a Genuine Dispute About Employment Status?
The LAT cannot decide whether someone is an employee or an independent contractor — that determination belongs to the Workplace Safety and Insurance Appeals Tribunal. What the LAT can do is assess whether the insurer has met its burden of proving WSIB entitlement on the evidence before it.
If no WSIB decision has been made and the evidence is ambiguous or contradicted, the insurer cannot simply assert that the bar applies and walk away from its accident benefits obligations. The Tribunal in this case was clear: unresolved employment status questions do not automatically favour the insurer.
What About Procedural Fairness at the LAT?
The decision also addressed a procedural dispute worth noting. The insurer filed written submissions that exceeded the page limits set out in the case conference order. When reformatted to the required double-spacing, the submissions were 16 pages instead of the permitted 10.
The Tribunal refused to consider the excess pages and declined to allow the insurer to re-file a compliant version. The reasoning was straightforward: parties are expected to put their best case forward within the rules, and non-compliance that advantages one side creates real prejudice to the other. Procedural orders at the LAT are not suggestions — they carry weight, and failing to follow them can cost you arguments.
Questions and Records to Discuss with a Lawyer
- Do you have documentation of your working relationship at the time of the accident — such as contracts, invoices, or communications with the person or company who hired you?
- Has WSIB formally accepted or rejected your claim, or has no determination been made at all?
- Has your insurer provided written reasons explaining why it believes section 61 applies to your situation?
- Were you struck by a third party who is unconnected to your employer or worksite — and has the insurer explained why that matters to your accident benefits claim?
- Are there deadlines in your denial letters or case conference orders that you may need to respond to?
Our Ontario motor vehicle accident lawyers regularly assist people navigating disputes between accident benefits and WSIB coverage. If your insurer has denied benefits on the basis that WSIB applies, understanding who carries the burden of proof can make a significant difference to your claim. You can also learn more about accident benefits in Ontario and how these disputes are handled at the LAT.
If you have questions about your own situation, you are welcome to reach out to UL Lawyers through /connect to discuss the specifics of your circumstances.
This article is automated commentary on a public court decision and is for general information only — not legal advice. Decisions rely on facts unique to each case. If you are affected by a similar issue, contact a lawyer for advice specific to your situation.
FAQ
Frequently asked questions
The insurer bears the burden of proving that you are entitled to WSIB benefits before it can use that as a reason to deny accident benefits. You do not have to disprove WSIB entitlement on your own.
Generally no, but there is a limited exception if you elect to pursue a tort action against a third party rather than claim WSIB benefits, and that election was not made primarily to access accident benefits. The rules are fact-specific and the timing of your election matters.
The absence of a WSIB determination or record can weigh against the insurer's position at the LAT. Without evidence that WSIB has actually accepted your claim, the insurer may struggle to prove that the accident benefits bar applies to you.