Introduction

In May 2026, a Certas decision produced a strange result. The applicant lost the catastrophic impairment issue. His injuries did not meet the CAT definition, and his attendant care claim was dismissed. He still walked away with $55,000 in special awards: 25 percent of $61,000 in treatment plans and 25 percent of $159,000 in income replacement benefits.

That is what section 10 of Regulation 664 does. It does not ask who was right about the injury. It asks how the insurer ran the file. When the answer is conduct that is excessive, imprudent, stubborn, inflexible, unyielding or immoderate, the Tribunal orders a lump sum of up to 50 percent of the benefits withheld, plus special award interest that compounds at 2 percent per month until payment.

In 2026, that happened 12 times in published ON LAT decisions, from $440 to $55,000. The files that produced those awards are the same files that drive the denial and invoicing disputes covered in our roundup of 2026 LAT decisions affecting HCAI invoicing: defective denial letters, ignored assessments, and unreasoned reductions.

Here are the 12 awards, the conduct that triggered them, and how your clinic builds a file that is positioned for one.

The Law in One Paragraph

Section 10 of Reg. 664 says that if the Tribunal finds an insurer unreasonably withheld or delayed payments, it may award a lump sum of up to 50 percent of the amount the insured person was entitled to, in addition to the benefits and interest. The test is conduct, not outcome. The insurer must have acted in a way that can be described as excessive, imprudent, stubborn, inflexible, unyielding or immoderate.

The quantum follows seven factors, set out in a Commonwell decision: (1) the blameworthiness of the insurer's conduct, (2) the applicant's vulnerability, (3) the harm or potential harm caused, (4) the need for deterrence, (5) any advantage wrongfully gained, (6) other penalties already or likely imposed, and (7) the overall length of the delay.

The 12 Awards of 2026

| Case | Award | What Triggered It | |------|-------|-------------------| | Certas decision | $55,000 (25% x 2) | Withholding $61K of plans and $159K of IRBs | | Peel Mutual decision | $13,777.31 (40%) | Arguing the 260-week defence a year after conceding it | | Onlia decision | $13,019.34 (15%) | Unreasonable withholding of approved plans and ACBs | | Allstate decision | $7,336.27 (50% x 3) | Unreasoned denials of three treatment plans | | Economical decision | $2,913.08 (50%) | Unreasonable denial of OCF-6s | | RR v TD General | $9,898.37 (25% + 18%) | ACBs withheld at 25%, Guardianship Application at 18% | | Belair decision | $1,511.68 (25%) | Withheld balances on approved OT and psych plans | | Intact decision | $1,423.00 (10% + 5%) | Psych file at 10%, chiropractic file at 5% | | Security National psych assessment | $550.00 (25%) | Inflexible denial of a $2,200 psych assessment | | Security National IRB decision | 10% of IRBs | Withholding $400/week IRBs without reassessment | | Commonwell decision | $440.00 (10%) | Keeping a claimant in the MIG after the evidence said out | | TD General decision | 15% + $1,000 costs | Maintained plan denials, benchmarked against the Allstate decision |

The percentages cluster at 10 to 25 percent. Two cases reached the 50 percent maximum: the Allstate and Economical decisions. Three cases layered costs or split percentages across benefit types.

What Separates a Win from a Denial

For every award ordered in 2026, roughly three s. 10 claims were denied. The pattern is consistent, and it is good news for clinics that document well.

The merits are not the test. The Certas decision is the proof: the applicant lost the CAT issue and still collected $55,000 because the insurer's withholding was the problem, not the diagnosis. The inverse is also true. Most 2026 denials happened on files where no benefits were owing at all, so there was nothing withheld to penalize.

A defective denial letter alone is not enough. The case law applied in the Peel Mutual decision says an award does not follow automatically from a section 38(8) violation. The insurer's overall conduct must cross the threshold. But the Peel Mutual decision shows the flip side: a defective denial, paired with a timeline of aggravating conduct, funded one of the largest awards of the year.

The winning files had a timeline. In the Peel Mutual decision, the insurer confirmed in August 2024 that the policy was not subject to the 260-week period, then ran that argument at the August 2025 hearing anyway. The adjudicator found the conduct excessive, imprudent, stubborn, inflexible, unyielding and immoderate, and ordered 40 percent. In the Commonwell decision, the timeline was the months the applicant sat in the MIG after removal was warranted. In the Security National psych assessment decision, it was the insurer's inflexible treatment of a psychological assessment the treating team endorsed, the same kind of assessment evidence that decides validity testing disputes at the LAT.

The practical lesson: the award is won in the chronology. The amounts withheld in these files are the same amounts disputed in ordinary billing battles, the kind covered in our guide to billing above guideline rates. What turns a billing dispute into a special award is the documented pattern of how the insurer withheld them.

The Second Award: Interest on the Award Itself

Three 2026 reconsiderations settled the interest question that had been quietly building. The issue was whether the 2 percent monthly special award interest runs on the lump sum itself, or only on the underlying benefits.

The answer emerging from those decisions is that interest under s. 10 accrues on all amounts owing, including the award, until it is paid. A Security National decision set out the formula: A (the benefits withheld) plus B (s. 51 interest) plus C (compound special award interest on everything owing, including the lump sum).

For clinics, this changes the math. A $13,019.34 award with 2 percent monthly interest compounding is not $13,019.34. Every s. 10 submission should claim interest on the award itself, not just interest on the benefits.

The Clinic Playbook

For Clinic Directors and Billing Administrators

1. Keep a conduct log. Date, document, and action for every insurer interaction: denial letters, EOB reductions, section 44 requests, settlement positions, and concessions the insurer later walked back. The Peel Mutual and TD General files were won on exactly this record.

2. Raise the award early and particularize it. Several 2026 claims died on procedure because the award was never properly put in dispute. In a Security National decision, the award was not before the adjudicator because no particulars had been provided in advance of the hearing. The same procedural trap appears across the 2026 batches and is covered in our breakdown of the files that fail on procedure. Raise s. 10 at the case conference and file the particulars.

3. Anchor the request. Cite the Allstate decision for the 50 percent benchmark, the Certas decision for scale, and the seven factors for structure. Adjudicators in 2026 consistently engaged with anchored submissions and dismissed bare requests for the maximum.

For Assessors and Treating Practitioners

1. Document what the insurer ignored. The Security National psych assessment decision turned on a psychological assessment the insurer denied inflexibly. Your report, plus the insurer's response to it, is the evidence of blameworthiness.

2. Quantify the harm of the delay. The factors reward concrete harm: treatment forgone, deterioration, out of pocket costs. A clinical note that says what the delay cost the patient is worth more than a general complaint.

Conclusion

Section 10 is the one remedy that punishes how the insurer ran the file rather than whether the treatment plan was ultimately right. In 2026, the Tribunal used it 12 times, from $440 to $55,000, and the winners all shared the same asset: a documented timeline of insurer conduct that crossed the line into excessive, imprudent, stubborn, inflexible, unyielding or immoderate.

For the clinic, the special award is not a lottery. It is the product of the same discipline that wins billing disputes: keep the file, log the conduct, and claim the award early with particulars. The next time a denial letter arrives without reasons, that letter is not just a billing problem. It is the first entry in a conduct log that can end in a s. 10 award.