Aviva has defeated a bid to exceed Ontario's minor injury cap, after a tribunal found a psychotherapist's diagnosis fell outside her scope of practice.
The Ontario Licence Appeal Tribunal dismissed the accident benefits claim, keeping the claimant within the $3,500 Minor Injury Guideline (MIG) funding limit.
The applicant was injured in an automobile accident on June 6, 2023, and sought statutory accident benefits under the Statutory Accident Benefits Schedule. Aviva denied the benefits, and the applicant asked the Tribunal to be removed from the MIG on the basis of a psychological injury and chronic pain.
For claims professionals, the decision turned on evidence quality and scope of practice. The applicant relied on a section 25 psychological assessment that diagnosed adjustment disorder with mixed anxiety and depressed mood, and a specific phobia at a moderate-to-severe level. The report was prepared by a registered psychotherapist under the supervision of a psychologist.
The adjudicator placed less weight on that report. She found it unclear who actually made the diagnosis, noting the psychotherapist appeared to have taken the lead role - yet making such a diagnosis fell outside a registered psychotherapist's scope of practice. Because the report was signed by both practitioners without stating who diagnosed the applicant, she said she was unable to assess who made the call.
Aviva relied on a section 44 insurer's examination by a psychologist, who concluded the applicant did not present with an accident-related psychological condition meeting the threshold. The adjudicator also found that a chiropractor who recorded the applicant's reported anxiety was not qualified to diagnose psychological impairments.
Absent corroborating medical evidence, the Tribunal found the applicant had not established an accident-related psychological impairment warranting removal from the MIG.
On chronic pain, the applicant pointed to a disability certificate diagnosing multiple sprains and strains. The Tribunal found most of those conditions appeared to be minor injuries on their face. Ultrasound imaging of the right shoulder revealed mild tendinosis and bursitis, and a follow-up scan showed "a degenerative condition that is not related to the accident." Clinical records recorded pain at 5 to 6 out of 10 but made no reference to chronic pain.
The Tribunal also found no functional impairment. The applicant had returned to full-time work immediately after the accident and resumed the majority of his housekeeping chores.
The decision restated the governing framework. Section 18(1) of the Schedule limits medical and rehabilitation benefits to $3,500 where impairments are predominantly minor, and section 3(1) defines a minor injury as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation, including clinically associated sequelae. The burden of establishing removal from the MIG rests with the applicant, and the parties agreed the MIG limits had been exhausted.
The adjudicator found the applicant had not met that burden on either ground and dismissed the application on June 22, 2026. Because no payments were owing, no interest was due.
