What happened: An Ontario tribunal ordered Aviva to fund most of a chronic pain assessment but backed it on report fees.
Who's involved: Aviva Insurance Company of Canada and a claimant hurt in a 2021 car accident.
What's at stake: $2,486 awarded on a $2,855.50 assessment plan; two $448.83 progress-report charges denied.
Why it matters: Assessment plans are judged on the file as it stood when they were submitted.
Where it stands: Ontario's Licence Appeal Tribunal released its decision on September 24, 2026.
His x-ray showed "no explanation" for his shoulder pain. For an Ontario tribunal, that was one more reason to fund a closer look.
In a decision released September 24, 2026, the Licence Appeal Tribunal ordered Aviva Insurance Company of Canada to pay $2,486 toward a $2,855.50 chronic pain assessment plan.
Aviva did score a win on the same file. It beat back two charges for psychological progress reports.
The claimant was hurt in a car accident on November 12, 2021. Three days later, he was at an emergency department with back pain. His shoulder started hurting a few days after that, he said.
He kept raising shoulder pain with his family doctor from December 2021 through August 2023, and said it was worst when he slept.
His psychologist wrote in August 2022 that he "met the clinical definition of chronic pain," and recommended an assessment.
By August 2023, his doctor was calling the pain chronic. With the x-ray coming up empty, she referred him to a sports medicine specialist.
Aviva leaned on its own medical examiner, who said the assessment wasn't reasonable or necessary. He saw "no objective sign of an ongoing accident-related musculoskeletal impairment."
The tribunal noticed something else in that same exam. The examiner had recorded tenderness in the claimant's lower back and right shoulder, and the claimant reported pain in both spots.
Aviva also argued the claimant didn't complain about his right shoulder in 2024 or 2025. The tribunal set that aside.
What counted was the picture on June 6, 2023, when the plan was submitted. An assessment only has to clear what the tribunal called "the low bar": enough reason to think a condition exists and is worth checking out.
One small line didn't make it. A $150 transportation charge was listed "if required," and no evidence showed it was, so it was cut along with its tax.
On the psychology side, Aviva approved most of two treatment plans from February and October 2023. It refused $448.83 in each for a progress report.
The claimant said the Professional Services Guideline, published by the Financial Services Commission of Ontario, meant those reports had to be funded. Aviva said the guideline is a fee schedule, and noted it never asked for a report.
The tribunal agreed with Aviva. The guideline "merely sets out the fees for services," it said, and the claimant had shown no evidence a report was needed.
Aviva will also owe interest on any overdue amounts.
Adjusters can expect an assessment plan to be judged on the medical file as it stood when the plan arrived, and providers will need more than the fee guideline to get a progress report paid.
The decision reflects only the evidence and submissions before the tribunal in this proceeding.
