Belair Insurance has defeated a claimant's bid to escape Ontario's $3,500 minor injury cap and secure a non-earner benefit.
The claimant was injured on August 17, 2023, when another vehicle merged into his lane and struck the driver's side of his car. He sought statutory accident benefits from Belair, which determined his injuries were predominantly minor and limited his treatment to the Minor Injury Guideline's $3,500 funding cap. Belair denied three physiotherapy treatment plans proposed by his rehabilitation clinic, together worth $5,930.47, a $2,200 chronic pain assessment, and a non-earner benefit of $185 per week. The claimant took the dispute to the Licence Appeal Tribunal - Automobile Accident Benefits Service, seeking those benefits along with interest on any overdue payment.
To escape the MIG, the claimant argued he suffered accident-related chronic pain, panic attacks and pre-existing conditions warranting removal from the cap. He relied on a chronic pain assessment from a specialist who diagnosed him with chronic pain syndrome more than a year after the crash. Adjudicator Ulana Pahuta gave that report limited weight, finding it conflicted with the claimant's own family doctor's clinical notes, which described him as “in much better health in the past year than in previous years” and recorded his neck and back pain as no longer bothering him.
The tribunal reached similar conclusions on the claimant's psychological complaints and pre-existing medical history. It found no evidence linking his panic attacks to the accident, tracing them instead to episodes of claustrophobia during an MRI and in a tunnel. It also found no health-practitioner opinion showing his pre-existing conditions would prevent his recovery within the MIG limit.
On the non-earner benefit, the tribunal found the claimant had not shown a complete inability to carry on a normal life. He had given limited evidence of his pre-accident activities or how the accident changed them, and the tribunal noted he continued to complete many of the same activities after the crash.
The decision also addressed a procedural dispute over two insurer's examination reports Belair served after the deadlines set out in the case conference order. The tribunal admitted the reports anyway, finding the claimant had not shown he was prejudiced by the delay and that he still received them more than a month before his written submissions were due.
With the MIG finding upheld and no benefits found overdue, the tribunal ordered no interest payable and dismissed the application in full.
