An Ontario tribunal kept a claimant's injuries capped under the Minor Injury Guideline, then refused to even hear his bid for a special award.
The claimant was hurt on May 25, 2020, when he could not avoid a vehicle turning left in front of him. Certas Home and Auto Insurance Company approved treatment within the $3,500 Minor Injury Guideline limit, then denied a further physiotherapy plan worth $3,447.20 submitted on April 9, 2025, finding his injuries predominantly minor.
Three issues were before the tribunal: whether the injuries were predominantly minor, whether the physiotherapy plan was payable, and whether interest was owed on any overdue benefit.
He argued he should be removed from the guideline altogether, pointing to anxiety, paranoia and sleep disturbance he said developed after the crash, and relied on his Application for Accident Benefits and a Disability Certificate completed shortly after the collision. That certificate otherwise listed a whiplash-associated disorder, sprains and strains across his shoulder, thoracic spine and lumbar spine, pain in his left hand and thighs, headaches, and an unspecified nonorganic sleep disorder.
Licence Appeal Tribunal member Kimberly Gruetzman found that record insufficient. Beyond the two initial forms, the claimant produced no further medical documentation - no treating physician's notes - to support the reported psychological symptoms. Gruetzman also noted the disability certificate had been completed by a physiotherapist, whose scope of practice does not extend to psychological diagnosis. She found the reported symptoms were instead "clinically associated sequelae of the minor injuries sustained in the accident." Because the claimant remained within the guideline, the tribunal did not need to decide whether the physiotherapy plan itself was reasonable and necessary.
He also failed on two further grounds. A prior accident on April 15, 2020, one month before this collision, was referenced in his forms, but no records were filed to show it left him with a pre-existing condition. Nor did any medical documentation point to chronic pain with functional impairment, a route that can otherwise take a file outside the guideline.
Separately, he had asked the tribunal to order a special award under section 10 of Regulation 664, alleging Certas unreasonably withheld or delayed his payments. Gruetzman declined to even consider it: the request had not been raised through a Notice of Motion, appeared only as a single line under the order sought, and came with no supporting submissions at hearing or in reply.
The tribunal dismissed the application in full and found no interest owed, since no benefits were determined to be overdue. The decision was released August 7, 2026.
