Co-operators held the line on a Minor Injury Guideline dispute - helped, in large part, by a claimant's own silent medical records.
In a decision released April 16, 2026, Ontario's Licence Appeal Tribunal dismissed a challenge to a MIG determination in [FAH] v. Co-operators General Insurance Company, finding that the applicant had not proven her injuries warranted removal from the MIG and its $3,500 cap on medical and rehabilitation benefits.
The case stemmed from a July 2022 automobile accident involving a minor, identified as [FAH], who was represented by a litigation guardian. Following the accident, the applicant submitted four treatment plans worth a combined $11,143 - covering chiropractic services, a chronic pain assessment, and a concussion assessment. Co-operators denied them all, maintaining that the injuries fell within the MIG.
The applicant pushed back, arguing she had sustained a concussion, a fractured wrist, sprains and strains to the elbow, low back pain, whiplash, and psychological conditions including anxiety and sleep disturbances. To support those claims, she relied on treatment plans from two chiropractors who had identified concussion, non-organic sleep disorder, and anxiety disorders among her injuries.
Adjudicator Kathleen Wells was not persuaded. She noted that both treating practitioners were chiropractors, and that concussion and psychological diagnoses fall outside their scope of practice. The treatment plans were given little weight as a result.
But the more telling problem was closer to home. The applicant's own family doctor's clinical records - spanning March 2023 to December 2023, with the first visit coming more than seven months after the accident - contained no mention of the accident, headaches, concussion, or any accident-related injuries. Records from the London Health Sciences Centre told the same story. And the fractured wrist claim did not surface until more than 17 months after the accident, with nothing contemporaneous to back it up.
The applicant also challenged the insurer's denial notices on procedural grounds, arguing they did not meet the requirements of section 38(8) of the Schedule, which obliges insurers to provide medical and other reasons for denying a treatment plan within ten business days. For the first treatment plan, the Tribunal found Co-operators' refusal was final and not subject to review under sections 38(5) and 38(6), as the treatment was eligible for payment within the MIG limit. For the remaining three, the denial letters were found compliant - clear enough, the Tribunal said, for an unsophisticated person to make an informed decision about whether to dispute the denial.
With the MIG upheld and none of the treatment plans found payable under section 38(11), the application was dismissed entirely. No benefits, no interest, and no award under section 10 of Regulation 664.
For insurers and claims teams handling MIG disputes, the takeaway is practical: primary care records remain one of the most effective tools in defending a MIG determination, and diagnoses issued by practitioners outside their scope of practice will face scrutiny at the Tribunal.
