A chiropractor's concussion evidence could not lift an injured driver past Ontario's $3,500 minor injury cap, a tribunal ruled.
The Ontario Licence Appeal Tribunal released its decision on July 22, 2026, dismissing a claimant's attempt to move beyond the Minor Injury Guideline after a car accident on July 16, 2024. Co-operators General Insurance Company had denied the disputed benefits, and the tribunal sided with the insurer.
Under section 18(1) of the Statutory Accident Benefits Schedule, medical and rehabilitation benefits are capped at $3,500 when an insured's impairments are predominantly a minor injury. Section 3(1) defines a minor injury as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation, plus any clinically associated sequelae. The burden of escaping that cap rests with the claimant.
He tried three routes out - concussion, chronic pain and psychological injury - and each turned on the strength of his medical evidence.
On the concussion claim, the claimant relied on records from a chiropractor and a "SHIFT Concussion Management Provider." The tribunal found he had not provided a concussion diagnosis from a qualified professional, agreeing with Co-operators that such a diagnosis falls outside a chiropractor's scope of practice.
The chronic pain argument met a similar end. The tribunal weighed the six criteria from the American Medical Association Guides, noting a claimant must satisfy at least three. Co-operators pointed out that the claimant continued to work and drive, had not seen his family physician in over a year, took no regular prescribed pain medication - using only a topical cream - and had no referral to a pain clinic. The tribunal found no evidence of functional impairment due to pain.
On psychological injury, the claimant's own psychologist diagnosed adjustment disorder with anxiety and depressed mood, along with a specific phobia around driving. But the insurer's section 44 psychologist concluded there was "a lack of consistent objective information" pointing to a substantial psychological impairment tied to the accident. The tribunal found the diagnosis was not corroborated by other medical evidence, such as the family doctor's records.
Claims professionals will also note a fight over disclosure. The claimant asked the tribunal to give no weight to the insurer's assessment reports because it had not produced the assessors' clinical notes and records. The tribunal declined, finding Co-operators had made its best effort and could not be expected to produce records that do not exist.
With the claimant held inside the guideline, the tribunal found no entitlement to the four disputed treatment plans or interest, and no award against the insurer. The application was dismissed.
The decision tracks the tribunal's own logic: each of the claimant's three routes out of the cap failed on the quality of the evidence behind it. A diagnosis from outside a practitioner's scope, or one resting on self-reporting without corroboration, did not carry this claimant past the $3,500 threshold.
