Co-operators lost the minor-injury fight at Ontario's accident-benefits tribunal but escaped a special award and saw a psychological-services claim sharply reduced.
The Ontario Licence Appeal Tribunal released its decision on June 17, 2026, in a dispute over statutory accident benefits.
The claimant was injured in an automobile accident on January 12, 2024, and sought benefits under the Statutory Accident Benefits Schedule. Co-operators denied them, treating her injuries as predominantly minor and capping medical and rehabilitation benefits at the $3,500 Minor Injury Guideline (MIG) limit. She applied to the tribunal to be removed from the MIG and to fund two psychological treatment plans.
Adjudicator Jeff Chatterton found the claimant's injuries were not minor. She argued she suffered accident-related anxiety, post-traumatic stress disorder and depression, relying on clinical notes from her family physician, a section 25 psychological report, and a later progress report. Three separate mental-health professionals diagnosed her with depression, anxiety and PTSD.
Co-operators pointed to a gap in the family physician's notes between February 2024 and January 2025, arguing she had only psychological sequelae from the accident rather than a psychological condition. The insurer noted she complained of anxiety only three times over two years. Chatterton was not persuaded, finding the clinical notes and counselling reports corroborated accident-related concerns soon after the crash and again in January 2025. He removed her from the MIG.
The tribunal granted the disputed $2,486.00 psychological assessment, finding it reasonable and necessary given objective evidence of psychological symptoms. On the psychological services plan, however, the insurer's challenges largely succeeded. That plan, submitted March 28, 2024, sought $4,282.87 for 14 counselling sessions plus brokerage, planning and documentation services.
Co-operators argued the plan billed psychologist hourly rates of $149.61 even though a qualifying psychotherapist would deliver the services, at a Professional Services Guideline rate of $58.19. It also challenged $1,047 in brokerage and planning fees, saying those belonged under the $200 document fee. The claimant made no submissions on either point.
Chatterton agreed. He allowed 14 sessions at $58.19 per hour, plus $200 for documentation and HST, totalling $1,146.57 - well short of the amount sought.
The claimant also sought an award under section 10 of Regulation 664, which lets the tribunal order up to 50 per cent of benefits payable where an insurer unreasonably withholds or delays payment. Chatterton declined. An award should not follow simply because an insurer made an incorrect decision, he found, and the claimant had not shown the insurer's conduct was "excessive, imprudent, stubborn, inflexible, unyielding, or immoderate." Interest is payable on the overdue benefits.
For claims professionals, the decision shows that losing a MIG dispute does not by itself trigger a special award, and that rate and fee challenges to treatment plans can sharply cut what an insurer ultimately pays.
