A tribunal found a woman's psychological trauma from watching her family's crash justified chiropractic and yoga therapy, but not a penalty against her insurer.
The Licence Appeal Tribunal's Automobile Accident Benefits Service ruled that the applicant was entitled to two disputed treatment plans after finding her accident-related psychological injuries manifested as physical symptoms, even though she was not physically involved in the collision that triggered her claim.
The applicant was driving behind her husband's vehicle, which was carrying their two children, when she witnessed a pickup truck run a red light and collide with the vehicle on February 9, 2024. She sought statutory accident benefits from The Dominion of Canada General Insurance Company, which denied two treatment plans: $3,495.16 for chiropractic services and $4,369.26 for yoga therapy.
The insurer argued both plans addressed physical injuries rather than psychological impairment, relying on an insurer examination by a physiatrist who concluded the applicant was not directly involved in the collision and had not sustained accident-related musculoskeletal injuries. The insurer also pointed to other possible causes for her symptoms, including increased work responsibilities, physical labour tied to her business, cottage activities, and softball.
Adjudicator Harouna Saley Sidibé disagreed with that framing. Family physician records showed the applicant developed anxiety, insomnia and intrusive recollections of the crash within days of the accident, and by October 2024 was reporting fatigue, neck pain and low back pain alongside ongoing psychological distress. A disability certificate and a psychological assessment diagnosing Major Depressive Disorder and post-traumatic stress disorder supported a finding that her physical symptoms, including muscle tension, pain and fatigue, stemmed from the psychological trauma of witnessing the collision involving her spouse and children.
Sidibé found the chiropractic and yoga therapy plans were reasonable and necessary given that link, ordering the insurer to pay both amounts plus interest under section 51 of the Statutory Accident Benefits Schedule.
The applicant also sought a special award under section 10 of Regulation 664, which allows the tribunal to add up to 50 per cent of benefits payable where an insurer unreasonably withholds or delays payment. She argued the insurer's physiatrist examination failed to meaningfully address her psychological impairments and their physical effects.
Sidibé agreed the insurer's approach to the treatment plans was too narrow, but stopped short of finding its conduct unreasonable. The insurer had accepted the applicant's status as an insured person, paid other accident benefits, obtained a section 44 insurer examination, and issued denial notices explaining its position. The tribunal found the parties were engaged in a genuine dispute over entitlement, not conduct that was "excessive, imprudent, stubborn, inflexible, unyielding, or otherwise unreasonable manner."
For claims professionals, the decision illustrates how an insurer examination focused narrowly on direct physical impact can miss psychologically driven physical symptoms. It also shows that losing an entitlement dispute does not automatically expose an insurer to a penalty award, provided the file reflects a documented examination and clear denial reasoning.
The decision was released July 30, 2026, following a hearing conducted by way of written submissions.
