A claimant tried to sideline an insurer's occupational therapist over a 2021 assessment tied to an unrelated accident. The tribunal was not persuaded.
The Ontario Licence Appeal Tribunal has dismissed a bid for statutory accident benefits brought against The Dominion of Canada General Insurance Company (Dominion), rejecting the applicant's attempt to discount an insurer-retained assessor's findings over a prior, unrelated file.
The applicant was hurt in an automobile accident on July 4, 2024, and later sought removal from the Minor Injury Guideline (MIG), a non-earner benefit (NEB) of $185.00 per week, and payment of a $2,940.00 physiotherapy plan. Dominion denied all three, arguing the applicant's injuries were minor and that he did not meet the test for the NEB.
At the hearing, held by video conference on July 21, 2026, the applicant argued that less weight should be given to the report of the occupational therapist Dominion retained, because she had also assessed him in 2021 in relation to a separate, prior accident. He argued this created a conflict of interest.
Dominion countered that the 2021 assessment involved a different accident and that both the occupational therapist and the insurer's examining physiatrist already had a copy of that earlier report as part of the medical brief on file. The Tribunal found the applicant had not explained why the 2021 report's existence amounted to a conflict of interest, and declined to reduce the weight given to the 2025 report on that basis.
On the MIG question, the applicant pointed to a letter from his family doctor stating he had a pre-existing left shoulder and back injury that would hinder recovery; a note from the same doctor stated his "previous accident has affected the recovery." The Tribunal gave this opinion little weight, finding it was contradicted by the applicant's own reports to the insurer's examiners that his earlier pain had resolved roughly a year and a half after that prior accident, and by pre-accident chiropractic records showing no shoulder or back complaints in the year before the July 2024 collision. The applicant remains subject to the MIG's $3,500.00 funding limit.
The NEB claim also failed. Applying the test from Heath v. Economical Mutual Insurance Company, the Tribunal found the applicant had modified rather than abandoned his pre-accident routines - attending church online instead of in person, having grandchildren visit at home instead of travelling to see them, and completing housekeeping tasks with help from his daughter once a month. That fell short of a complete inability to carry on a normal life.
Because the Tribunal found the applicant remained in the MIG, it did not need to rule on whether the disputed physiotherapy plan was reasonable and necessary. With no benefits found overdue, the applicant was also denied interest and a special award under section 10 of Regulation 664, which allows the Tribunal to order an insurer to pay up to 50 per cent of the benefits payable where payment was unreasonably withheld or delayed.
The decision was released August 5, 2026.
