What happened: An Ontario tribunal ruled a chemist's chronic wrist pain took her outside the $3,500 minor injury cap.
Who's involved: Echelon General Insurance Company and a claimant seeking accident benefits after a 2023 car accident.
What's at stake: Treatment beyond the $3,500 cap, including a $4,026.62 chiropractic plan plus interest.
Why it matters: Echelon's examination report said she hadn't fully recovered, with no sign it was updated after her MRI.
Where it stands: Decided October 5, 2026. Chiropractic plan awarded, two psychological plans denied.
Echelon General Insurance Company's examining physiatrist called a claimant's injuries minor. In the very same report, he said she hadn't finished healing.
He figured that would take two years from the accident.
Echelon leaned on that report at Ontario's Licence Appeal Tribunal. In an October 5, 2026, decision, the tribunal gave it “little weight” and found it actually supported her complaints of ongoing pain and limited function.
The upshot: she's out of the Minor Injury Guideline, or MIG, the rule that caps medical and rehab funding at $3,500 when injuries are mostly minor, like sprains, strains and whiplash.
The claimant was hurt in a car accident on July 1, 2023. Echelon treated her injuries as minor and turned down treatment plans that went past the cap.
She spent seven months off work, then started working as a chemist.
Her right wrist was the sticking point. A walk-in clinic note lists what made it worse: pipetting and squeezing at work, plus yoga, the gym, twisting and opening things, and washing dishes.
A physiatrist's June 2025 report added two more culprits at work - using a mouse and holding a four-litre jug. She switched to modified duties, then stopped working in early June.
Echelon saw it differently. Ongoing pain complaints, on their own, don't add up to chronic pain, and her file showed conservative treatment, largely benign imaging and no objective sign of structural injury.
Then the MRI landed.
An April 14, 2025, scan of her right wrist showed “slightly increased signal in the dorsal radial ulnar ligament, consistent with sprain or chronic injury.” Two later assessments pointed to a chronic sprain, or possibly a partial tear, of that ligament. The tribunal treated the scan as objective evidence of a chronic pain condition caused by the accident.
Pain on its own still wasn't enough. She also had to show it was getting in the way of her daily life, and the tribunal found her clinic records did that.
Echelon's examination report was dated May 8, 2024, 11 months before the MRI. The tribunal found no evidence Echelon asked for an addendum, or that anyone looked at the MRI or the two later reports diagnosing chronic pain.
The examination also came late in the game. It took place on April 30, 2024, five months after the chiropractic plan in dispute was submitted.
That plan, dated November 14, 2023, was worth $4,026.62. It covered 21 manipulation sessions, 21 exercise sessions, 21 therapy sessions and 14 massage sessions, plus $200 for claim paperwork.
Echelon argued she'd already had a substantial round of treatment, with no objective proof that more would make a real difference. The tribunal wasn't persuaded: “the time for determining whether a treatment plan is reasonable and necessary is at the time of submission.”
At that point, she was a regular at her clinic. She kept going until April 4, 2024, even after Echelon said no, and the tribunal said that commitment supported the treatment being reasonable and necessary.
Echelon has to pay for the plan, plus interest.
Echelon came out ahead on the psychological side. The claimant wanted a psychological assessment and a $3,491.52 psychological services plan dated August 9, 2024.
Two psychological assessments, both with interviews and testing, landed on what the tribunal called “completely contradictory” findings. One diagnosed an adjustment disorder with mixed anxiety and depressed mood. Echelon's examiner found no accident-related psychological disorder.
So the tribunal used her other medical records as the tiebreaker. None mentioned a psychological complaint, and both plans were denied.
The same records that won her the wrist fight lost her the psychological one.
An examination report that says a claimant hasn't recovered, and never gets a second look once new imaging arrives, can end up doing the claimant's work at the tribunal.
The tribunal decided the case on written submissions.
