An Ontario tribunal has confirmed that a partial rotator cuff tear alone will not lift a claimant out of the province's Minor Injury Guideline cap.
The Licence Appeal Tribunal - Automobile Accident Benefits Service dismissed an application for statutory accident benefits brought against Intact Insurance Company, ruling that the claimant's injuries remained predominantly minor despite imaging that confirmed a partial tear. Adjudicator Jotvinder Sodhi released the decision on August 4, 2026.
The applicant was involved in a parking lot collision on October 22, 2022, and reported neck, back and right shoulder pain afterward. Imaging confirmed a partial tear of the right shoulder supraspinatus tendon. He sought statutory accident benefits, including two disputed chiropractic treatment plans worth $225.60 and $1,328.00, and Intact denied the claims, sending the dispute to the Tribunal.
At issue was whether the applicant's injuries fell outside the Minor Injury Guideline, which under section 18(1) of the Statutory Accident Benefits Schedule limits medical and rehabilitation benefits to $3,500 where impairments are predominantly minor. Section 3(1) defines a minor injury as a sprain, strain, whiplash-associated disorder, contusion, abrasion, laceration or subluxation, including any clinically associated sequelae. The burden of proving injuries fall outside that definition rests with the claimant.
The applicant argued that his ongoing pain and the confirmed partial tear took him outside the guideline. Intact relied on a section 44 insurer's examination report from a general practitioner, who diagnosed sprain and strain injuries and concluded the applicant's impairments fell within the Minor Injury Guideline.
The Tribunal sided with the insurer. The guideline's definition of a strain, it found, already covers this kind of injury - the decision states that the Tribunal has consistently held there is "a partial tear which does not take an applicant outside of the MIG." The applicant had not pointed to medical evidence or legal authority showing his partial tear should shift the claim beyond the guideline's scope.
The applicant also argued that chronic pain removed him from the guideline. He attended his family physician multiple times, including on October 22, 2022, November 10, 2022, November 19, 2022 and January 21, 2023, and attended approximately 20 chiropractic sessions between October 2022 and April 2023. The Tribunal found that pain complaints alone are not enough - a claimant must show the pain causes functional impairment. Here, the clinical notes and records did not reference a chronic pain diagnosis, and the applicant did not point to evidence of functional restrictions linked to his symptoms.
Because the injuries stayed within the Minor Injury Guideline, the Tribunal did not need to assess whether the two disputed chiropractic treatment plans were reasonable or necessary. With no benefits found owing, no interest was payable either. The application was dismissed in full.
For claims professionals, the ruling reinforces that a diagnostic finding like a partial tendon tear does not automatically justify treatment above the guideline's cap, so long as the injury still fits the Schedule's definition of a sprain or strain and no separate functional impairment is established.
