An Ontario claimant invoked a Court of Appeal precedent to break free of the $3,500 minor injury cap. Intact's file held anyway.
The applicant was injured in a car accident on February 4, 2022, and sought statutory accident benefits after Intact Insurance Company capped his medical and rehabilitation coverage at $3,500 under the Minor Injury Guideline. He took the dispute to Ontario's Licence Appeal Tribunal, arguing his injuries fell outside the Guideline because of an accident-related psychological impairment and chronic pain with functional limitations.
By the time the case reached a hearing, the parties agreed only $237.77 remained available under the Guideline's $3,500 limit. Beyond that, four disputed treatment plans were in play - two for psychological assessment and services, two for chiropractic care - totalling $12,164.15. To clear the cap, the applicant pointed to Pastore v. Aviva Canada Inc., a 2012 Ontario Court of Appeal decision, arguing it supported removal from the Guideline for claimants with a psychological impairment.
Adjudicator Gordon Stencell was not persuaded. The applicant pointed to his family doctor's clinical notes from March and May of 2022 as evidence his mental health had deteriorated because of the crash. Stencell reviewed those same notes and found no mention of the accident - only references to pressure at home. The tribunal also noted the applicant's anxiety and depression pre-dated the collision: his doctor had already recorded comparable symptom scores in July 2021, seven months earlier, and the applicant had already started and stopped a prescribed antidepressant that same year.
The chronic pain argument fared no better. The applicant said constant pain in his neck, back and shoulder kept him from returning to one of two driving jobs he held before the accident, but Stencell found no clinical record of functional impairment to support the claim. The applicant did return to his other driving job, which the tribunal treated as evidence he was not withdrawing from work or social life. Stencell also noted that the applicant had barely engaged with ongoing treatment, finding he "is not excessively dependent on a healthcare provider."
With both arguments rejected, the applicant remained capped within the Minor Injury Guideline. That finding made a separate reasonableness review of the four disputed treatment plans unnecessary - none were payable. The tribunal also denied interest, since no benefits were found to be overdue. The decision was released July 27, 2026.
For insurers, the decision turns on the applicant's own clinical history rather than any dispute over expert opinion: contemporaneous notes that made no mention of the accident, combined with pre-existing scores for anxiety and depression, were enough to keep the claim inside the $3,500 Guideline limit despite the appellate precedent cited against it.
