Intact Insurance has defeated a security guard's bid to escape Ontario's $3,500 minor injury cap, after failed validity testing undercut his psychological claim.
The Ontario Licence Appeal Tribunal released the decision on July 8, 2026, following written submissions. It dismissed the application in full and kept the claimant's treatment within the Minor Injury Guideline, or MIG.
The dispute arose from an automobile accident on October 8, 2022. The applicant, a full-time security guard, sought statutory accident benefits after Intact denied him. He asked to be removed from the MIG, and claimed an income replacement benefit of $400.00 per week from May 23, 2023 to December 31, 2023, along with $1,328.10 for chiropractic services and $2,852.05 for a psychological assessment.
Adjudicator Aric Bhargava rejected each claim.
Section 18(1) of the Schedule caps medical and rehabilitation benefits at $3,500.00 where an insured's impairments are predominantly minor. A claimant can be removed from the MIG by showing a documented pre-existing condition plus compelling evidence that it precludes recovery inside the guideline, or by establishing chronic pain with functional impairment or a psychological condition. The burden sits with the applicant.
The claimant pointed to pre-existing conditions including type 2 diabetes, back and neck complaints, anxiety, and sleep disruption. But the adjudicator found his family physician's records documented pain and anxiety without any opinion linking those conditions to impaired recovery. A section 44 insurer's examination concluded he had no pre-existing conditions blocking maximal recovery within the MIG.
The psychological claim turned on competing reports. A section 25 assessment diagnosed post-traumatic stress disorder, major depressive disorder, and pain catastrophizing disorder. The insurer's section 44 psychological evaluation found a 67 per cent probability that symptom validity testing results were invalid. As the report put it, "There is no psychological diagnosis as the test results were deemed invalid."
Bhargava placed more weight on the family doctor's records, which did not note accident-related anxiety or sleep disturbance across 12 visits between April 2023 and April 2025. He found the psychological report stood in clear contrast to those notes, and that the claimant had not explained the inconsistency.
The chronic pain argument failed for want of functional impairment. The adjudicator found the applicant could walk, drive, and attend to his self-care, and had returned to work - undercutting any claim of disability.
That return also sank the income replacement benefit. The employer confirmed the applicant rejoined work in the last week of May 2023, with duties not modified. Intact had paid the benefit until May 23, 2023, around the time he went back.
Finally, the claimant sought a special award under section 10 of Regulation 664, arguing Intact relied exclusively on its own examinations. The insurer countered that it had relied on its adjusting and the evidence of two medical experts. Bhargava found the insurer's reliance on section 44 reports - which reviewed the family doctor's records and emergency records - was not unreasonable conduct. No award was payable.
With the injuries minor, no benefits were overdue and no interest applied. The application was dismissed.
