An Ontario tribunal has kept a claimant capped under the province's $3,500 minor injury guideline, rejecting three separate arguments for removal.
Licence Appeal Tribunal adjudicator Gurleen Thethi upheld Intact Insurance Company's decision to limit the applicant's treatment to the Minor Injury Guideline in an August 20, 2026 ruling, finding that none of his three grounds for removal - chronic pain, a psychological impairment and a pre-existing condition - held up against the medical record.
The applicant was hurt in an automobile accident on August 9, 2023, and later sought statutory accident benefits after Intact denied coverage beyond the guideline's limit. He disputed two chiropractic treatment plans worth $2,023.03 and $1,525.84, a $2,486.00 psychological assessment and a $2,486.00 chronic pain assessment, and also claimed interest on the outstanding amounts.
His family physician diagnosed whiplash-associated disorder, cervical disc disorder with radiculopathy, headaches and lumbar strain shortly after the crash, but the tribunal gave that opinion limited weight, noting it was completed within days of the accident and offered little supporting analysis. The tribunal also pointed to contemporaneous evidence working against the claim - the applicant left the accident scene on his own, did not go to hospital, and waited about two weeks before seeking treatment.
A neurologist's later examination, including electrodiagnostic testing and imaging, turned up no neurological deficits or evidence of radiculopathy. The insurer's own examiner, who assessed the applicant twice, found only uncomplicated soft tissue injuries, observing normal gait, no significant functional restrictions and continued employment.
The applicant also underwent a series of fluoroscopically guided lumbar epidural steroid injections between March 2024 and April 2025, and pain clinic records linked his ongoing pain to the accident. The tribunal accepted that he experienced pain following the crash but found the evidence insufficient to establish a chronic pain condition warranting removal from the guideline.
On the psychological ground, the tribunal preferred the insurer's examiner's report over the applicant's own psychological assessment, partly because he had a documented history of major depressive disorder and adjustment disorder dating to 2021, which his own assessor's report did not adequately address. The insurer's examiner administered psychometric testing and concluded that while the applicant may have experienced residual adjustment difficulties, the evidence did not support a clinically significant psychological impairment.
The pre-existing injury argument fared no better. Medical records showed the applicant had reported lower back pain for six months before the accident, but no treating provider offered an opinion that this pre-existing condition would prevent his recovery within the guideline's limits, a requirement for removal under the Schedule.
With the applicant remaining subject to the guideline, Thethi found it unnecessary to determine whether the four disputed treatment plans were reasonable and necessary, and denied his claim for interest on the outstanding amounts.
