An Ontario tribunal freed a driver from the $3,500 minor injury cap - then ruled her insurer had not withheld her benefits unreasonably.
Intact Insurance Company lost its bid to keep a claimant within the province's Minor Injury Guideline, but defeated her claim for a special award over alleged delayed payments, the Licence Appeal Tribunal ruled on August 6, 2026.
The case arose from a motor vehicle accident on December 30, 2022. The applicant sought statutory accident benefits after Intact denied six separate treatment and assessment plans, taking the position that her injuries were predominantly minor and therefore subject to the $3,500 MIG funding cap.
Vice-Chair Julian DiBattista found the applicant qualified for removal from the MIG under section 18(2) of the Statutory Accident Benefits Schedule, which allows removal where a documented pre-existing condition prevents maximal medical recovery within the guideline's limits. The applicant's pre-existing bipolar disorder was central to that finding.
Her family physician wrote a letter, dated February 9, 2025, stating that the applicant's physical and psychological injuries were exacerbated by the accident and hindered her recovery. Intact's own psychological assessor examined the applicant on June 20, 2024 and concluded she had not suffered a psychological injury as a result of the accident - but did not address whether her pre-existing condition affected her ability to reach maximal medical recovery within the MIG. DiBattista gave that report less weight as a result, and found in the applicant's favour on the MIG question.
With the MIG cap lifted, DiBattista assessed each of the six disputed plans individually. He approved a psychological assessment, psychotherapy services involving 20 sessions of 1.5 hours each, a driver reintegration assessment, a chronic pain assessment and a cognitive assessment. A physiotherapy plan was denied because the applicant made no submissions establishing its goals or reasonable cost. Interest was awarded on the overdue benefits under section 51 of the Schedule.
Despite losing on the central MIG issue, Intact defeated the applicant's bid for a special award under section 10 of Regulation 664, which permits a penalty of up to 50 per cent of benefits payable where an insurer unreasonably withholds or delays payment. DiBattista found that by retaining a psychological assessor to examine the applicant's pre-existing conditions, Intact had taken good faith steps to investigate the claim. The applicant provided no adjuster log notes or other evidence showing the insurer ignored corroborating medical evidence or otherwise acted unreasonably.
The tribunal's order removed the applicant from the MIG, granted five of the six disputed treatment and assessment plans plus interest, and denied both the physiotherapy plan and the special award.
