The applicant was injured in a motor vehicle accident on July 16, 2023, and sought statutory accident benefits after Intact Insurance Company determined her injuries fell within the $3,500 Minor Injury Guideline cap. She argued that chronic pain in her shoulder, neck and lower back, combined with a psychological impairment, took her outside the guideline. The Licence Appeal Tribunal disagreed on both counts.
The applicant's left shoulder injury was central to her case. An ultrasound performed on March 16, 2024 revealed a partial tendon tear and impingement, which the applicant presented as objective evidence of an accident-related injury. The respondent's examining physician, who conducted an in-person assessment on December 4, 2024 and reviewed the full clinical record, reached a different conclusion: the tear pattern was inconsistent with a motor vehicle collision and more likely stemmed from repetitive strain. The applicant works as a cleaner, and adjudicator Steve Gilchrist noted that the physically demanding nature of that work offered a plausible alternative explanation.
The applicant also argued that her lack of OHIP coverage created financial barriers to accessing medical treatment. Gilchrist acknowledged the difficulty but found it did not excuse the gap in evidence, pointing to more than $4,000 the applicant had already spent on physiotherapy as proof she was able to make treatment decisions when she considered them necessary.
On the psychological claim, the applicant relied on a pre-screening report recommending further assessment, completed on January 23, 2024. Gilchrist gave that report limited weight, noting it amounted to a recounting of the applicant's self-reporting without objective testing. The respondent's psychological examiner, who interviewed the applicant on March 18, 2025 and administered psychometric testing, concluded she did not meet the clinical threshold for a diagnosis tied to the accident. During that interview, the applicant repeatedly described her mental health as "great. I am good," while separately expressing sadness and frustration at being unable to play netball, though she continued attending her team's games. The examiner found her test responses consistent with over-endorsement of her pain symptoms.
Gilchrist found the applicant had not shown grounds to leave the guideline, so the disputed treatment plans needed no further review. He also found Intact had not unreasonably delayed the claim, denying both a special award and interest, since none of the claimed benefits were overdue.
