An insurer's own medical examiner said its claimant belonged outside Ontario's minor injury cap - then the insurer sat on the report for months.
The Ontario Licence Appeal Tribunal has reopened a minor injury dispute after finding that a section 44 insurer's examination report, prepared for The Commonwell Mutual Insurance Group, surfaced too late to be weighed at the original hearing.
In an amended reconsideration decision released June 23, 2026, Vice-Chair Craig Mazerolle granted the applicant's request in part and ordered a written rehearing before a different adjudicator.
The claim stemmed from a May 17, 2022 accident. The applicant sought accident benefits, but a September 23, 2025 decision held her to the Minor Injury Guideline, which caps medical and rehabilitation benefits at $3,500. That ruling also denied a non-earner benefit, six disputed treatment plans, and interest.
At the centre of the reconsideration was a section 44 physiatry examination report dated June 17, 2025. The report concluded that the claimant had chronic pain and fibromyalgia that would prevent her from achieving maximal recovery within the $3,500 limit. That finding cut against the insurer's own position that she belonged in the guideline.
The report was not disclosed to the applicant until October 22, 2025, after the decision had already been released. Alongside it, the insurer served an Explanation of Benefits stating it was not bound by the report because it produced conflicting findings. The insurer also described the assessment as fundamentally flawed.
Mazerolle accepted that the report and the Explanation of Benefits were not before the Tribunal when it rendered its decision, and that the applicant could not have obtained them earlier. He rejected the insurer's argument that she should have delayed her hearing to wait for the report, finding the timeline was outside her control.
On whether the evidence mattered, Mazerolle was direct. "An insurer is not bound by the findings of its assessors," he wrote, but the guideline question turns on whether the applicant met the test for removal, not on whether the insurer was right to maintain its position. An expert report indicating she met that test, he found, was highly relevant.
The rehearing will address only whether the applicant qualifies for removal from the guideline under section 18(2) and, if she does, the disputed treatment plans and interest. The Tribunal's denial of the non-earner benefit and its findings on section 38(8) notice remain undisturbed.
Mazerolle rejected the applicant's other grounds, including challenges to how the Tribunal weighed a psychologist's report and interpreted the compelling-evidence standard. Only the newly disclosed report justified reopening the file.
For claims professionals, the decision shows that a late-disclosed insurer's examination supporting the claimant can be enough to reopen a decided minor injury file.
