Ontario tribunal hands Aviva a clean win in MIG fight, spelling out what counts as a proper denial
The Licence Appeal Tribunal has reminded claimants that ongoing pain is not enough to break free of Ontario's Minor Injury Guideline cap.
In a decision released on April 14, 2026, adjudicator Leo Demarce sided with Aviva General Insurance Company in a dispute over accident benefits stemming from a July 20, 2023 car crash. The ruling keeps the applicant, Xiaoxia Tang, inside the $3,500 Minor Injury Guideline, commonly known as the MIG, and denies her bid for further chiropractic care, an in-home occupational therapy assessment, and a psychological assessment.
For accident benefits adjusters, the case is worth a careful read. It revisits two issues that surface constantly in MIG disputes: how much medical evidence a claimant actually needs to get out of the guideline, and what an insurer must say in a denial letter to stay on the right side of the rules.
Tang asked to be moved out of the MIG on two grounds - a psychological impairment and chronic pain with functional impairment. Her file included pre-screening reports from a psychologist and an occupational therapist, two section 44 assessment reports, and a clinical note from her family doctor.
The tribunal was not persuaded. The adjudicator described her psychological evidence as "primarily self-reported," noted there was no formal diagnosis, and pointed out that none of the reports clearly linked her symptoms to the accident. The only note from her treating physician was written roughly six months after the crash and mentioned only wrist pain.
The chronic pain argument fared no better. Drawing on earlier tribunal reasoning, the adjudicator held that "ongoing pain alone is insufficient to take one out of the MIG. Rather, that ongoing pain also must be accompanied by some functional impairment." Treatment plans on their own, he added, are not medical evidence - they need to be backed by documented clinical findings tied to the accident.
The more practical takeaway concerns section 38(8) of the Schedule, which gives insurers 10 business days to explain why a treatment plan is being denied. Miss that window, and the insurer loses the ability to rely on the MIG and must pay up.
Tang argued Aviva's denial leaned on boilerplate language and failed to identify her injuries or the documents the insurer relied on. She pointed to Jamily v. Certas Home and Auto Insurance Company, 2022 CanLII 98064, as support.
The adjudicator read Jamily differently. That decision, he noted, says an insurer's reasons "should, at the very least, include specific details about the insured's condition forming the basis for the insurer's decision or, alternatively, identify information about the insured's condition that the insurer does not have but requires."
Aviva had told Tang it reviewed her documents and concluded her injuries appeared predominantly minor, then asked for her family doctor's clinical notes and scheduled an insurer's examination. That, the tribunal found, was enough. The insurer, Demarce wrote, "upheld their responsibility," and the request was "straightforward."
Tang's claim for a special award under section 10 of Regulation 664 was dismissed, with the adjudicator finding no evidence Aviva had acted unreasonably. With no overdue benefits on the books, no interest was payable either.
