An Ontario driver's push for physiotherapy, acupuncture and psychological treatment coverage fell apart at tribunal once her medical history came into focus.
She was hurt in a car accident on June 24, 2020 and applied to Certas Home and Auto Insurance Company for accident benefits. What followed was a dispute over several treatment plans and expense claims - physiotherapy, acupuncture, myofascial release and psychological care. The Licence Appeal Tribunal issued its ruling on September 11, 2026.
Two physiotherapy plans were at the centre of the dispute: $2,294.25 proposed by CBI Health Centre and $1,695.75 proposed by Upper James Physiotherapy, the latter linked to a shoulder injury confirmed on MRI. Certas had approved only the assessment portion of the CBI plan, holding off on the rest until a medical exam could weigh in.
The tribunal's adjudicator, Matthew Frontini, pointed to a wrinkle in her case - she had reported similar neck, back and arm symptoms years earlier, including after a 2019 assault, and pre-accident scans had already flagged issues in her cervical spine. Her physiotherapist connected her symptoms to the crash but never addressed that earlier history. An insurance company doctor who reviewed both sets of records concluded her injuries had healed, and Frontini leaned on that opinion instead.
Her shoulder claim fared no better. Frontini accepted that imaging showed significant labral tearing, serious enough to warrant surgery. But no one had explained why treatment proposed years after the crash should be pinned on the accident. "The record does not contain a persuasive medical opinion," he wrote, on why the treatment should be tied to the crash.
The same gap doomed her $980 and $80 claims for acupuncture and myofascial release, along with $4,015.12 in proposed psychological treatment. Frontini noted she had a documented history of Borderline Personality Disorder and a previous Bipolar II Disorder diagnosis, and that in an appointment after the accident, she herself described her mood as declining for about a year, with the slide starting before the crash. He gave more weight to a psychiatrist hired by Certas, who found her condition was not accident-related, though that doctor had not seen her 2022 and 2025 hospital records.
Certas also tried to have her late reply thrown out and argued her request for a special award came too late in the process. Frontini disagreed on both counts, finding no real prejudice from the delay, though he limited what he considered in the reply to points that directly answered Certas's own arguments.
In the end, none of it added up to a payout. With no entitlement established on any of the disputed benefits, no payments were overdue and no interest applied. The application was dismissed in full.
