An Ontario insurer has again lost a billing-rate fight over osteopathic treatment it tried to cap at rock bottom.
In a decision released April 14, 2026, Licence Appeal Tribunal Adjudicator Gary Marshall ruled that Traders General Insurance Company was wrong to limit an osteopath's hourly rate to $58.19 - the floor rate for unregulated health professionals under Ontario's Professional Services Guideline. The case, Harmer v. Traders General Insurance Company, centered on a treatment plan for Sarah Harmer, who was injured in a car accident on March 20, 2022, and filed for statutory accident benefits.
Health Partners Professionals submitted a plan on November 3, 2022, recommending four sessions of osteopathic therapy at $128.32 per hour. Traders General pushed back, arguing that the treating osteopath, Byron Curtis, was an unregulated provider and should be paid no more than the Guideline's lowest listed rate. The insurer pointed to section 15(2) of the Statutory Accident Benefits Schedule, which says insurers are not liable to pay for any medical benefits that exceed the maximum rate or amount, or expenses established under the Guidelines.
The problem with that argument? Osteopaths are not listed in the Guideline at all. As Harmer's legal team pointed out, the Guideline sets maximum rates for physiotherapists, massage therapists, psychometrists, and others - but says nothing about osteopaths. That gap, they argued, means the rate has to be worked out between the parties or decided by the Tribunal, not automatically pinned to the floor.
Marshall agreed. He followed the reasoning from Ossipova v. BelairDirect Insurance Company, a 2023 Tribunal decision where Vice Chair Todd found that "simply because osteopaths are not on the list set out by the Guideline does not necessitate that it be relegated to the lowest rate of compensation." Marshall approved $80.00 per hour - the rate recommended by the National Academy of Osteopathy (Canada) - bringing the total to $280.52, plus taxes and interest.
Not everything went Harmer's way. Two later chiropractic treatment plans worth $2,110.05 and $3,509.99 were denied. The latter plan, which also included a request for a king-size mattress, was rejected alongside the first. The Tribunal relied on a section 44 assessment by Dr. Pankaj Bansal, who found Harmer had sustained uncomplicated soft tissue injuries that would have long since healed. A proposed occupational therapy assessment worth $1,796.02 was also turned down after the insurer's own assessment found normal cognitive function and no safety concerns. Harmer's bid for a penalty award under section 10 of Regulation 664 was denied as well, with the Tribunal noting that Traders General had been flexible during the dispute.
The pattern here matters more than the dollar amount. Two Tribunal decisions now say the same thing: when the Guideline is silent on a provider, insurers cannot simply slot them into the cheapest category. For claims teams still defaulting osteopath files to $58.19 an hour, the math is getting harder to justify - especially once you factor in the cost of losing at the Tribunal.
