A chiropractor who treated his own wife - and was co-insured under her policy - could not secure her accident benefits before Ontario's licence tribunal.
The Licence Appeal Tribunal released its decision in Nikols v Security National Insurance Company on June 8, 2026, dismissing every claim brought by applicant Nola Nikols. She had been involved in an automobile accident on October 26, 2016, and sought benefits under the Statutory Accident Benefits Schedule after Security National Insurance Company denied them.
Four chiropractic treatment plans were in dispute, all proposed by Dr. Bill Nikols at the Back Pain and Joint Treatment Centre: $8,040.00 submitted in December 2022, $2,580.00 in January 2024, and two plans of $2,600.00 each in June and October 2024.
Dr. Nikols is the applicant's husband, her treating chiropractor, and a co-insured under the policy. Security National argued that those overlapping roles compromised the independence and reliability of his recommendations, pointing to section 46 of the Schedule and to court authority on the impartiality of experts. The insurer urged the Tribunal to deny the claims outright on conflict-of-interest grounds.
Adjudicator Melanie Malach declined to go that far. She found a potential conflict in treating a family member but noted the respondent had not identified any rule from the College of Chiropractors of Ontario barring it. The College generally advises against treating relatives, she wrote, but "family treatment is not explicitly named as a prohibited conflict of interest." She also observed that the insurer had not raised the issue when assessing the claim. The adjudicator refused to dismiss the claims simply because the applicant's spouse authored the plans, but held that his authorship was a factor in weighing the evidence.
The first claim failed on procedure. The December 2022 expense was submitted on an OCF-6 expense form rather than a treatment plan, and was denied on January 5, 2023. Malach found this breached section 38(2) of the Schedule, which relieves an insurer of liability for an expense incurred before a compliant treatment plan is submitted. None of the provision's exceptions applied, and she held she had no discretion to waive the requirement.
The remaining three plans failed on the evidence. Malach found that a treatment plan, on its own, does not establish that care is reasonable and necessary, and that objective support is required. The applicant had not provided contemporaneous clinical records from her treating practitioners during the relevant period, and her family physician's last note pre-dated the disputed plans. Insurer examination reports from a neurologist and a general practitioner, both dated May 2024, concluded no further treatment was warranted.
Where medical opinions competed, the adjudicator gave the most weight to the records of treating practitioners - and found those records too thin to carry the applicant's burden. She concluded the claims were not proven on a balance of probabilities.
With no entitlement to the treatment plans, there were no overdue benefits, so no interest was payable. The applicant's request for an award under section 10 of Regulation 664, available where an insurer unreasonably withholds or delays benefits, was also refused. The application was dismissed in full.
