An Ontario tribunal has ruled in Sonnet Insurance Company's favour, keeping a driver's accident injuries within the $3,500 minor injury cap.
The decision released June 22, 2026, shows how the Licence Appeal Tribunal weighed competing medical evidence in a Minor Injury Guideline dispute.
The applicant was involved in an automobile accident on November 7, 2022, and sought statutory accident benefits under the Statutory Accident Benefits Schedule. Sonnet denied the disputed treatment plans, and the applicant brought the dispute to the Tribunal.
At the centre of the case was the Minor Injury Guideline. Under section 18(1) of the Schedule, medical and rehabilitation benefits are capped at $3,500 where an insured's impairments are predominantly a minor injury. Section 3(1) defines a minor injury as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation, and any clinically associated sequelae. The claimant carried the burden of proving her injuries warranted removal.
The applicant argued two routes out of the cap: chronic pain with a functional impairment, and a psychological condition.
On chronic pain, she pointed to neck pain and headaches, her family physician's clinical notes, records from a rehabilitation clinic, and a July 17, 2023 MRI. The adjudicator accepted she suffered chronic migraines but found that insufficient. Her physician's notes referenced migraines pre-dating the accident, with pharmacy complaints in July and August 2020. The MRI showed mild neuroforaminal stenosis and degenerative disc disease - a spinal condition the adjudicator found also pre-dated the crash. The test, the tribunal noted, is chronic pain with a functional impairment, and it was not persuaded a functional impairment existed.
The psychological claim turned on a contest between experts. The applicant relied on a one-page section 25 psychological pre-screening report from a social worker, dated December 12, 2022, recommending cognitive behavioural therapy. The report contained no testing data.
Sonnet countered with a general practitioner's assessment and a section 44 psychological report from a psychologist. The psychologist administered three tests and concluded the applicant's symptoms did "not meet the clinical criteria for impairment."
The tribunal assigned more weight to the insurer's evidence, finding a psychologist better qualified than a social worker to assess a psychological condition, and preferring the report that contained psychometric testing and results.
The claimant's own conduct also mattered. Both the insurer's assessors noted she continued to drive, and her family physician's notes lacked consistent complaints of fear or anxiety - undercutting her report that she avoided driving overall.
The tribunal found the applicant had not met her onus on either ground. She remained in the Minor Injury Guideline, subject to the $3,500 limit. With no benefits overdue, no interest was payable, and the application was dismissed.
