TD General held the line on Ontario's Minor Injury Guideline after a claimant's chronic pain, concussion, and psychological arguments all failed at the Tribunal.
The decision in Arafat v. TD General Insurance Company, released April 21, 2026, is the latest in a string of Licence Appeal Tribunal rulings that reinforce how difficult it is for claimants to break out of the MIG - and how well-built insurer files continue to carry the day.
The case arose from a November 10, 2023 automobile accident. The claimant, Arafat Arafat, sought statutory accident benefits beyond the $3,500 MIG cap, arguing his injuries included chronic pain with functional impairment and an accident-related psychological condition. He submitted treatment plans and assessment requests totalling roughly $14,488. TD General denied the claims, maintaining the injuries were predominantly minor - sprains, strains, and whiplash-associated disorder - and belonged squarely inside the MIG.
Adjudicator Roderick Walker agreed with the insurer.
On the chronic pain front, the claimant's family physician, Dr. S. Fahmy, had noted post-traumatic chronic pain in July 2024. But the Tribunal found the diagnosis rested on the claimant's own reports, with no documented restrictions on daily activities or evidence of functional limitation in the medical records. A neurological exam by Dr. Fahmy in December 2023 turned up nothing abnormal - no weakness, no sensory loss, normal vision. The insurer's independent assessor, Dr. A. Belfon, classified the injuries as neck and back sprains and strains consistent with the MIG definition.
One of the more striking elements of the case involved a concussion diagnosis. The claimant said his family doctor referred him to a concussion clinic. The Tribunal found otherwise - the referral came from his physiotherapist, M. Yassa, who also diagnosed the concussion based solely on the claimant's self-reported symptoms. Walker agreed with TD General that making a concussion diagnosis falls outside a physiotherapist's scope of practice. The claimant had also denied hitting his head during the collision. The insurer's neurological assessor, Dr. N. Yahmad, attributed the headaches to neck and muscle issues and found no neurological disability.
The psychological claim fared no better. The claimant's assessor, Dr. J. Pilowsky, diagnosed Persistent, Moderate Somatic Symptom Disorder with Predominant Pain, depressed mood, and vehicular anxiety. But the claimant's own test results told a different story - mild depression on the Beck Depression Inventory II and minimal anxiety on the Beck Anxiety Inventory. The Tribunal found those scores did not support the diagnoses. TD General's assessor, Dr. D. Mandel, reported that the claimant described his mood as "okay," denied hopelessness and panic attacks, said he was still driving without anxiety, and stated he did not feel he needed therapy. The Tribunal preferred Dr. Mandel's conclusions.
Surveillance footage from October 2024 added another layer. It showed the claimant walking at a normal pace and without visible pain more than a year after the accident - around the same time the disputed treatment plans were prepared.
The application was dismissed. All treatment plans were denied, and no interest or award was granted.
For claims teams, the case is a practical reminder: independent medical assessments, attention to provider scope of practice, and surveillance remain effective tools when defending MIG classifications.
