What happened: A tribunal upheld an insurer's refusal to pay three accident benefit treatment plans, ruling the driver's injuries were minor.
Who's involved: The Personal Insurance Company and the injured driver it insured.
What's at stake: Three disputed treatment plans worth $4,348.56, $2,144.93 and $84.40.
Why it matters: One treatment plan alone isn't enough to lift a claimant out of the minor injury cap.
Where it stands: Decided - the Licence Appeal Tribunal released its ruling on September 18, 2026.
Fourteen hours of psychological assessment. That's what one driver's own expert recommended after a car accident - and the tribunal said his injuries didn't need it.
The driver was hurt in a car accident in May 2024 and turned to his auto insurer, The Personal Insurance Company, for help covering his recovery. The Personal capped his benefits under Ontario's Minor Injury Guideline (MIG) - a $3,500 ceiling for soft-tissue injuries like sprains, strains and whiplash. He pushed back at Ontario's Licence Appeal Tribunal, asking for coverage of chiropractic care, that psychological assessment, and a small medication bill the insurer had refused.
Getting out from under that cap isn't easy. A claimant needs to prove the injury falls outside the guideline, or point to a pre-existing condition that blocks recovery, backed by solid medical evidence. The burden is on the claimant, not the insurer.
The driver leaned on two documents: a chiropractor's opinion that his injuries weren't exactly minor, and the psychologist's recommendation for that 14-hour assessment.
But the insurer pointed out something simple - a chiropractor isn't trained to diagnose psychological or neurological issues. The tribunal agreed. A soft-tissue specialist weighing in on someone's mental health was outside his lane.
There was another problem, too: the driver's own family doctor had already diagnosed whiplash and a lumbar strain - both squarely within the MIG's definition of a minor injury.
So his case came down to those two documents, with nothing else behind them. The tribunal said that's not enough - a treatment plan written by the very provider recommending the treatment doesn't prove much on its own.
It needs backup: independent medical evidence from somewhere else in the patient's file. Without it, the chiropractic care, the psychological assessment, and the medication claim all stayed denied.
The driver also argued the insurer's own denial letters broke the rules - too vague, too late, and that should have knocked out the MIG argument entirely. The tribunal checked the paperwork and found the opposite: The Personal had notified him within ten business days each time, explained its reasons, and made clear the MIG applied. Paperwork, it turned out, wasn't the weak link.
No interest was owed, since nothing was overdue. And the driver's bid for a penalty payment over delayed claims handling went nowhere too.
There's no sign of an appeal. And this isn't a one-off: other Ontario tribunal rulings this year have landed the same way - a treatment plan needs real medical backup to clear the MIG bar, and a denial letter that explains itself on time tends to hold up.
Adjusters fighting similar MIG disputes now have one more ruling to point to when a treatment plan shows up without any backup.
