What happened: An Ontario claimant tried to escape the $3,500 minor-injury cap after a January 2024 crash, and lost.
Who's involved: Certas Home and Auto Insurance Company, the insurer, and a claimant represented by a paralegal.
What's at stake: $7,656.20 in chiropractic and psychological-assessment costs the $3,500 cap wouldn't stretch to cover.
Why it matters: The case turned on whether a late, outside report matched the claimant's own file, not the injury itself.
Where it stands: Decided. The Licence Appeal Tribunal dismissed the application on September 22, 2026.
A psychologist's report, commissioned to free a claimant from Ontario's $3,500 injury cap, described things that never showed up in his own medical file. He was hurt in a January 2024 crash and asked to be let out of the cap. It didn't work.
He took the fight to the Licence Appeal Tribunal, which resolves disputes over statutory accident benefits after a crash. Under Ontario's Statutory Accident Benefits Schedule, insurers like Certas Home and Auto Insurance Company, a Desjardins Insurance brand, only have to fund a short list of common injuries, such as sprains, strains, whiplash and similar soft-tissue harm, up to $3,500 in total. That cap is known as the Minor Injury Guideline, or MIG.
Escaping the MIG takes two things: a documented condition that predates the crash, and medical evidence that this pre-existing problem, on its own, would block full recovery if treatment stayed capped. The claimant cleared the first hurdle easily.
The second hurdle was the problem.
Clinical records from a Toronto addictions and mental health centre showed he had already been diagnosed with obsessive-compulsive disorder, recurrent major depressive disorder, two anxiety disorders and a mild intellectual disability in the year before the crash. None of that was disputed.
What was missing was proof that those pre-existing conditions, not the crash, were the real barrier to recovery. To supply it, the claimant turned to an outside psychologist and psychological associate, who examined him seven months after the crash and diagnosed major depressive disorder plus a new phobia of vehicles and of being a pedestrian. The tribunal gave the report little weight.
The problem was consistency. The claimant told the assessors he had suffered physical injuries and been sent for imaging.
Neither his family doctor's notes nor his mental-health clinic's file ever mentioned an injury or an imaging referral. He also described new anxiety as a pedestrian, something that appeared nowhere else in his records.
His own file told a flatter story. He saw his family doctor twelve days after the crash and said nothing about it. He raised it for the first time a month later, through his mother, who said he had grown anxious about driving.
Three more visits passed with no further mention. By his next appointment that May, the note simply read that his anxiety was "controlled."
At the mental health clinic, the crash came up exactly once, a note that he felt more scared afterward, with no change to his diagnosis or medication. The timeline worked against him one more way, too: he told the tribunal his depression diagnosis came after the crash. His own clinic's records put that diagnosis in May 2023, nine months earlier.
The tribunal found the claimant had not proven his pre-existing conditions, rather than the crash, were what stood between him and recovery inside the MIG. His accident-related injuries were ruled predominantly minor. The $3,500 cap stood, the five disputed treatment plans were never assessed on their own merits, and no interest was owed, since nothing was outstanding to begin with.
The ruling, released September 22, 2026, closes the file. It doesn't say whether either side plans to seek a reconsideration or judicial review.
A privately commissioned report is only as strong as its match with what a claimant told their own treating providers all along, the detail that matters most when a late MIG-removal bid lands on a claims desk.
