What happened: An Ontario tribunal freed a crash claimant from the minor injury cap but turned down most of her plans.
Who's involved: Security National Insurance Company and a claimant hurt in a July 28, 2023 car crash.
What's at stake: Four plans worth $2,486.00, $4,959.75, $4,675.30 and $2,712.00, plus a special award.
Why it matters: Counselling delivered by someone other than the clinician named on the plan went unpaid.
Where it stands: Decided - released September 25, 2026; the claimant won in part.
The plan called for sixteen counselling sessions with a psychologist, priced at $4,959.75. The notes the claimant filed showed 13 sessions with a psychotherapist.
That one mismatch cost her the entire plan.
Ontario's Licence Appeal Tribunal turned down the bill in a decision released September 25, 2026. The insurer was Security National Insurance Company, which underwrites TD Insurance's Meloche Monnex home and auto program. The claimant still came away with two wins: she was freed from Ontario's minor injury cap, and one of her four plans was approved.
The crash happened on July 28, 2023, and Security National turned down her benefits. The fight centred on the Minor Injury Guideline, which caps medical and rehab benefits at $3,500 when injuries are mostly minor - think sprains, strains and whiplash. Proving a psychological condition is one way out, and it's up to the claimant to prove it.
Her medical file told a consistent story. Her family doctor logged psychological complaints from her first visit after the crash, on August 23, 2023, and kept logging them into 2024. A psychiatrist diagnosed generalized anxiety disorder tied to the accident, and a psychologist later diagnosed an adjustment disorder, among other conditions.
Security National's own examining psychologist saw her in January 2025 and found no diagnosis was warranted. The insurer also noted that the psychiatrist hadn't run any psychological tests.
The tribunal wasn't swayed. A psychiatrist works from clinical observation, not tests, it agreed, and the insurer's report didn't line up with the rest of her file. She was out of the cap, and a $2,486.00 psychological assessment was approved, with interest.
Then came the $4,959.75 plan. Dated November 26, 2024, it proposed sixteen counselling sessions of 1.25 hours each with a psychologist. The claimant said the treatment had already happened and filed notes and a progress report from a psychotherapist covering 13 sessions between December 6, 2024 and April 4, 2025.
The notes weren't signed.
The tribunal accepted that the psychotherapist wrote them and ran the sessions - her own report said as much. That's where the claim came apart. What was delivered was "not the treatment which was proposed in the treatment plan," the tribunal said.
Under Ontario's accident benefits rules, an insurer doesn't have to pay for treatment that happens before a plan for it is submitted. There was no evidence anyone had submitted a plan for the psychotherapist's sessions. The tribunal also called the claimant's arguments on this plan "very superficial in nature."
Two more plans stalled for lack of detail. A $4,675.30 physiotherapy plan failed because she never explained what the treatment was meant to achieve. A $2,712.00 attendant care assessment failed because she never named a daily task she couldn't handle on her own after the crash.
She also asked for a special award, which can add up to 50 per cent of the benefits payable when an insurer unreasonably holds back or delays payment. Her argument: relying on its own psychologist's report was unreasonable in itself. Security National countered that insurers aren't held to a standard of perfection.
The tribunal agreed with the insurer. It found no evidence Security National's conduct was "excessive, imprudent, stubborn, inflexible, unyielding or immoderate." The insurer had booked an examination and handled the claim based on its assessor's opinion, and no award followed.
The examiner's report lost the diagnosis argument. Relying on it still kept the insurer clear of a penalty.
Adjusters reviewing treatment invoices in Ontario can compare who delivered the sessions with who is named on the plan - here, that gap left the insurer nothing to pay under section 38(2) of the accident benefits schedule.
The decision does not mention any appeal or reconsideration request.
