Tribunal penalizes insurer for holding the line on minor injury classification after concussion diagnosis.
A concussion diagnosis, a $3,500 cap, and an insurer that would not budge - until the Tribunal stepped in.
In Zapanta v. Security National Insurance Company, 2026 ONLAT 24-010462/AABS, released April 24, 2026, the Ontario Licence Appeal Tribunal ordered Security National Insurance Company to pay a 25% penalty award for unreasonably maintaining that a claimant's concussion fell within the Minor Injury Guideline. The decision applies the Divisional Court's ruling in Marcelo v. The Personal Insurance Company, 2026 ONSC 974, which confirmed that concussions are not minor injuries.
Here is what happened.
On April 20, 2022, Mariedel Zapanta was driving when her vehicle struck a curb. She did not seek medical attention right away but went to the hospital a few days later, where emergency department physician Dr. S. Brady diagnosed her with a concussion. She then applied for statutory accident benefits under the Statutory Accident Benefits Schedule.
Security National placed her injuries under the MIG, which caps treatment funding at $3,500 under section 18 of the Schedule. The insurer pointed to the low severity of the collision, Zapanta's pre-existing medical history - which included two prior concussions, borderline personality disorder, ADHD, and autism - and the fact that she continued to her destination after the accident, waited days to visit the hospital, and returned to work.
A second automobile accident on January 8, 2023, in which Zapanta sustained another concussion, added further complexity. The insurer argued the subsequent accident broke the chain of causation for the 2022 claim.
Vice-Chair Brian Norris was not persuaded. He found the concussion diagnosis was "clear and uncontroverted," supported by hospital records and a subsequent diagnosis of post-concussion syndrome from chiropractor Dr. J. Dixon. Applying Marcelo, the Tribunal stated that "the determination in Marcelo is indisputable - concussions are not a minor injury." It also noted the Divisional Court had found it "illogical" for an injury with the potential to be classified as "catastrophic" to also be considered "minor."
The Tribunal also pushed back on the insurer's argument that Zapanta's medical history undermined her claim, stating it is "settled law that the Respondent must take their insured as they are, even if the insured has a history of concussions, or hitting their head on walls."
That said, the second accident did limit what the Tribunal was willing to approve. Using the "but for" causation test from Sabadash v. State Farm et al, 2019 ONSC 1121, only two optometric treatment plans by Dr. K. Dolman totalling $6,440 were approved - both submitted before the January 2023 collision. Claims for psychological services, occupational therapy, a nutritional assessment, income replacement benefits, and attendant care benefits were denied, with the Tribunal finding the applicant had not met her onus to show they were reasonable and necessary as a result of the 2022 accident.
On the penalty, Vice-Chair Norris found that the insurer "cannot reject uncontroverted evidence of a non-minor injury, such as a diagnosis of a concussion by emergency room physicians," adding that the insurer "acted in a manner which was inflexible or unyielding, which an award is meant to discourage." The award landed at 25% rather than the maximum 50% available under section 10 of Regulation 664. The reason: Zapanta herself had delayed providing hospital records until November 2022, and the overlap between her pre-existing conditions and accident-related complaints made further investigation reasonable. Where the insurer went wrong was in holding its MIG position after those records arrived.
The takeaway for claims departments is straightforward. Once medical evidence of a concussion lands on the file, maintaining the MIG classification is a risk that now carries a price tag.
