Tribunal removes benefits claimant from Minor Injury Guideline due to accident-caused chronic pain

In Oudeh v Co-operators General Insurance Company, 2026 CanLII 68591 (ON LAT), the applicant requested benefits under the Statutory Accident Benefits Schedule (SABS). The respondent insurer denied the benefits sought. 

Before the Licence Appeal Tribunal’s Automobile Accident Benefits Service, the applicant applied for the resolution of the dispute. 

Removal from Minor Injury Guideline

The Licence Appeal Tribunal granted the application. In removing the applicant from the MIG, the tribunal considered a pain specialist’s report, which: 

• diagnosed the applicant with chronic pain in her neck, as well as her upper, middle, and lower back 
• identified functional limitations in the applicant’s ability to sit or stand for lengthy periods of time 
• found cognitive impairment and additional limitations in squatting, climbing, lifting, carrying, and driving 
• attributed the applicant’s pain to the motor vehicle accident 

The tribunal also weighed the independent observations reported by the family physician, who confirmed the diagnosis issued by the pain specialist, and noted the applicant’s worsening neck and back pain, as well as the pain radiating to her lower legs. 

The tribunal pointed out that the insurer opted not to include medical evidence in its submissions. 

While the applicant made additional arguments regarding her removal from the MIG due to a pre-existing condition, the tribunal saw no need to tackle these submissions, given its determination that her case fell beyond the MIG. 

Entitlements to treatment

Based on the objective medical evidence, the Licence Appeal Tribunal found the applicant entitled to the chronic pain assessment, two physiotherapy treatment plans, and a psychological assessment, which were all found reasonable and necessary. 

The tribunal noted that the chronic pain assessment included a recommendation for a psychological assessment due to accident-related chronic pain. 

Interest and award

The Licence Appeal Tribunal applied interest on the payment of any overdue benefits under s. 51 of the SABS.

Lastly, the tribunal rejected the applicant’s requested award under s. 10 of Reg. 664. The tribunal explained that the respondent insurer did not act unreasonably, stubbornly, or imprudently. 

The tribunal added that the insurance company’s refusal of a plan was not, on its own, a basis to argue that the insurer had behaved unreasonably. 

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