Tribunal Finds Insurer’s Own Examiner Undercut Minor Injury Classification
A Canadian insurance tribunal has found that an insurer’s own medical examiner undermined its decision to treat a claimant’s injuries as minor. The case highlights how insurer-commissioned assessments can become key evidence in disputes over auto insurance benefits.
What happened
A Canadian insurance tribunal has found that an insurer’s own medical examiner undercut the insurer’s decision to classify a claimant’s injuries as minor in an auto insurance benefits dispute. The ruling turned on inconsistencies between the insurer’s minor injury position and the evidence from the assessment it commissioned.
What it means for consumers
An insurer-commissioned medical report can become key evidence if the insurer later denies benefits on minor-injury grounds. If an assessment contains findings that conflict with a minor injury designation, claimants may be able to challenge the denial and seek access to benefits beyond the minor injury cap.
What it means for premiums
No direct premium change has been announced.
Coverage considerations
If a claim is removed from the minor injury stream, coverage may expand to include additional medical and rehabilitation benefits, and potentially other benefits such as income replacement or attendant care depending on the policy and provincial rules. The decision also signals that insurers should reconcile examiner recommendations with their minor injury determinations before denying or limiting benefits.