Concussion after a car accident in Ontario: the proof that takes you out of the Minor Injury Guideline

A concussion is outside the definition of a minor injury in Ontario, so a person with a proven concussion should come out of the $3,500 Minor Injury Guideline (MIG). The dispute with the insurer is usually about proof: the Licence Appeal Tribunal looks closely at who diagnosed the concussion, when, and on what basis.

This article is part of our series on the MIG. For the basics, see our guide to the Minor Injury Guideline in Ontario and what the $3,500 limit pays for.

Why is a concussion outside the MIG?

Section 3(1) of the Statutory Accident Benefits Schedule (SABS, O. Reg. 34/10) defines a minor injury as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation”, together with their clinically associated sequelae. A concussion is missing from that list. As one Tribunal decision put it, “Concussions and post-concussive syndrome, if established, fall outside the MIG.”

In February 2026 the Divisional Court made a related point about brain contusions seen on a CT scan. In Marcelo v. The Personal Insurance Company, 2026 ONSC 974, the Court held that the definition is about the type of injury. It also noted that the only diagnostic test available under the MIG without insurer approval is an X-ray, and that the neuropsychological assessment the claimant asked for cost $6,723.50, almost twice the whole MIG limit. Our MIG guide covers Marcelo and the later Zapanta decision.

In practice, the important words are “if established”. Insurers rarely argue that a concussion is a minor injury. They argue that the person did not have one.

Two Tribunal decisions with opposite results

Two decisions released in August 2024 show where the line usually falls.

Dawkins v. BelairDirect Insurance Company, 2024 CanLII 81222 (ON LAT). The CT scan on the day of the accident was normal. The family doctor’s notes soon after the accident mentioned a “head injury”. The word “concussion” appeared in another family doctor’s notes about six months later, with no explanation of how that diagnosis was reached. The chiropractor wrote “possible concussion” and listed a likely concussion on the OCF-23 form. The Tribunal found the basis of the late diagnosis unclear, gave little weight to the chiropractor because a medical diagnosis is outside a chiropractor’s scope of practice, and relied on the normal CT scan. The claimant stayed in the MIG.

Gavey v. Wawanesa Insurance, 2024 CanLII 77430 (ON LAT). The claimant did not hit her head. The day after the accident she went to urgent care with headaches and sensitivity to light. Three days after the accident a physician at the same hospital diagnosed a likely concussion and referred her to a concussion clinic. Her family doctor recorded the concussion at two later visits, along with headaches, dizziness and nausea. Eight months after the accident the insurer’s examining physician found no evidence of a concussion. The Tribunal preferred the diagnoses made close to the accident, said a family physician can diagnose a concussion and a neurologist’s opinion is not required, and noted that “it is common knowledge that a concussion may occur without the head being impacted.” She came out of the MIG.

The difference is the medical record from the first days and weeks. In Gavey a physician wrote down the symptoms, gave a diagnosis, made a referral and repeated the diagnosis later. In Dawkins the record had a vague note, a late diagnosis without reasons and an opinion from a practitioner who could not make that diagnosis.

Gavey also shows the limit of a win on the MIG. The physiotherapy plan in dispute was still refused, because there was no evidence that it was reasonable and necessary when it was submitted. Each Treatment and Assessment Plan (the OCF-18 form) has to be supported on its own.

What evidence carries weight

From these decisions and others like them, the Tribunal tends to give weight to:

• A diagnosis from a physician. An emergency, walk-in or family physician can diagnose a concussion.
• Records made close to the accident. In Gavey they outweighed an insurer examination done months later.
• Symptoms written in the chart. A diagnosis with no recorded symptoms behind it is easier to challenge.
• A referral and follow-up, such as a referral to a concussion clinic.
• The right professional for the question. Physiotherapy and chiropractic notes are useful as a record of symptoms, and the diagnosis itself should come from a physician. In Gavey the Tribunal found the insurer’s psychologist unhelpful on the concussion question, because the psychologist had done a psychological assessment and declined to comment on the physical injuries.

Concussion symptoms in a second language

This is a problem we see often with clients who came to Canada as adults. Many concussion symptoms are described in words: feeling foggy, losing words, struggling to follow a conversation, getting tired from reading. A person describing these problems in English during a short emergency visit often says only “headache”. That single word is what ends up in the record, and months later it is the record the Tribunal reads.

Before you see your family doctor, write down every change you have noticed since the accident, in your own language if that is easier, and bring the list. If reading or speaking English has become harder than before the accident, say so, because that is a change too. Ask whether an interpreter can join the appointment. If you later have cognitive or neuropsychological testing, ask which tests are used and in what language. We ask the same questions when we review a file, and we work with clients in English, Russian, Ukrainian and Armenian.

When a CT or MRI shows a brain injury

For adults, section 3.1(1) of the SABS includes a traumatic brain injury with positive CT or MRI findings “indicating intracranial pathology”, such as “intracranial contusions or haemorrhages”, as one part of the test for catastrophic impairment. The second part is the person’s outcome rating on the Extended Glasgow Outcome Scale at set times after the accident. In Marcelo the Court called this kind of injury potentially catastrophic for a person over 18.

If your imaging shows a brain injury, the question may be bigger than the MIG. VIA Legal represents clients in Accident Benefits claims, including those under the Minor Injury Guideline (MIG); for cases involving potential catastrophic impairment (CAT), we collaborate with experienced personal injury lawyers. See Paralegal or lawyer after a car accident in Ontario.

The insurer kept you in the MIG after a concussion: what next?

1. Collect the records: emergency or urgent care notes, the CT report if a scan was done, and your family doctor’s notes from the first weeks.
2. Ask your doctor to state the diagnosis clearly, with the symptoms it is based on and the date they began.
3. Send the evidence to the insurer in writing and ask it to reconsider the MIG decision.
4. Ask your treating practitioner about an OCF-18 for concussion treatment or an assessment outside the MIG.
5. Keep the insurer’s written refusal. Under section 56 of the SABS, an application to the Tribunal has to be started within two years after the insurer’s refusal to pay. See our pages on the Licence Appeal Tribunal and on Accident Benefits denials.

If the insurer asks you to attend its own examination, read what an insurer examination means for your claim first.

If a doctor told you that you had a concussion and the insurer still treats your injuries as minor, our team can go through your records with you. Send us a message and we’ll get back to you shortly.

Frequently asked questions

Sources: O. Reg. 34/10, sections 3(1), 3.1(1), 18(1) to 18(3), 38 and 56 (e-Laws, consolidation from July 1, 2026); Marcelo v. The Personal Insurance Company, 2026 ONSC 974; Dawkins v. BelairDirect Insurance Company, 2024 CanLII 81222 (ON LAT); Gavey v. Wawanesa Insurance, 2024 CanLII 77430 (ON LAT).

VIA Legal Services Professional Corporation. Naira Velumyan is a Licensed Paralegal in Ontario (LSO #P21370). This article is for general informational purposes only and does not constitute legal advice for your specific situation.

Who handles your claim

Naira Velumyan is a Licensed Paralegal in Ontario and the founder of VIA Legal. She holds a PhD in Psychology, which shapes how she handles psychological injury claims. Read more about Naira