Written By: Kate Hunter, Associate and Avery Kavanaugh, Student-at-law
8 Minute Read
Disputing injury severity Ontario is one of the most common and most frustrating issues people face after a serious accident.
In many cases, insurance companies do not deny that a collision occurred. Instead, they focus on the severity of your injuries.
If you feel like your pain, limitations, or ongoing symptoms are being minimized, you are not alone. Many individuals in insurance disputes are told, directly or indirectly, that their condition is “minor,” “resolved,” or not as significant as they claim, which can become confusing and invalidating.
Understanding why severity becomes the central issue and learning how to address this can help you respond with confidence and clarity.
Why Injury “Severity” Matters in Claims
Severity directly affects what benefits and compensation may be available to you. In Ontario, injury severity can determine:
- The type and amount of accident benefits you receive
- How long treatment will be funded
- Whether you qualify for enhanced medical and rehabilitation coverage
- The value of a tort claim for pain and suffering
- Whether an injury meets catastrophic impairment thresholds
In many serious injury claim dispute cases, severity becomes the defining issue. Because severity impacts financial exposure for insurers, it often becomes the focal point of the dispute.
How Insurers Assess Injury Severity
An injury severity assessment is not based solely on how much pain someone reports. Insurers typically look at documented evidence, including:
- Formal medical diagnoses
- Imaging results (C-rays, CT scans, MRIs)
- Objective findings on examination
- Functional limitations
- Treatment frequency and duration
- Recovery timelines
Importantly, severity is often measured by documented impact, not just subjective experience. For example, if a medical record reflects that a person can return to work without restrictions, an insurer may interpret that as evidence of limited severity. If records show ongoing restrictions, therapy attendance, and specialist referrals, that supports a different conclusion. Often, self-reported symptoms are not viewed as credible as the opinions and conclusions of medical and treatment providers. This underscores the importance of seeking treatment early to establish the evidentiary foundation for your injuries and impairments, and why consistent and thorough medical documentation is so critical in proving injury severity.
For more information on how accident benefit disputes are handled in Ontario, the Financial Services Regulatory Authority of Ontario (FSRA) provides helpful guidance on accident benefits disputes and insurer assessments.
Why Insurers Push Back on Serious Injury Claims
Insurance companies are businesses. Severity classifications influence compensation amounts, reserve calculations, and claim costs. As a result, there may be internal thresholds that shape how injuries are categorized. Common strategies in a claim dispute include:
- Framing injuries as “minor” under statutory definitions
- Arguing that symptoms have “resolved”
- Suggesting the injury is pre-existing
- Relying heavily on early emergency room records
- Emphasizing normal imaging findings
Early medical records can carry significant weight. If initial documentation does not capture the full extent of symptoms, insurers may rely on those records to downplay severity later. This dynamic often leaves injured individuals feeling that their struggles are being overlooked and unfortunately, is inconsistent with the reality that symptoms can be delayed or subtle at onset, and that the recovery process is rarely linear.
Common Ways Injuries Are Minimized
In cases involving insurance minimizing injury, certain patterns frequently emerge.
- Focus on “Normal” Imaging: An MRI may not show soft tissue damage or certain types of concussions. However, normal imaging does not mean an injury is not serious. Many chronic pain conditions and brain injuries are diagnosed clinically rather than radiologically.
- Emphasis on a Short ER Visit: A brief emergency room visit does not reflect the long-term impact of an injury. ER departments prioritize life-threatening conditions, not chronic recovery issues.
- Delayed Symptom Arguments: Symptoms that develop days or weeks later may be framed as unrelated. In reality, delayed onset symptoms are medically recognized, particularly in soft tissue and brain injuries.
- Gaps in Treatment: If there is a break in care, whether due to financial stress, childcare responsibilities, or misunderstanding discharge instructions, insurers may argue that the injury was not severe. However, gaps do not automatically mean recovery occurred.
These arguments often simplify what is a complex recovery process.
How Medical Evidence Shapes Severity Disputes
Proving injury severity is best done by cumulative records. Severity is often established through longitudinal family physician notes, specialist reports, functional capacity evaluations, neuropsychological testing, documented work restrictions, and ongoing therapy records.
The Ontario Ministry of Health outlines how medical documentation and assessments are used to guide care decisions. That same documentation often becomes central in legal disputes.
For brain injuries in particular, organizations like the Ontario Brain Injury Association explain how severity can be misunderstood without proper cognitive testing and specialist input.
In many insurance dispute cases, the strength of the claim grows over time as the medical record reflects persistent limitations and unsuccessful attempts to return to baseline functioning.
The Role of Advocacy in Severity Disputes
Lawyers play a critical role in connecting medical evidence to legal definitions of seriousness. Medical professionals document symptoms and impairments. Lawyers translate those findings into the language required by insurance policies and legislation. In a claim dispute, legal advocacy may involve:
- Reviewing insurer examination reports
- Responding to denial letters
- Gathering additional specialist opinions
- Coordinating independent assessments
- Challenging improper classifications
- Representing clients in mediation, arbitration, or litigation
Severity disputes are not simply medical disagreements. They are structured legal disputes governed by statutory definitions and evidentiary standards.
Having experienced counsel ensures that medical documentation is interpreted within the correct legal framework.
What to Do If Your Injury Severity is Being Disputed
If you are facing disputes over the severity of your injuries in Ontario, there are practical steps you can take:
- Continue treatment: Consistent care demonstrates ongoing need and supports longitudinal documentation.
- Document functional impact: Ask your healthcare providers to record how symptoms affect daily activities. Limitations in walking, sitting, concentration, or sleep are highly relevant.
- Keep personal notes: A symptom journal can help ensure concerns are raised during appointments.
- Follow through on referrals: Specialist assessments can significantly strengthen a severity case.
- Seek legal advice early: Understanding your rights early can prevent missteps and clarify how documentation supports your claim.
In Conclusion: Seriousness Is Not Defined By a Label
Injury severity is not determined by how an insurer characterizes your condition. It is determined by the real-world impact on your body, your work, your independence, and your quality of life, which is supported by medical evidence.
If you feel that your injuries are being minimized, you do not have to navigate that process alone. Our team at McLeish Orlando has extensive experience handling serious injury claim disputes and advocating for clients in personal injury insurance disputes.
To learn more about how we can help, visit our Practice Areas page, review our FAQs, or connect directly with our office for a free consultation.
