Introduction

Four chiropractic treatment plans land at the Licence Appeal Tribunal. They look like any other plans, except for one detail: they were all authored by the claimant's husband, who was also her treating chiropractor and a co-insured on the same policy.

The plans fail, every one of them. But not for the reason most clinics would assume. In a 2026 Security National Insurance decision, 2026 CanLII 56628 (ON LAT), the Tribunal declined to dismiss the claims on conflict-of-interest grounds. It held that spouse authorship was a factor in weighing the evidence, then denied the claims on procedure and documentation instead.

That distinction matters for every Ontario clinic. Family treatment is not prohibited, but it raises the documentation bar exactly where most clinics are weakest. Here is what the decision actually says, and how to protect your own claims (see the 2026 LAT decision roundup for the year's full pattern).

What Happened

The applicant was injured in an October 2016 accident and applied for accident benefits. After Security National denied the benefits, four chiropractic treatment plans proposed by the applicant's treating chiropractor went to the Tribunal: $8,040.00 submitted in December 2022, $2,580.00 in January 2024, and two plans of $2,600.00 each in June and October 2024.

The treating chiropractor was also the applicant's husband and a co-insured under her policy. Security National argued those overlapping roles destroyed the independence and reliability of his recommendations, pointing to section 46 of the Schedule and to court authority on the impartiality of experts. The insurer asked the Tribunal to dismiss the claims outright on conflict-of-interest grounds.

Adjudicator Melanie Malach declined. She found a potential conflict in treating a family member, but noted the College of Chiropractors of Ontario has no rule explicitly barring it. "Family treatment is not explicitly named as a prohibited conflict of interest," she wrote, adding that the insurer had not raised the issue when it assessed the claims. The claims would not be dismissed simply because a spouse authored them. His authorship would instead be a factor in weighing the evidence.

The claims then failed on their own weaknesses:

  • The December 2022 claim was submitted on an OCF-6 expense form instead of a treatment plan. Under section 38(2) of the Schedule, an insurer is not liable for an expense incurred before a compliant treatment plan is submitted. The adjudicator held she had no discretion to waive that requirement.
  • The remaining three plans failed for lack of objective support. A treatment plan, on its own, does not establish that care is reasonable and necessary. The applicant had no contemporaneous clinical records from her treating practitioners for the relevant period, and her family physician's last note pre-dated the disputed plans. Insurer examination reports from a neurologist and a general practitioner concluded no further treatment was warranted.

The application was dismissed in full. No benefits, no interest, and no award under section 10 of Regulation 664.

Why Spouse Authorship Still Hurts

The conflict-of-interest argument did not win this case. The thin record did. But the two are connected.

When a plan is authored by the claimant's spouse, the Tribunal knows the clinical judgment is not arm's length, and it weighs that authorship accordingly. Every gap in the file gets a harder look. A plan that might survive on minimal documentation from an independent provider will not survive the same documentation when a family relationship is in play.

The practical lesson is not "never treat your spouse." It is that spouse-authored plans carry a built-in credibility handicap, and the only way to overcome it is a file stronger than the baseline: contemporaneous clinical records, compliant forms, and objective support beyond the plan itself.

What This Means for Clinics

The decision's reasoning applies to any relationship that compromises clinical independence:

  • A chiropractor or physiotherapist who treats their spouse and authors the treatment plans
  • A clinic director who prepares plans for a business partner
  • A provider who treats a parent, child, or sibling and submits the resulting claims

In each case, the Tribunal will not necessarily reject the claim because of the relationship. But it will weigh the relationship, and it will require the documentation to stand on its own.

How to Protect Your Claims

1. Refer family members out when you can.

The simplest rule still applies. If a family member is injured in a car accident, refer them to another clinic. The treatment may be identical, but the claim will not carry the relationship handicap.

2. If you treat a family member, expect scrutiny and add independent review.

Where referral is not practical, have every treatment plan and significant clinical decision reviewed and co-signed by an independent provider. It does not erase the relationship, but it adds the arm's-length voice the Tribunal looks for.

3. Disclose the relationship to the insurer.

In this case, the insurer's failure to raise the conflict at assessment was part of why the outright denial failed. Do not hand the insurer the same mistake in reverse: disclose the relationship at the time of the initial claim so it cannot be spun as concealment.

4. Use the right form.

The $8,040.00 claim died because it was submitted as an OCF-6 expense rather than a treatment plan. Confirm every claim is on the correct form for its benefit type before it goes out. It is the same form discipline the 2026 Allstate admin time ruling demands of treatment hours.

5. Keep contemporaneous clinical records.

This is what actually decided the case. The plans failed because there were no clinical notes from the treating practitioners for the relevant period. A treatment plan is not evidence of itself, and the same minimum documentation standard applies to every invoice and plan your clinic submits.

Conclusion

The decision is subtler than its news coverage suggests. The LAT did not say a spouse cannot treat a spouse. It said a spouse-authored plan is a weight factor, and it let the claims die on the record: the wrong form, no contemporaneous notes, no objective support.

For clinics, the decision is a two-part warning. Independence matters, and documentation matters more. A family relationship raises the bar on the evidence, and a thin file will not clear it. Review your active files for relationship conflicts and documentation gaps before the next plan goes out.