For many Manitobans injured in motor vehicle accidents, the practical question is not who was at fault, but whether Manitoba Public Insurance Corporation (“MPIC”) will continue to fund treatment under the Personal Injury Protection Plan (“PIPP”). This issue becomes especially important when an injured person has reached maximum medical improvement but still depends on periodic physiotherapy to maintain function, manage chronic symptoms, or prevent deterioration.

This article argues that the Automobile Injury Compensation Appeal Commission (“AICAC” or “the Commission”) decision  AC-18-042 reflects an important but narrow shift in the way ongoing physiotherapy claims should be analyzed. The central question is not whether a claimant can satisfy a rigid supportive-care checklist imported from chiropractic practice. The controlling question is whether, on the evidence, the further physiotherapy remains medically required because of the accident. That shift does not make evidence less important. It makes the quality of the medical and functional evidence even more central.

The discussion below first sets out the Manitoba no-fault framework and the statutory basis for physiotherapy reimbursement. It then reviews the older supportive-care approach, explains how AC-18-042 moved the analysis away from terminology and toward medical necessity, and concludes with practical guidance for claimants, physiotherapists, and counsel preparing or responding to these disputes.

Manitoba’s No-Fault Insurance System: The Starting Point

In Manitoba, individuals injured in motor vehicle accidents generally do not pursue personal injury damages through traditional lawsuits against the other driver. Instead, Manitoba employs a no-fault system for bodily injury claims under Part 2 of The Manitoba Public Insurance Corporation Act. This legislation provides that compensation is available regardless of fault and prohibits tort actions for bodily injury where Part 2 applies.

For most Manitoba residents injured in Canada or the United States, claims are processed through PIPP. This background establishes the legal context for disputes regarding continued entitlement to treatment coverage by MPIC.

When MPIC Stops Paying for Physiotherapy

With this legal background, the central issue in these cases shifts from fault to entitlement. Section 136(1)(a) of The Manitoba Public Insurance Corporation Act authorizes reimbursement for medical and paramedical expenses resulting from the accident. Section 5(a) of Regulation 40/94 requires MPIC to pay for medical or paramedical care, including physiotherapy, when such care is medically required.

Therefore, when MPIC discontinues physiotherapy coverage, the primary legal question is not the terminology used to describe the treatment, but whether the ongoing care continues to be medically required as a result of the accident. Without a legal definition in the Act or its regulations, however, what does ‘medically required’ mean?

The Historical Supportive-Care Framework

Historically, these disputes were frequently outlined in terms of supportive care, a concept originating from chiropractic literature and adopted by AICAC in physiotherapy appeals. Earlier decisions distinguished supportive care from standard treatment aimed at improvement, recognizing that an individual might have reached maximum therapeutic or medical benefit yet still require periodic intervention to prevent regression.

In such cases, claimants were typically required to demonstrate more than persistent pain. Evidence of deterioration following cessation of treatment, improvement upon resumption, and consideration of alternative care options was often necessary. Some decisions also incorporated home-based self-care or exercise programs within this evaluative framework.

What the Older AICAC Cases Required

This earlier approach is exemplified by cases such as AC-06-07 and AC-08-132. In AC-06-07, the Commission referenced the traditional supportive-care framework and emphasized the importance of objective evidence of deterioration following the cessation of treatment. The claimant was successful because the Commission identified sufficient objective or corroborative evidence from multiple caregivers indicating deterioration without treatment and improvement with periodic intervention.

Similarly, in AC-08-132, the evidence centered on withdrawal from care, observable worsening, monthly treatment to prevent decline, and adherence to a home exercise program. Thus, claimants seeking supportive physiotherapy historically needed to align their claims with a structured evidentiary pattern. While the label itself was not determinative, the supportive-care test influenced the type of evidence AICAC required.

AC-18-042 and the Move Away from the Old Checklist

A significant development is found in AC-18-042, the latest published AICAC decision that substantially revised the analysis of physiotherapy claims. In this case, the panel reconsidered the appropriateness of applying the supportive-care test, originally derived from chiropractic practice, to physiotherapy.

Testimony from physiotherapists was particularly influential. One practitioner stated that ‘supportive care’ is not a standard term in physiotherapy, preferring instead to refer to ‘maintenance treatment’ or management of chronic conditions. MPIC’s physiotherapy expert similarly indicated that the term lacks a substantive basis within the physiotherapy field. The panel accepted this evidence.

This decision is particularly instructive because the panel emphasized that the central issue is whether additional physiotherapy treatments are medically required, irrespective of the terminology used. The panel clarified that labeling treatment as supportive-care physiotherapy does not affect its potential medical necessity. Importantly, the panel affirmed that ‘medically required’ under section 5(a) encompasses not only physiotherapy intended to achieve maximum medical improvement, but also treatment designed to prevent deterioration after such improvement has been reached. Consequently, claimants can justify their need for ongoing physiotherapy treatment by demonstrating that this modality of treatment is medically required because it prevents the decline of their medical condition and satisfies the statutory requirement.

In my assessment, this represents a substantive legal shift. The terminology itself was never the primary determinant, as the legal standard has always been based on whether treatment is ‘medically required’. The change introduced by AC-18-042 is the panel’s recognition that it may no longer be appropriate to apply the traditional chiropractic definition and test to physiotherapy claims without additional justification. Accordingly, I do not interpret the current law as obligating physiotherapy claimants to satisfy every criterion from earlier supportive-care cases. Evidence such as participation in a home-based program may still be relevant, but it is no longer a mandatory element of a distinct physiotherapy test.

The prevailing standard is now more straightforward: has the claimant established, on a balance of probabilities, that further physiotherapy is medically required due to the accident? In other words, has the claimant established that they reached maximum medical improvement and that physiotherapy is needed to prevent further deterioration?

Why Evidence Still Matters

However, this evolution does not necessarily simplify these cases. In AC-18-042, the claimant was ultimately unsuccessful in obtaining regular ongoing physiotherapy. Although the panel acknowledged that the claimant reported feeling better with treatment and believed it supported her quality of life, AICAC determined that subjective reporting alone was insufficient. The analysis required corroborating medical evidence.

In this instance, the panel found no objective documentary medical evidence indicating that her condition would deteriorate without regular physiotherapy, nor any evidence linking physiotherapy to reduced medication use. As a result, the claimant’s request for ongoing physiotherapy was denied, although further vestibular assessment and treatment were permitted. This outcome underscores that sufficient supporting evidence remains essential.

AICAC and Its Own Prior Decisions

It is also important to recognize that AICAC functions as an independent administrative tribunal rather than a court, and it is not bound by its own prior decisions. This explains why earlier supportive-care cases remain relevant but do not rigidly dictate future approaches.

Previous decisions are persuasive, particularly when well-reasoned and aligned with statutory provisions, but subsequent panels retain the authority to refine the analysis, as demonstrated in AC-18-042. Accordingly, older supportive-care cases continue to inform the analysis but must now be interpreted with caution, especially in the context of physiotherapy appeals.

Practical Takeaways for Claimants, Physiotherapists, and Counsel

For the public, the practical implication is that the use of the term maintenance care rather than supportive care by a physiotherapist does not, in itself, undermine a claim. AICAC has acknowledged that ‘supportive care’ is not standard terminology in physiotherapy. The critical consideration is whether the medical records substantiate the ongoing need for treatment. Do the records establish a connection between the treatment and the accident? Do they document the effects of reducing or discontinuing treatment? Do they provide sufficient detail regarding clinical findings, functional status, and treatment objectives to support medical necessity?

These factors are now central. While evidence such as participation in a home program, attempts at alternative treatments, and withdrawal from care may still be relevant, they serve as components of the overall proof rather than elements of a mandatory checklist.

Conclusion

Individuals struggling after a car accident should be aware that they do not have to navigate this process alone. Manitoba’s Claimant Adviser Office is a free and independent resource, separate from both MPIC and AICAC, and can assist individuals appealing bodily injury decisions after an Internal Review decision has been issued. In certain cases, consulting a lawyer may also be advisable.

This is important because not all physiotherapists are experts in documenting evidence for maintenance-care or supportive-care disputes in the manner expected by insurers or tribunals. Their primary responsibility is to treat the injury, not to build an appeal record. As a result, even when ongoing treatment genuinely helps prevent deterioration, the clinical chart may not always contain the detailed evidence needed to establish that the care remains medically required. Early guidance can help ensure that the necessary evidence is gathered before such issues arise.