Chiropractor Complaints, Investigations and Discipline in Ontario

When the College of Chiropractors Contacts You

This page is for chiropractors registered in Ontario, including clinic owners and those who provide third-party evaluations for insurers. Complaints commonly follow an injury after an adjustment, a dispute about a treatment plan or prepaid package, or an independent evaluation the patient disagrees with.

Illustrative example, not an actual CCO letter

“The College has received a complaint regarding care you provided, including a cervical adjustment following which the patient reports experiencing dizziness, and a prepaid treatment plan the patient was asked to sign at the first visit. Please provide your response and the complete patient record.”

Who Investigates and Who Decides

Regulator: The College of Chiropractors of Ontario, continued, under the Chiropractic Act, 1991. Its complaint, investigation and discipline procedures come from the Health Professions Procedural Code, Schedule 2 to the Regulated Health Professions Act, 1991 (“the Code”), which applies to every regulated health profession in Ontario.
Who investigates: Investigators appointed for the Inquiries, Complaints and Reports Committee. They can examine your practice, enter your business premises at reasonable times, and access relevant patient records. In a Registrar’s investigation you must co-operate fully (Code, s. 76(3.1)).
Who decides at the investigation stage: A panel of the Inquiries, Complaints and Reports Committee (ICRC) (Code, s. 26).
Who holds hearings: The CCO Discipline Committee, under its Rules of Procedure and the Statutory Powers Procedure Act. Hearings are open to the public, and notices of hearing are posted on the public register under the chiropractor’s name.

Authorized acts

Chiropractors may communicate certain diagnoses, perform spinal manipulation (moving the joints of the spine beyond the usual range of motion with a fast, low-amplitude thrust), and put a finger beyond the anal verge to manipulate the tailbone (Chiropractic Act, 1991, s. 4). CCO standards govern how these acts are performed.

Key timelines in the Code

The Registrar must notify you within 14 days of receiving a complaint or report (Code, s. 25(6)).
You may make written submissions to the Inquiries, Complaints and Reports Committee within 30 days of receiving that notice. The committee can shorten that time if it believes, on reasonable and probable grounds, that your conduct exposes or is likely to expose patients to harm or injury (Code, s. 25.2).
Complaints are expected to be disposed of within 150 days. If that is missed, the Registrar must give the complainant a new expected date no more than 60 days later (Code, s. 28).
With both your and the complainant’s consent, the Registrar can refer a complaint to alternative dispute resolution, but not if it involves an allegation of sexual abuse or has already been referred to discipline (Code, s. 25.1).

CCO describes the 30-day response as required. The Code itself says you may make submissions within 30 days (s. 25.2), but in practice you should treat the deadline as firm.

Common Issues in Chiropractor Investigations

Adjustments and adverse events

Injury or symptoms after manipulation, especially cervical adjustments, and whether risks were explained and screening was done. See CCO standard S-005: Chiropractic Adjustment or Manipulation.

Radiographs

Ordering X-rays without clinical justification, or interpreting and reporting them inadequately (S-006).

Treatment plans and fees

Long prepaid packages, pressure to commit early, and refunds when care ends. Conflict of interest in commercial ventures is addressed in S-019.

Third-party evaluations

Complaints from people assessed for insurers or employers about objectivity and conduct during the evaluation (S-018).

Boundaries and records

Sexual relationships with patients are prohibited (S-014) and sexual abuse findings carry mandatory penalties (Code, s. 51(5)). Record keeping and record security are covered by S-022.

What Can Happen Next

Complaint or Registrar’s investigation

After considering the investigation and your submissions, a panel of the Inquiries, Complaints and Reports Committee (ICRC) may take no further action; give advice or recommendations; require a specified continuing education or remediation program (SCERP); require you to appear to be cautioned; refer specified allegations of professional misconduct or incompetence to the Discipline Committee; or refer you for incapacity proceedings (Code, s. 26). Matters are also sometimes resolved through an undertaking, such as an agreement to restrict or monitor your practice. If the panel considers a complaint frivolous, vexatious, made in bad faith, moot or an abuse of process, it must give notice and allow 30 days for written submissions before declining to act (s. 26(4)–(5)).
Interim order

If the committee believes your conduct exposes or is likely to expose patients to harm or injury, it can suspend your certificate or impose terms, conditions or limitations while the matter continues (Code, s. 25.4(1)). You must normally receive notice and at least 14 days to make written submissions first, unless the risk is urgent (s. 25.4(6)–(7)). The order lasts until it is varied or the matter is finally resolved (s. 25.4(4)).
Discipline hearing

A panel of the Discipline Committee hears evidence and decides whether professional misconduct or incompetence is proven (Code, ss. 51, 52). If misconduct is found, it may revoke or suspend your certificate, impose terms, conditions and limitations, order a reprimand, or order a fine of up to $35,000 (s. 51(2)). Findings of sexual abuse carry mandatory orders, including revocation for the conduct listed in s. 51(5). CCO posts joint submissions accepted by a panel and final decisions on the public register.
Review or appeal

HPARB review: you or the complainant may ask the Health Professions Appeal and Review Board to review an ICRC decision on a complaint, except a referral to discipline or for incapacity proceedings (Code, s. 29(2)). The request must be made within 30 days after receiving the notice of the right to request a review that comes with the decision (s. 29(3)), and HPARB cannot extend that time by more than 60 days (s. 29(4)).

Divisional Court: discipline and fitness to practise decisions can be appealed on questions of law, fact or both (Code, s. 70). Orders based on incompetence, incapacity or certain sexual abuse findings, and orders in matters where an interim order was in place, take effect immediately despite an appeal (ss. 25.4(5), 71, 71.1).

Checklist: Responding to a CCO Complaint

Documents to gather

The College’s letter and the date you received it
The complete patient record: history, examination findings, diagnosis, consent, treatment notes and re-assessments
Radiographs and reports, and the clinical reasons for ordering them
Treatment plans, financial agreements, receipts and refund records
For evaluations: the referral letter, your report and your notes of the session
Clinic policies and staff involved in the patient’s care

Details to check in the notice

Complaint or Registrar’s investigation?
Your 30-day response date
Whether an investigator will attend your clinic
Whether an interim order is being considered

Rules and resources to consult

Health Professions Procedural Code, ss. 25–29, 51–52, 70–71 and 75–76
Chiropractic Act, 1991 and its professional misconduct regulation
CCO standards of practice, guidelines and policies relevant to the allegations
CCO Discipline Committee Rules of Procedure
Your professional liability insurer

Frequently Asked Questions

Do I need the patient’s consent to send their record to the College?

CCO says that when the patient made the complaint, consent is implied and the College does not need additional consent for you to release the record. Investigators also have power to access relevant patient records. Keep a record of exactly what you provided and when.

What is the difference between a complaint and a report?

A complaint is filed by someone, usually a patient or family member, who becomes a party and receives the decision. A report is information the Registrar acts on by appointing investigators (Code, s. 75), for example after a mandatory report from an employer or another professional. The same committee decides both, but HPARB review rights under s. 29 are tied to complaints.

Can I keep practising during the investigation?

Usually, yes. Your certificate is unaffected unless the committee makes an interim order (Code, s. 25.4) or you agree to an undertaking that limits your practice.

Will this appear on the public register?

The Code requires the public register to note cautions, SCERPs, acknowledgements and undertakings, and allegations referred to discipline (s. 23(2)). College by-laws can add more. Check what will be posted before agreeing to any resolution.

Sources

Statutory references are to the provisions listed below, as consolidated on e-Laws when this page was prepared.

Regulated Health Professions Act, 1991, S.O. 1991, c. 18, Schedule 2 (Health Professions Procedural Code), ss. 23, 25–29, 51–52, 70–71, 75–76, 85.5 — e-Laws consolidation period beginning January 1, 2026; checked November 10, 2026.
Chiropractic Act, 1991, S.O. 1991, c. 21, ss. 4–5 — e-Laws consolidation period beginning June 3, 2021; checked November 10, 2026.
CCO, “Responding to a Complaint” — Checked November 10, 2026.
CCO, “The Discipline Process” — Checked November 10, 2026.
CCO, “Standards of Practice” — Titles checked November 10, 2026.
Health Professions Appeal and Review Board (role; Consolidated Rules of Practice and Procedure in effect May 4, 2026) — Checked November 10, 2026.