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I.L.G. v. Aviva General Insurance Company (18-009010)

  • January 17, 2020

The claimant sought removal from the MIG and entitlement to a chronic pain assessment, a neurological assessment, an orthopedic assessment, assistive devices, and interest on the payment of overdue benefits. Adjudicator Grant found that the claimant’s injuries were predominantly “minor injuries” and that injuries she suffered later, as a result of a July 21, 2016 accident, were more significant. As such, Adjudicator Grant did not have to address the disputed assessments, which were denied due to the insurer’s position that the MIG applied to the claimant’s injuries. With respect to OCF-18 for assistive devices, the insurer approved it subject to the claimant submitting the treatment plan to her collateral benefits provider; the insurer agreed to pay the remaining balance. Since the claimant did not provide any evidence that the OCF-18 was submitted to her collateral benefits provider, Adjudicator Grant found that the insurer was not required to pay any amount of the treatment plan until the claimant provided proof of submission to her collateral benefits provider.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline
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