Category: Minor Injury Guideline

B.H. v. Certas Home and Auto Insurance Company (17-006967)

The insurer sought reconsideration of the Tribunal’s decision that the denial letter for a psychological assessment was deficient and that the insurer was barred from applying the MIG; the assessment was also found reasonable and necessary. Vice Chair Lester dismissed the reconsideration. She held that the Tribunal had not violated the rules of procedural fairness or natural justice. She also held that the Tribunal had not made a significant error of law or fact such that a different result would have been reached.

W.P. v. Travelers Insurance (18-010458)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of impairments falling outside of the MIG definition.

E.G. v. Wawanesa Insurance (18-010183)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of pre-existing conditions, psychological impairments, or chronic pain syndrome.

Applicant v. Certas Direct Insurance Company (17-008853)

The claimant sought removal from the MIG, and entitlement to ACBs and various medical benefits. The insurer argued that the claimant was barred from proceeding to a hearing due to his failure to attend an IE addressing attendant care benefits. Vice Chair Helt concluded that the claimant was not barred from proceeding with his claim for ACBs because the IE notices contained the wrong address for the IE location. In terms of the claimed benefits, Vice Chair Helt found that the claimant suffered from psychological injuries falling outside of the MIG. She awarded the claimed psychological assessment and therapy, but held that the proposed physical therapy was not reasonable and necessary. Finally, in terms of the ACBs, Vice Chair Helt concluded that the claimant did not require personal care and that he had not incurred any attendant care expenses.

J.A. v. Aviva General Insurance Company (18-008207)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant found that the claimant suffered from minor injuries. He rejected the argument that the claimant suffered from chronic pain syndrome because there was no evidence of the claimant having impaired functionality.

J.A. v. Aviva Insurance Company (18-005595)

The claimant sought removal from the MIG and entitlement to three treatment plans and two assessments. Adjudicator Grant concluded that the claimant suffered from psychological injuries which was not a minor injury. He awarded the proposed psychological assessment, but rejected the proposed treatment plans for physical therapy and the proposed attendant care assessment.

K.P. v. Security National Insurance Company (18-007561)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Sharda found that the claimant failed to prove that her injuries fell outside of the MIG. There was little evidence of psychological impairment causing a loss of functional ability.

D.T. v. Wawanesa Mutual Insurance Company (18-005613)

The claimant sought entitlement to IRBs, the MIG, and various medical benefits. The insurer argued that the claimant’s entitlement to IRBs had already been decided and was res judicata. The Tribunal had already adjudicated an application for IRBs (among other things), which was upheld on reconsideration and at the Divisional Court. There was no new evidence to support that the claimant had additional injuries or conditions. The new medicolegal reports the claimant obtained could have been obtained prior to the first hearing.

G.M.K. v. Aviva Insurance Company of Canada(18-009487)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a psychological assessment. Adjudicator Manigat concluded that the claimant’s injuries fell within the MIG. The claimant relied on a section 25 psychological report, in which he was diagnosed with PTSD and Major Depressive Disorder. The respondent relied on a psychological IE, in which the assessor opined that the claimant did not suffer from a psychological impairment as a result of the accident. The adjudicator preferred the respondent’s IE report, noting that the claimant had attended his family doctor’s office on several occasions after the accident, but had at no point brought up any psychological issues.

B.M. v. Allstate Insurance (18-008410)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a chronic pain assessment. Adjudicator Maleki-Yazdi concluded that the claimant’s injuries fell outside of the MIG due to chronic pain, and that the claimant was entitled to the cost of the chronic pain assessment. The claimant continued to reported severe and persistent pain in her right shoulder and neck over five years after the accident, which had not improved with treatment. The adjudicator concluded that the claimant’s pain affected her life in a significant way, as it limited her ability to work, perform her regular activities of daily living, and caused disturbed sleep.