Category: Minor Injury Guideline

P.Y. v Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal’s decision based on there being new evidence that the claimant could not have reasonably obtained earlier and based on the insurer’s concession at the close of the proceedings that the MIG did not apply. Adjudicator Grieves granted the claimant’s reconsideration request. Adjudicator Grieves accepted that the new evidence, being a s. 25 psychological report, was not reasonably available to the claimant at the time of the hearing and would have affected the Tribunal’s result with respect to its MIG finding. Adjudicator Grieves also criticized the parties for not advising the Tribunal that the insurer had agreed at the close of proceedings to remove the claimant from the MIG, as this would have affected the Tribunal’s result. Adjudicator Grieves ordered that the matter be sent back to the Tribunal to determine the reasonableness and necessity of the disputed treatments plans as the claimant was now out of the MIG.

F.J.H. v. Unica Insurance Inc. (18-008249)

The claimant disputed his entitlement to a medical benefit and the MIG. Adjudicator Lester held that the claimant’s injuries fell within the MIG and that he was not entitled to the disputed medical benefit. Adjudicator Lester held that while the claimant suffered from pain and poor sleep pre-accident, the claimant had not submitted compelling evidence to prove that his pre-existing conditions prevented him from achieving maximal recovery within the MIG limits. With respect to his post-accident complaints, Adjudicator Lester noted that while the claimant’s treating chiropractor diagnosed him with radiculopathy, the claimant’s family doctor did not mention radiculopathy in his records nor were there any referrals made for further investigation into the radiculopathy. Adjudicator Lester concluded that there was no compelling evidence that the radiculopathy prevented the claimant from achieving maximal recovery within the MIG limits. Adjudicator Lester concluded that as the claimant’s injuries fell within the MIG and the claimant had exhausted the MIG limits, the disputed treatment plan was not payable.

W.J.L. v. Security National Insurance Company (18-009896)

The claimant sought entitlement to NEBs, removal from the MIG, and medical benefits. Adjudicator Chakravarti held that the claimant failed to prove that he did not suffer a non-minor injury. The claimant’s testimony was not credible, and there was lack of evidence that he sustained any impairment as a result of the accident. The claim for NEBs was also dismissed.

T.A. v. Unifund Assurance Company (18-005029)

The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Reilly held that the claimant sustained soft tissue injuries falling within the definition of “minor injury”. The claimant failed to provide any medical evidence from his family physician disputing the diagnoses of the IE assessors.

H.S. v. Aviva Insurance Canada (17-007384)

The claimant sought removal from the MIG and entitlement to four treatment plans for physical therapy. As a preliminary matter, the insurer sought to admit as evidence two addendum report authored after the production deadline. Adjudicator Harper refused to admit the addendum reports, reasoning that they could have been obtained much earlier, since the records reviewed were in the insurer’s possession for some time. Regarding the claimed benefits, Adjudicator Harper concluded that the claimant suffered a concussion, which fell outside of the MIG. She also concluded that the disputed physical treatment was reasonable and necessary because the claimant had long-lasting injuries and she had not achieved maximal recovery.

A.E. v. Aviva General Insurance Company (18-006132)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Grant concluded that the claimant’s accident-related injuries were “minor.” The claimant’s post-accident complaints were similar to pre-accident complaints; the accident caused only soft tissue injuries; and the claimant returned to work and was engaging in her regular activities of daily living.

E.O. v. BelairDirect (18-006718)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Grant concluded that the medical records supported that the claimant suffered a predominantly minor injury as a result of the accident. Furthermore, the claimant’s family doctor did not support the need for any further treatment.

O.T. v. Allstate Insurance Company of Canada (18-006520)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Grant preferred the opinions of the insurer’s experts and concluded that the claimant suffered a predominantly minor injury.

N.S. v. Coseco Insurance Company (18-002659)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Grant concluded that although the claimant suffered serious physical issues, those issues were not caused by the accident. There was no accident-related issue supporting removal from the MIG or the disputed treatment plans.

P.S. v. Certas Home and Auto Insurance Company (18-001199)

The claimant sought removal from the MIG, five medical benefits, and attendant care benefits. Adjudicator Msosa concluded that the claimant’s injuries were predominantly “minor”. His injuries were soft tissue in nature, he did not suffer a psychological impairment, and there were no pre-existing injuries preventing maximal recovery under the MIG.