Category: Minor Injury Guideline

D.S. v. The Personal Insurance Company (18-001204)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a s. 25 psychology assessment. The insurer raised the preliminary issue of whether the claimant was statute barred from applying to the LAT for the psychology assessment because he failed to attend a s. 44 examination. The claimant was involved in an accident in 2014 and had previously attended a s. 44 psychology examination. In 2018, the claimant submitted an OCF-18 for a s. 25 psychology assessment. The insurer denied the treatment plan and arranged for a second s. 44 psychology assessment to address the claimant’s entitlement to benefits. The claimant did not respond to the s. 44 request and did not attend the s. 44 assessment. The claimant submitted that there was no non-compliance with the s. 44 notice as the notice was provided to the claimant only and not the claimant’s counsel. Adjudicator Ferguson found there was nothing in the SABS indicating that failing to provide a copy of a notice to a claimant’s representative provides a reasonable excuse for ignoring a notice. Adjudicator Ferguson agreed with the insurer that its request for another psychological assessment was reasonable considering the lengthy timeline between treatment requests and the lack of up-to-date medical records, and rejected as baseless the claimant’s submission that scheduling a s. 44 assessment reflects an insurer’s awareness that there is need of s. 25 assessments. Adjudicator Ferguson held that the claimant was statute barred from applying to the LAT for the psychological assessment, and that he was not entitled to treatment outside of the MIG. The application was dismissed.

D.0. v. Primmum Insurance Company (18-001673)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to two treatment plans for physiotherapy. The claimant submitted that the he developed chronic pain as a result of the accident. In support of his position, he relied on three OCF-3s, a s. 25 chronic pain report, and family doctor records. The insurer relied on a s. 44 physiatry report and argued that the claimant was not diagnosed with chronic pain syndrome and had not been referred to a chronic pain specialist. Adjudicator Hans found that the claimant’s physical impairments were outside of the MIG as a result of chronic pain and that the disputed benefits were reasonable and necessary. Adjudicator Hans held that a diagnosis of chronic pain syndrome was not required to remove a claimant from the MIG.

B.E. v. Aviva General Insurance Company (18-005760)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a various medical benefits. Vice Chair Kershaw found that the claimant established that she had a psychological injury and chronic pain injuries, and was therefore not subject to the $3500 MIG limit. Based on these findings, the adjudicator concluded that the disputed treatment plans for physical rehabilitation, a psychological assessment, and a chronic pain assessment were reasonable and necessary.

H.A. v. Travelers Insurance (18-005178)

The claimant sought entitlement to IRBs, removal from the MIG, and three medical benefits. Adjudicator Lake concluded that the claimant had proven entitlement to only three months of IRBs, but that his injuries fell within the MIG. The remainder of the MIG limits was awarded on one of the treatment plans.

J.R. v. RSA Insurance (18-000770)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Hamud concluded that the claimant suffered chronic pain syndrome and that his injuries did not fall within the MIG. The family physician’s clinical notes and records supported the conclusion, and the IE physicians failed to fairly consider the claimant’s reports of pain. Adjudicator Hamud also found the claimed treatment plans for physical therapy and a chronic pain assessment to be reasonable and necessary.

M.K. v. Waterloo Insurance (17-001265)

The claimant sought reconsideration of the Tribunal’s decision that his injuries fell within the MIG. Associate Chair Batty held that the Tribunal did not make an error in its factual conclusions regarding the claimant’s alleged psychological injuries or pre-existing conditions. The reconsideration was dismissed.

J.S. v. Cooperators General Insurance Company (18-000007)

The claimant sought entitlement to IRBs, removal from the MIG, and two treatment plans. Adjudicator Norris rejected the claim for IRBs, but removed the claimant from the MIG and awarded the medical benefits for psychological and physical treatment. The claimant failed to attend an IE regarding IRBs, so was not entitled to IRBs between April and June 2016. Outside of that period, Adjudicator Norris concluded that the claimant was not rendered unable to complete the essential tasks of her employment as a collector at a collections agency. In terms of the MIG, Adjudicator Norris held that the claimant suffered psychological injuries. He concluded that a psychological assessment was reasonable and necessary, as was a treatment plan for physical therapy.

F.A. v. Certas Home and Auto Insurance Company (18-000591)

The claimant sought removal from the MIG and entitlement to a psychological assessment. Adjudicator Ferguson held that the claimant suffered minor injuries. The claimant failed to prove evidence of a pre-existing condition, a chronic pain condition, or a psychological condition. He noted that the records from the family physician did not support the position advanced by the claimant.

R.S. v. Aviva Insurance Company (17-008532)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Norris concluded that the claimant suffered a minor injury. The claimant’s family physician and the insurer’s assessor came to the same conclusion that the claimant suffered soft tissue injuries and did not suffer chronic pain. The claimant’s expert was not persuasive because it relied upon self-reporting that was inaccurate. Finally, the adjudicator dismissed the argument that high cholesterol was a condition that would prevent maximal recovery under the MIG.

R.D. v. Wawanesa Mutual Insurance Company (18-000054)

The claimant sought removal from the MIG and three medical benefits for psychological and physical services. Adjudicator Norris held that the claimant suffered minor injuries. He noted that a partial muscle tear fell within the definition of “minor injury”. He also wrote that the claimant’s family physician’s records did not show evidence of a psychological injury. Finally, there was no evidence of pre-existing injury that would prevent maximal recovery under the MIG.