The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Ferguson held that the claimant’s injuries fell within the MIG. He was critical of the claimant’s asserted accident-related injuries, which contradicted evidence in the WSIB file which showed pre-existing complaints of the same nature. Adjudicator Ferguson also held that the insurer’s denials complied with section 38 of the SABS.
The claimant sought removal from the MIG and five medical benefits. Adjudicator Parish concluded that the claimant suffered minor injuries and did not suffer psychological injuries or chronic pain as a result of the accident. She did not accept the opinions of the claimant’s experts. Adjudicator Parish did not permit the claimant to rely upon written submissions that were not served in accordance with the Case Conference Order timelines. She also did not allow the claimant to rely upon case law that had not been submitted in accordance with the Case Conference Order timelines.
The claimant sought removal from the MIG and entitlement to ACBs and various medical benefits. Adjudicator Sewrattan held that the claimant suffered minor injuries and dismissed the claim. He rejected that the claimant suffered from chronic pain or chronic pain syndrome because there was no medical testing in support of such diagnosis. He also rejected that the claimant suffered from a psychological impairment, given that testing results suggested mild symptoms.
The claimant sought removal from the MIG and entitlement to four treatment plans. Adjudicator Johal concluded that the claimant’s psychological injuries fell outside of the MIG, and the claimant was entitled to all four treatment plans. The insurer’s assessor acknowledged that the claimant’s emotional condition was significantly affecting her ability to function effectively, but did not assign a diagnosis; the assessor acknowledged an adjustment disorder in an addendum. The treatment plans for psychological and physical treatment were awarded, the latter based on the recommendations of the claimant’s family physician.
The claimant disputed the insurer’s MIG determination and sought medical benefits for psychological assessment, psychological treatment, and chiropractic treatment, as well as a special award. Adjudicator Grant held that the claimant’s injuries were subject to treatment within the MIG and it was unnecessary to consider whether the treatment plans were reasonable and necessary. The claimant sustained soft-tissue injuries to his back, shoulder, and neck. The claimant subsequently injured his back changing a tire. The adjudicator could not conclude that the claimant’s impairment was solely from the accident. The adjudicator further held that the claimant’s physical injuries did not have a significant impact on his life or require any further treatment. The adjudicator further held that the claimant did not suffer from any accident-related psychological impairment that was significant enough to remove him from the MIG. The claimant’s psychological complaints did not amount to anything other than minor accident-related sequelae and he continued to participate in his regular pre-accident activities. The adjudicator preferred the insurer’s expert with respect to psychological impairment as the insurer’s expert’s opinion was corroborated by clinical notes and records. The adjudicator declined to award a special award as it was not unreasonable for the insurer to deny the treatment plans based on its interpretation of its assessors reports.
The claimant sought a determination that her impairments were outside of the MIG and entitlement to attendant care and medical benefits proposed in eight treatment plans. Adjudicator Go found that the claimant’s injuries fell within the MIG and she was not entitled to any of the benefits in dispute. As a preliminary issue, the respondent asked that the Tribunal exclude medical records that were served by the claimant less than 10 days before the written hearing date. Adjudicator Go allowed the claimant to rely on the disputed medical records because they were relevant, excluding the records might undermine the claimant’s ability to make her case, and the respondent had had an opportunity to review the records and make submissions on them.
The claimant argued that her injuries including chronic pain syndrome, psychological impairments, jaw injury, and post-traumatic headaches fell outside the MIG and sought medical benefits and the costs of examinations. Adjudicator Daoud held that the claimant suffered from minor injuries that fell within the MIG. The adjudicator found that claimant did not suffer from chronic pain syndrome, but rather soft tissue injuries and associated sequelae. She also concluded that while the claimant’s orthopaedic report diagnosed her with chronic pain syndrome, it provided no objective medical findings to support the diagnosis, did not address frequency and duration of pain, and failed to discuss post-accident activities and functional limitations. Further, the orthopaedic surgeon failed to review both the claimant’s family physician’s records and physiotherapy records. Adjudicator Daoud further held that the claimant’s psychological impairments fell within the MIG, as the claimant provided no objective medical opinion and the insurer’s IE report found no DSM-IV or DSM-V diagnosis. The claimant also failed to provide sufficient medical evidence demonstrating that her jaw pain was not a minor injury, as she only provided a diagnosis of TMJ pain from an orthopaedic surgeon, which was outside the scope of his specialty.
The claimant sought a determination that his impairments were outside of the MIG and entitlement to one treatment plan for psychological services. This was the claimant’s second LAT application relating to MIG determination. The adjudicator in the hearing relating to the first application (Adjudicator Sewrattan) found that the claimant’s injuries were minor. When the second LAT application was filed, the respondent brought a motion to dismiss the application on the basis of res judicata. The motions adjudicator dismissed the motion on the basis that it was premature, finding that there was a possibility of new evidence being submitted for the second application that was not available at the first hearing. The second application then proceeded to a written hearing before Adjudicator Punyarthi, who held that only evidence that had become available since the release of Adjudicator Sewrattan’s decision would be considered. Adjudicator Punyarthi found that the claimant’s injuries were minor and that the proposed treatment was not payable as it was outside of the MIG limits.
The claimant sought a determination that her impairments were outside of the MIG and entitlement to attendant care and medical benefits proposed in six treatment plans. Pursuant to s. 56 of the SABS, Adjudicator Watt found that the claimant was statute barred from seeking attendant care benefits as the benefits were denied more than two years before the LAT application was filed. The respondent’s letter advising that there was no entitlement to attendant care benefits as the claimant’s injuries were within the MIG was found to have started the limitations period clock. Adjudicator Watt also found that there was no evidence demonstrating attendant care benefits had been incurred or were reasonable and necessary. Adjudicator Watt found that the claimant’s injuries fell with the MIG and that none of the treatment plans in dispute were payable as the MIG limits had been exhausted.
The claimant argued that his injuries fell outside the MIG due to a pre-existing condition that prevented him from achieving maximal recovery under the MIG and due to a psychological injury that was not mere sequelae of his soft tissue injuries. The claimant sought medical benefits for a psychological assessment and chiropractic services, as well as interest and a special award. Adjudicator Kershaw held that the claimant’s injuries fell within the MIG, and as such, he was not entitled to the medical benefits and interest sought, nor a special award. Adjudicator Kershaw held that the claimant had pre-existing, medically-documented shoulder tenosynovitis and rotator cuff tendinopathy, which continued after the accident but did not prevent maximal recovery, and that the claimant’s small partial shoulder tear was a minor injury.
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles
Subscribe to get TGP’s case summaries straight to your inbox
Subscribe to get TGP’s case summaries straight to your inbox
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP