Category: Minor Injury Guideline

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.

The claimant sought removal from the MIG and payment of various medical benefits. Adjudicator Ferguson concluded that the claimant did not suffer chronic pain, and was therefore restricted to MIG-level benefits. The insurer, and the claimant accepted, that the Tribunal should refer to the AMA Guides in determining whether the claimant suffered chronic pain syndrome. The AMA Guides set out six factors, of which three had to be met for a diagnosis. Adjudicator Ferguson held that the claimant did not suffer at least three of the factors, and therefore did not suffer chronic pain syndrome. The claimant maintained a full time job; he returned to school after the accident; his relationship with his girlfriend was maintained; he continued to drive a vehicle; and he was independent with self-care, housekeeping, and domestic activities.

The claimant appealed Unifund’s MIG determination due to a pre-existing condition and sought medical benefits for physiotherapy. Adjudicator Ferguson held that the claimant’s pre-existing scoliosis of the upper thoracic spine did not remove her from the MIG because her condition was undetected before the accident, and the claimant provided no evidence that her condition would prevent maximal recovery within the MIG. Further, none of the IE assessors found any evidence of a pre-existing condition that would remove the claimant from the MIG, and the IE reports were not contested by the claimant. The adjudicator also held that the claimant’s evidence did not support a finding of chronic pain because her medical reports did not contain evidence regarding the severity, frequency, and duration of her pain or the functional impacts of her pain complaints.

The applicant sought various medical benefits and assessments and argued that his injuries fell outside the MIG. Adjudicator Hamud held that the applicant’s injuries fell within the MIG, and the applicant failed to establish that he could not achieve maximal recovery from within the MIG. The applicant sustained sprain and strains of the spine, shoulder, wrist, and ankle, and had sleep difficulties. The applicant had pre-existing chronic lower back pain. The adjudicator held that there was no compelling evidence to establish that the claimant’s pre-existing lower back pain would prevent maximal recovery within the MIG.

The claimant argued that her injuries fell outside the MIG and sought medical benefits and the costs of examinations. Adjudicator Lake held that the claimant’s injuries fell within the MIG. The adjudicator concluded that there was insufficient documentary evidence, supporting reasons, or analysis to establish that the claimant had cervical radiculopathy. The claimant relied on a report that stated there was some suggestion of a cervical radiculopathy down the claimant’s right side. However, a Nerve Conduction Test was not conducted, which would have been strong evidence of cervical radiculopathy. Adjudicator Lake also noted that a Spurling’s Test was not conducted, which would have also been strong evidence. With regard to chronic pain, the claimant was not diagnosed with chronic pain syndrome, and could not demonstrate that her pain was ongoing or that she was experiencing any functional impairment.