Category: Minor Injury Guideline

Applicant v. Aviva Insurance Canada (17-006159)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant’s injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held that the claimant did not suffer a psychological impairment, preferring the IE assessor’s conclusions that there was no objective evidence of a DSM-5 diagnosis.

Applicant v. Aviva Insurance Canada (17-006157)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant’s injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held that the claimant did not suffer a psychological impairment, preferring the IE assessor’s conclusions that there was no objective evidence of a DSM-5 diagnosis.

Applicant v. Pembridge Insurance Company (17-005315)

The claimant sought removal from the MIG and entitlement to chronic pain treatment. Adjudicator Grant dismissed the claims. He accepted the opinions of the IE assessors that the claimant had normal physical functional limits and that no diagnosable psychological condition was demonstrated.

Applicant v. Royal Sun Alliance (RSA) (17-006236)

The claimant sought entitlement to two years of IRBs, removal from the MIG, and six treatment plans. Adjudicator Punyarthi concluded that the claimant sustained a concussion and that his injuries were therefore not minor. All of the disputed treatment plans were awarded because they directly addressed the impairments the claimant was suffering. Finally, Adjudicator Punyarthi awarded IRBs on the basis that the claimant could not complete the essential tasks of his employment as a produce clerk at a grocery store.

Applicant v. The Guarantee Company of North America (17-004431)

The claimant sought entitlement to treatment outside of the MIG, and NEBs. Adjudicator Gosio held that the claimant’s injuries fell within the MIG. Adjudicator Gosio held that while the claimant had pre-existing back pain, she failed to submit compelling evidence that her pre-existing back pain prevented her from achieving maximal medical recovery within the MIG. With respect to NEBs, Adjudicator Gosio held that while the claimant demonstrated that there were some changes in her post-accident life with respect, she failed to establish that those changes amounted to her being continuously prevented from engaging in substantially all of her pre-accident activities.

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

The claimant sought a determination that her impairments were outside of the MIG as well as entitlement to medical benefits proposed in two treatment plans. Adjudicator Parish found that the claimant was removed from the MIG as a result of the insurer’s failure to comply with the “medical and all other reasons” requirement in s. 38(8) of the SABS. The incurred psychological assessment in dispute was found payable pursuant to s. 38(11) of the SABS. Adjudicator Parish found the proposed psychological treatment to be reasonable and necessary. The claim for a Special Award was denied.

Z.V. v Aviva Insurance Canada (17-006874)

The claimant sought treatment outside of the MIG, entitlement to a disputed chiropractic treatment plan, a special award, and interest. The claimant argued that she had been removed from the MIG as the insurer had approved previous treatment plans above the MIG limits. The insurer, however, claimed that these approvals were an administrative error, and not an admission that the claimant fell outside of the MIG. Adjudicator Purdy agreed with the insurer, and held that payments above MIG limits due to administrative errors did not result in a claimant being automatically removed from the MIG. Adjudicator Purdy further held that the claimant’s injuries warranted treatment within the MIG, and denied entitlement to the benefits sought or the granting of a special award.

Applicant v Wawanesa (17-004541)

The claimant sought removal from the MIG, entitlement to medical benefits, and interest. The claimant argued that pre-existing back degenerative changes, in conjunction with his alleged chronic pain, warranted treatment outside of the MIG. The claimant further claimed that he had incurred significant treatment expenses to enable him to return to employment, and relied on s.57(2) of the SABS to argue that the insurer was responsible for those costs. Adjudicator Ferguson disagreed, finding that there was no connection between a prescribed duty to mitigate medical issues and an obligation by the insurer to pay for treatment of those issues. Adjudicator Ferguson held that the claimant’s injuries fell within the MIG, and denied the disputed treatment plans and interest claimed.

Applicant v Aviva Insurance Canada (16-003638)

The claimant sought removal from the MIG, entitlement to NEBs, nine disputed treatment plans, interest, costs, and a special award. Adjudicator Gosio concluded that the claimant’s psychological injuries warranted treatment outside of the MIG, and approved one of the treatment plans sought. However, Adjudicator Gosio held that the claimant was not entitled to NEBs, payment of the remaining treatment plans, or to the costs or award sought.

U.S. v. Certas Home and Auto Insurance Company (17-007003)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in five treatment plans. Adjudicator Lake found that the claimant’s injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted.