Category: Minor Injury Guideline

The insurer denied a treatment plan for chiropractic treatment and the cost of an examination based on its finding that the claimant’s injuries fell within the MIG. The claimant disputed the insurer’s denials. Adjudicator Driesel found that the claimant’s injuries fell within the MIG. Specifically, Adjudicator Driesel rejected the claimant’s assertion that pre-existing conditions precluded her from recovering within the MIG due to lack of evidence that her pre-existing back pain was extreme or continual or that she had a pre-existing mental or psychological conditions.

The claimant sought a determination that his impairments were outside of the MIG as well as entitlement to medical benefits proposed in ten treatment plans. The claimant argued that he should be removed from the MIG due to chronic pain. When assessing the claim of chronic pain, Adjudicator Ferguson applied the following criteria: i) Does the claimant suffer constant pain – more than simple ongoing or recurrent, intermittent pain? ii) Has the claimant’s pain persisted beyond the normal healing times for the injuries sustained? iii) Is the pain a clinically associated sequelae to minor injuries? iv) Does the claimant’s pain cause functional impairment and disability? Does it significantly disrupt or disable pre-accident activities of daily living? Adjudicator Ferguson found that the claimant failed to meet the onus to prove that he should be removed from the MIG on chronic pain grounds because i) the intermittent pain described in the medical records did not appear to meet the threshold of constant, severe pain; and ii) on balance, he did not find that the evidence illustrated that the claimant’s pain had significantly disrupted or disabled his pre-accident activities. Adjudicator Ferguson found that claimant was within the MIG and dismissed the application.

The insurer denied the claimant’s entitlement to medical benefits for chiropractic treatment based on its finding that her injuries fell within the MIG. Arbitrator Grant held that the claimant’s injuries fell within the MIG. As such, the claimant was not entitled to the medical benefits in dispute. Arbitrator Grant noted that while the clinical notes of the claimant’s family physician stated that she suffered from ongoing chronic pain, there was no indication that any objective testing was performed to inform the doctor’s opinion. There must be clear, objective evidence, obtained through diagnostic testing that concludes a person suffers from chronic pain and no such objective evidence was advanced by the claimant in this matter.

The insurer denied entitlement to medical benefits for chiropractic services and the cost of a psychological assessment based on its finding that the claimant’s injuries fell within the MIG. Adjudicator Kepman held that the claimant’s injuries fell within the MIG and therefore the treatment plans at issue were not payable. The claimant argued that a knee injury excluded her from the MIG; however Adjudicator Kepman found there was no evidence of that injury in the medical records until two years after the accident and therefore no causal connection could be found between the accident and the injury.

The claimant argued that she was diagnosed with a psychological impairment and chronic pain syndrome which did not fall within the MIG and appealed the insurer’s denial of physiotherapy treatment, costs of examinations, out of pocket expenses, and interest on overdue amounts. Adjudicator Létourneau held that the claimant had chronic neck pain which fell within the MIG as soft tissue sprains, strains or other minor injuries, which limited the insurer’s liability to $3,500. Adjudicator Létourneau held that the claimant’s evidence did not show a psychological impairment caused by the accident. The evidence showed that PTSD had been ruled out and the claimant’s anxiety had often been caused by school, her family, and situational causes. With regard to chronic pain, Adjudicator Létourneau held that the evidence only referenced sequelae of soft tissue strains, sprains or whiplash, and there was no diagnosis of or reference to chronic pain syndrome.