The claimant sought removal from the MIG, entitlement to ACBs, and entitlement to various medical benefits. Adjudicator Watt concluded that the claimant’s injuries fell within the MIG. He noted that the claimant had essentially returned to his pre-accident life shortly after the accident. He also held that the claimant’s self-reporting contradicted the statements in the section 25 reports regarding ongoing impairments.
The claimant appealed Aviva’s MIG determination and sought medical benefits for chiropractic services, the completion of numerous OCF-3s, a social work assessment, and an orthopaedic assessment. The claimant also sought IRBs. Aviva opposed the claimant’s request to have a treating chiropractor qualified as an expert. Adjudicator Hines held that the claimant’s injuries were within the MIG and none of the OCF-18s or OCF-3s were reasonable and necessary. The adjudicator further held that the claimant was not entitled to IRBs. The adjudicator also held that the treating chiropractor was not qualified as an expert witness, but could give evidence in his capacity as a treating chiropractor. The adjudicator held that the claimant sustained soft-tissue injuries, which fell within the MIG. The adjudicator held that the chiropractor’s diagnosis of post-concussion syndrome/concussion was outside the scope of his expertise, and the adjudicator also found inconsistencies in the claimant’s evidence with respect to “loss of consciousness”. The adjudicator preferred Aviva’s IE report from a psychologist over the claimant’s report from a social worker with respect to psychological injuries. The adjudicator also held that the rates charged on the OCF-18s exceeded the amounts payable under the FSCO Guideline. The OCF-3s were not payable as particulars were not provided with respect to the claimant’s change in condition and updated OCF-3s were not requested by Aviva. Lastly, the adjudicator preferred Aviva’s multi-disciplinary report over the claimant’s evidence (OCF-3s) with respect to IRBs, and held that the claimant did not suffer a substantial inability to perform the essential tasks of a material handler or casino dealer.
The claimant sought entitlement to IRBs, ACBs, and medical benefits. The insurer argued that the claimant failed to attend an IE assessment contrary to the SABS. Adjudicator Maedel agreed with the insurer in regard to most of the claimed benefits, and held that the IEs were not requested inappropriately. In terms of the MIG and a psychological treatment plan, the adjudicator held that the claimant failed to prove that she suffered a psychological injury as a result of the accident. He preferred the IE opinions over that of the claimant’s assessors, which appeared to be boilerplate. He also commented that the family physician’s records did not show any connection between the accident and the claimant’s psychological impairments.
The claimant sought entitlement to ongoing IRBs, various medical benefits outside of the MIG, and a special award. The claimant submitted that psychological impairments and chronic pain took him outside of the MIG. Adjudicator Boyce found that the claimant’s impairments were predominantly minor injuries, holding that in the absence of evidence of a full or partial tear, the claimant’s shoulder tendonitis was within the MIG. The claimant was found not to have a psychological diagnosis. Adjudicator Boyce held that the claimant had not proven that he had missed work as a result of the accident and was therefore not entitled to IRBs. A special award was denied.
The claimant sought entitlement to medical benefits outside of the MIG and a special award. Adjudicator Victor found that the claimant was outside of the MIG because of the extent of her psychological symptoms, and she was entitled to the cost of a psychological assessment, plus interest. The claimant was not found entitled to a special award.
The claimant sought medical benefits outside of the MIG and interest on the overdue payment of benefits. Adjudicator Ferguson held that the claimant’s injuries fell within the MIG and dismissed the claimant’s application. Adjudicator Ferguson relied on the claimant’s self-reporting to conclude that the claimant did not have a credible psychological injury arising from the accident. Adjudicator Ferguson noted that the claimant’s own words in examination were “powerful evidence” in determining whether the claimant’s claimed psychological issues were credible. Adjudicator Ferguson also concluded that the claimant had failed to prove that she suffered from chronic pain syndrome because her self-reports were contradictory and non-credible.
The claimant was involved in two motor vehicle accidents and appealed Certas’ MIG determination for each accident. The claimant also sought medical benefits for physiotherapy for the first accident and chiropractic services for the second accident. Adjudicator Cavdar held that the claimant’s injuries for each accident fell within the MIG. The claimant suffered soft-tissue injuries as a result from the first accident. While the claimant argued that she suffered a psychological injury, her only evidence was a note of emotional disturbance by a physiotherapist, and her self-report to an IE physiatrist that she had a fear of driving. The adjudicator further held that the claimant suffered soft-tissue injures as a result from the second accident, and there was no evidence of a psychological injury except for the claimant’s self-report of anxiety. The adjudicator also held that the claimant did not submit compelling medical evidence to detail how a pre-existing condition would remove her from the MIG for the second accident.
The claimant sought entitlement to medical benefits outside of the MIG, costs of a psychological examination, a special award, and interest. On the basis of the evidence presented by both parties, Adjudicator Hans held that the claimant’s injuries fell within the MIG. The claimant also failed to prove that an earlier motor vehicle accidents and a workplace injury constituted pre-existing conditions that should remove the claimant from the MIG. Adjudicator Hans further concluded that neither a special award nor interest were not warranted.
The claimant sought judicial review of the LAT’s decision that his injuries fell within the MIG, and that two treatment plans were not payable. The Court upheld the Tribunal’s decision, concluding that it fell within the range of possible acceptable outcomes, and was therefore reasonable. The Court also held that the Tribunal’s decision regarding the sufficiency of the insurer’s denials was correct and that the denials occurred within 10 days. It does not appear that the claimant first sought reconsideration before applying for judicial review.
The claimant sought entitlement to treatment outside of the MIG, various medical benefits, and a special award. The claimant argued that her psychological impairments took her outside of the MIG. Adjudicator Ferguson weighed the medical evidence and determined that the claimant did not suffer a psychological injury that would warrant removal from the MIG. As a result, Adjudicator Ferguson held that the claimant was not entitled to the benefits claimed, or to a special award.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP