Category: Minor Injury Guideline

The claimant disputed his MIG status; entitlement to a medical benefit for physiotherapy treatment; and interest on overdue payment of benefits. Adjudicator Norris rejected that the claimant suffered a psychological injury as a result of the accident, finding that the evidence of psychological injury relied upon by the claimant was inconsistent with the entire rest of the claimant’s medical record. Further, the claimant failed to adduce evidence sufficient to establish that a pre-existing finger fracture prohibited him from recovering within the MIG limit. Adjudicator Norris held that the claimant suffered a minor injury within the meaning of the Schedule and is subject to the MIG funding limit. Entitlement to the medical benefit in dispute was rejected as a result.

The claimant sought removal from the MIG and entitlement to psychological and physical assessments and treatment. The claimant had a pre-accident medical history relevant for depression and anxiety stemming from infertility issues. Adjudicator Hines concluded that based on the medical records and the evidence of the s. 44 and s. 25 assessors, the claimant’s pre-existing depression and anxiety did not prevent her from reaching maximum medical recovery under the MIG. Adjudicator Hines noted that the claimant had not demonstrated that the accident worsened and/or exacerbated her depression and anxiety. Adjudicator Hines preferred the evidence of the IE assessor to that of Dr. Shaul, s. 25 assessor, as Dr. Shaul’s medical reports contained inconsistencies and because she found Dr. Shaul’s reports unreliable, as Dr. Shaul never actually met the claimant. Adjudicator Hines concluded that the claimant’s injuries fell within the MIG, the disputed psychological assessment and treatment was not payable, and the disputed physical treatment was payable only up to the amounts remaining in the MIG limits.

The claimant sought a declaration that her injuries were not predominantly minor injuries to be treated within the MIG, as well as entitlement to medical benefits for treatment. Adjudicator Watt held that the claimant was not entitled to any of the relief sought. The applicant failed to adduce any medical evidence to indicate that her injuries fell outside of the MIG. The claimant also failed to adduce evidence to address the stated goals of the treatment plans at issue and how the plans would achieve those goals. As such, there was no evidence to show that the treatment plans were reasonable and necessary.

The claimant sought removal from the MIG and entitlement to psychological treatment. Adjudicator Grant concluded that the insurer failed to respond to the treatment plan within 10 days. Even though the treatment plan was denied on HCAI, no letter with the medical and other reasons for the denial was sent to the claimant until two months later. The insurer was therefore prohibited from relying upon the MIG. However, Adjudicator Grant held that the claimant failed to prove that the proposed psychological treatment was reasonable and necessary.

The claimant sought entitlement to various medical benefits, the costs of a chronic pain assessment, treatment outside of the MIG, and interest. Upon weighing the medical evidence, Adjudicator Boyce determined that the claimant’s chronic pain warranted treatment outside of the MIG. Moreover, Adjudicator Boyce found the requested chronic pain assessment was reasonable and necessary. Adjudicator Boyce further held that one of the requested benefits was partially reasonable and necessary, but denied another treatment plan for being duplicative. As the claimant was found to be entitled to some of the benefits sought, he was also entitled to interest.