Category: Minor Injury Guideline

Applicant v. Certas Direct Insurance Company (17-003571)

The claimant sought entitlement to treatment outside of the MIG and to three treatment plans. Adjudicator Johal dismissed the claimant’s claim finding that her injuries fell within the MIG. As Adjudicator Johal concluded that the MIG applied, he held that he did not need to address whether the proposed treatment plans were reasonable and necessary.

Applicant v. Co-operators General Insurance Company (16-003821)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Makhamra accepted that the claimant suffered from a compression fracture caused by the accident, and from psychological impairments; the claimant was removed from the MIG. The adjudicator awarded all of the claimed medical benefits, as being reasonable and necessary.

Applicant v. TD Insurance Meloche Monnex (17-000640)

The claimant sought entitlement to NEBs, removal from the MIG, and two treatment plans. Adjudicator Neilsen first exclude one report submitted by the claimant because it was given to the insurer 10 days prior to the hearing. In terms of the benefits in dispute, the adjudicator concluded that the claimant failed to adduce sufficient evidence supporting a pre-existing condition, psychological impairments, or chronic pain. She noted that chronic pain was not the same as chronic pain syndrome, and that pain does not take a person out of the MIG unless it is functionally disabling. The adjudicator also concluded that the claimant did not suffer a complete inability to live a normal life.

Applicant v. Wawanesa Mutual Insurance Company (16-002633)

The claimant sought removal from the MIG and two medical benefits. The insurer argued that the claim was time barred. Adjudicator Maedel held that the claimant had applied to the LAT within 90 days of receipt of the FSCO Report of Mediator, and was therefore within the limitation period. He concluded that the claimant’s injuries were minor in nature and that the claimant’s evidence did not support removal from the MIG.

M.K. v. Aviva Insurance Company (17-003608)

The claimant sought entitlement to NEBs, removal from the MIG, and one treatment plan. The insurer argued that the claimant failed to attend an IE. Adjudicator Watt agreed that the claimant failed to attend a scheduled IE, and he therefore could not dispute his entitlement to the denied treatment plan. In terms of NEBs, the adjudicator held that the claimant failed to submit sufficient evidence supporting his claim (the claimant had returned to work, and made very few complaints to his family doctor). The claimant’s injuries were found to fall within the MIG.

M.H.E. v. Aviva Insurance Company (17-002624)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Mather concluded that the claimant suffered from chronic pain, which was a non-“minor injury.” The adjudicator accepted that pain relief was a valid treatment goal, and awarded four of the claimed treatment plans. Two of the treatment plans were denied due to being too similar to earlier treatment plans without consideration for new modalities and anticipated improvement.

Applicant v. Aviva Insurance Company (17-002907)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Lester held that the claimant’s disc bulges, degenerative changes, and chronic pain disorder were not minor injuries, and removed the claimant from the MIG. She also awarded the cost of a chronic pain assessment, chronic pain treatment plan, and a psychological assessment. She denied entitlement to an orthopaedic assessment because it was unclear why it was warranted.

Applicant v. Unifund (17-000982)

The claimant sought entitlement to NEBs, removal from the MIG, and further medical benefits. The insurer argued that the claimant was barred from seeking NEBs due to the limitation period. Adjudicator Harmison accepted that the insurer had denied NEBs more than five years prior, and that the denial was clear and unequivocal. In terms of the medical benefits claim, the adjudicator held that the claimant failed to prove that his injuries were outside of the MIG. The adjudicator placed significant weight on the records from the family physician, which showed only one entry referring to the accident, and no reports of psychological injury.

Applicant v. Wawanesa (17-000565)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Billeh Hamud reviewed the medical evidence and found the claimant’s injuries to be predominantly minor. Adjudicator Hamud also reviewed surveillance footage and social media evidence and found the credibility of the claimant to be negatively impacted. None of the treatment plans claimed were awarded.

T. T. v. Aviva Insurance Canada (17-002535)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the treatment and asserted a MIG position. The insurer also tendered surveillance in support of its position, to which the claimant sought to exclude on the basis of bad faith. Adjudicator Avvy Go determined that the surveillance was in contravention of Rule 9.2 and was not served 10 days prior to the hearing. Moreover, a case conference Order stipulated timelines that the insurer was in contravention of without any explanation. Accordingly, the materials were excluded. Additionally, the insurer was ordered to pay costs on the motion to exclude. However, on the substantive merits of the claim, Adjudicator Go determined that the claimant had not tendered compelling evidence to demonstrate that recovery within the MIG was unavailable; as a result, none of the treatment plans were found payable.