The claimant sought entitlement to one treatment plan. The insurer maintained a MIG position. Adjudicator Gemma Harmison reviewed the evidence of the claimant and determined that it was not enough to warrant removal from the MIG. The claim was dismissed.
The claimant sought reconsideration of a Tribunal decision which upheld a MIG determination. The claimant asserted the Tribunal violated the rules of natural justice and erred in law when it failed to consider psychological, physical, and pre-existing medical evidence. Executive Chair Linda Lamoureux determined that it is open for a Tribunal adjudicator to prefer one party’s evidence above another’s and that the claimant’s assertion regarding a violation of natural justice was “entirely without foundation.” The claimant’s appeal was dismissed.
The claimant sought removal from the MIG and entitlement to two treatment plans for physical therapy. Adjudicator Watt held that the claimant’s injuries fell within the MIG and wrote that the claimant had not explained why her pre-existing obesity, hypertension, and sciatic nerve problems would prevent maximal recovery under the MIG. He favoured the opinions of the insurer’s assessors, and noted that the claimant had returned to work within five months of the accident. Adjudicator Watt also wrote that the proposed treatment plans were not reasonable and necessary because the description of the claimant’s injuries were inconsistent with the claimant’s actual injuries.
The insurer sought reconsideration of the Tribunal’s decision that the claimant’s injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal’s decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as it saw fit. Executive Chair Lamoureux was not satisfied that there was a significant error of fact or law.
The insurer sought reconsideration of the Tribunal’s decision that the claimant’s injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal’s decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as it saw fit. Executive Chair Lamoureux was not satisfied that there was a significant error of fact or law.
The claimant disputed his entitlement to income replacement benefits (IRBs), medical benefits and the MIG. Adjudicator Treksler concluded that the claimant’s injuries fell outside of the MIG due a post-accident psychological impairment and diagnosis of chronic pain syndrome. In her reasons, Adjudicator Treksler noted that she preferred the evidence of the claimant’s family physician to the IE assessors and concluded that there was sufficient evidence in the claimant’s clinical notes and records of a psychological impairment and chronic pain syndrome to warrant the claimant’s removal from the MIG. Adjudicator Treksler also found that the disputed psychological assessment was payable. With respect to his dispute over IRBs, Adjudicator Treksler concluded that the claimant met the pre-104 week IRB disability test. Adjudicator Treksler noted that the claimant’s pre-accident employment was physical in nature and concluded that she preferred the s. 25 assessors’ conclusions that the claimant could not return to work to the opinions of the s. 44 assessors.
The claimant sought removal from the MIG and entitlement to one treatment plan. Adjudicator Anwar held that the claimant’s suffered pre-existing conditions that would prevent maximal recovery under the MIG and development of chronic pain. He relied upon the expert reports completed for the claimant, which detailed pre-existing injuries. The insurer argued that the Tribunal could not remove the claimant from the MIG without actually receiving and reviewing the clinical records from the claimant’s physician (which had not been provided to the insurer either). Adjudicator Anwar disagreed with the insurer, and wrote that the claimant’s experts had sufficiently detailed the pre-existing issues. He also noted that the insurer had not made any attempt to obtain the claimant’s clinical notes and records at any point (including the Case Conference). The adjudicator did not award the claimed treatment plan because the claimant did not explain what made the passive treatment reasonable and necessary, particularly given the claimant’s failure to respond to earlier passive treatment.
The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Sewrattan concluded that the claimant suffered minor injuries in the accident. He wrote that neither of the claimant’s experts had diagnosed the claimant with a psychological disorder or chronic pain. He also held that the insurer’s denials satisfied the requirements of section 38 of the SABS. Adjudicator Sewrattan went on to state that he would not have awarded the claimed treatment plans because the claimant did not suffer a psychological disorder, and the treatment plan for chronic pain did not specify what the goals of the proposed treatment were.
The claimant sought entitlement to a treatment plan. The insurer denied payment and asserted a MIG designation. The claimant countered and argued the insurer failed to respond to the treatment plan within the prescribed time. Adjudicator Brian Norris reviewed the chronology of events and determined the insurer had responded to the treatment plan in time. Adjudicator Norris also determined that the claimant’s impairments were minor and that no pre-existing conditions warranted removal from the MIG. The claims were dismissed.
The claimant sought medical benefits outside of the MIG. Adjudicator Maedel found that the claimant sustained predominantly minor injuries as a result of the accident, and there was no compelling evidence that the claimant suffered from a pre-existing medical condition that would limit her recovery.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP