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.
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.
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.
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.
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.
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.
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416.507.1850
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Toronto, Ontario M5H 3S5
416.507.1850