Category: Minor Injury Guideline

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 entitlement to an orthopedic assessment at a cost of $2,912.00. The insurer asserted the claim was governed by the MIG and that the maximum allowable fee for an assessment was $2,000.00. Adjudicator Blaine Baker determined that since the claimant had broken her arm, the MIG did not apply. On review of the fees for the treatment plan, Adjudicator Baker concluded that the proposed fees were all payable. While $2,000.00 is a cap on assessments, travel (in this case $400.00), the cost of preparing the treatment plan (in this case $200.00) and HST (in this case $312.00) were also recoverable above the assessment cap. The treatment plan was deemed reasonable and payable in full.

The claimant sought entitlement to a number of medical benefits for physical and psychological treatment. The insurer asserted a MIG position. Adjudicator S.F. Mather, on review of the medical evidence, determined the claimant’s injuries fell outside of the MIG. The treatment plans that addressed the injuries removing the claimant from the MIG were found payable, while the remainder of the plans were dismissed. During the course of the proceedings, the claimant sought to add jurisprudence claiming the MIG was unconstitutional; however, Adjudicator Mather denied the adding of the case law to the book of authorities, since to do so would import a constitutional question without the proper notice to the Attorney General’s office.