Category: Minor Injury Guideline

Applicant v. Wawanesa Mutual Insurance Company (17-002337)

The claimant sought entitlement to a number of medical benefits, as well as income replacement and attendant care benefits. The insurer denied entitlement and also asserted a MIG position. Adjudicator Christopher Ferguson reviewed the medical evidence and determined that no compelling evidence was tendered by the claimant to support entitlement to any of the benefits claimed. The MIG was said to govern the claimant’s impairments and the matter dismissed.

F.W. v. Certas Direct Insurance Company (17-004604)

The claimant sought a determination that his impairments were outside of the MIG, and entitlement to two treatment plans. Adjudicator Johal concluded that the claimant sustained an impairment that is predominantly a minor injury. The claimant provided no evidence to show that his injuries fell outside of the MIG. The Adjudicator noted that clinical notes and records documenting continued pain complaints is not sufficient for removal from the MIG.

M.T. v. TD Insurance Meloche Monnex (17-001552)

The claimant sought entitlement to a number of prescription medications. The insurer denied payment and asserted the MIG governed, which had been exhausted. Adjudicator Rupinder Hans reviewed the medical evidence and concluded that the claimant suffered nothing more than soft tissue injuries and that no pre-existing condition was evidenced to prevent maximal recovery within the MIG. Notably, the adjudicator accepted that the “but for” causation test applied rather than the “material contribution” test. Accordingly, the claimant’s claims were dismissed.

T.T. v. Certas Direct Insurance Company (16-003055)

The claimant sought entitlement to IRBs and a number of treatment plans. Adjudicator Jeffrey Shapiro, on review of the medical evidence, as well as surveillance and employment records, noted that the claimant’s self-reporting was unreliable and had “failed to timely, honestly and accurately disclose his multiple actual returns to work and his ability to work.” As it pertained to the treatment plans sought, Adjudicator Shapiro concluded the claimant had failed to establish removal from the MIG was warranted. All claims were dismissed.

D.P. v. Aviva General Insurance (17-000636)

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.

Applicant v. Aviva Insurance Company of Canada (17-002688)

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.

Applicant v. Economical Mutual Insurance Company (17-000846)

The claimant sought entitlement to medical, attendance care, and income replacement benefits. The insurer asserted a MIG position. Adjudicator Nicole Treksler, on review of the evidence, determined that the claimant’s injuries were governed by the MIG and that the claimant failed to establish a substantial inability to perform the essential tasks of employment in the face of evidence that the claimant returned to work. Since the MIG was said to govern, the claimant’s attendant care claim was dismissed summarily pursuant to section 14.

Applicant v. Travelers Canada (17-002177)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG designation. Adjudicator Avvy Go reviewed the medical evidence submitted and concluded that the claimant had failed to meet the burden of proof necessary to remove a MIG designation from her claims. All of the claimed treatment plans were dismissed.

Applicant v. Aviva Insurance Canada (17-001939)

The claimant sought entitlement to NEBs, removal from the MIG, and an in-home assessment. Adjudicator Ferguson rejected all of the claims. In terms of NEBs, the adjudicator wrote that the claimant failed to adduce evidence as to his pre-accident activities and that without a baseline, entitlement to NEBs could not be proven. With regard to the MIG, the adjudicator wrote that the claimant failed to provide medical evidence proving that she suffered psychological injuries or chronic pain, or submit evidence that her pre-existing diabetes, arthritis, and obesity would prevent her from achieving maximal recovery under the MIG.

Applicant v. Royal Sun Alliance (17-001315)

The claimant sought entitlement to a treatment plan, which the insurer denied due to a MIG determination. The claimant asserted the insurer failed to comply with the Notice provisions of section 38 and that the claimant’s pre-existing psychological impairments warranted removal from the MIG. Adjudicator Gemma Harmison determined that the insurer failed to comply with section 38, by not providing Notice within 10 business days. In reviewing the chronology of events, it was noted that despite the date of the correspondence from the insurer, the fact that it was mailed added an additional five business days, thus falling outside the prescribed timelines. Accordingly, the insurer was barred from taking a MIG position. However, because none of the disputed treatment was incurred during the period following, no amounts were found payable. Instead, the treatment plan was evaluated on whether it was reasonable. On review of the evidence, the plan was deemed not reasonable and necessary.