Category: Minor Injury Guideline

Applicant v. RSA Insurance (17-000233)

Post author By tgp-admin
Post date January 11, 2018
No Comments on Applicant v. RSA Insurance (17-000233)

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.

C.R. v. Scottish & York Insurance Company (16-002077)

Post author By tgp-admin
Post date January 9, 2018
No Comments on C.R. v. Scottish & York Insurance Company (16-002077)

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.

Applicant v. Certas Direct Insurance Company (16-004675)

Post author By tgp-admin
Post date January 8, 2018
No Comments on Applicant v. Certas Direct Insurance Company (16-004675)

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.

A.P. v. Dominion Insurance (17-001651)

Post author By tgp-admin
Post date January 3, 2018
No Comments on A.P. v. Dominion Insurance (17-001651)

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.

Applicant v. TD Home and Auto Insurance Company (17-002501)

Post author By tgp-admin
Post date January 3, 2018
No Comments on Applicant v. TD Home and Auto Insurance Company (17-002501)

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.

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

Post author By tgp-admin
Post date December 29, 2017
No Comments on 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)

Post author By tgp-admin
Post date December 28, 2017
No Comments on 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)

Post author By tgp-admin
Post date December 21, 2017
No Comments on 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)

Post author By tgp-admin
Post date December 21, 2017
No Comments on 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)

Post author By tgp-admin
Post date December 18, 2017
No Comments on 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.

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