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.
The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Johal concluded that the claimant suffered minor injuries in the accident, and that the claimant’s pre-existing conditions did not prevent recovery under the MIG. The adjudicator was critical of the claimant’s failure to put any medical evidence before the Tribunal that he suffered chronic pain syndrome, or that his pre-existing conditions would prevent maximal recovery under the MIG.
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.
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.
The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Robert Watt, on review of the medical evidence, concluded that the claimant’s injuries were minor and governed by the MIG. Accordingly, the claimant’s claims were dismissed.
The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Ferguson held that the claimant had not submitted evidence that she sustained any injuries more severe than soft tissue injuries, and that the claimant had not proven any pre-existing conditions that would prevent recovery under the MIG.
The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. On review of the medical reports and evidence, Adjudicator Sandeep Johal concluded the claimant provided compelling evidence that the injuries sustained warranted removal from the MIG. The treatment plans were also considered reasonable and necessary. However, despite the claimant seeking a special award, Adjudicator Johal noted no evidence was tendered by the claimant to demonstrate the unreasonable withholding of benefits; the special award claim was dismissed.
The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Robert Markovits reviewed the evidence and determined that there was compelling evidence of a pre-existing medical condition preventing recover within the MIG. The treatment plans were considered reasonable and necessary, with a psychological assessment capped at $2,000.00 pursuant to section 25(5)(a). However, an additional $200.00 was also payable for the completion of the OCF-18 pursuant to Superintendent’s Guideline No. 03/14.
The claimant sought entitlement to a medical treatment plans. The insurer was previously successful in a prior hearing and obtained a decision in which the claimant’s injuries were said to be governed by the MIG. The claimant further appealed that decision and a Divisional Court upheld the previous ruling. Accordingly, the insurer sought a preliminary motion to preclude the claimant’s new claim on the grounds of res judicata. Adjudicator Cezary Paluch reviewed the new claims of the claimant and determined that the claims were different than the previous arbitration. While it was acknowledged that the MIG was decided previously, Adjudicator Paluch noted that the claimant may have new grounds to warrant removal and thus it was too early to rule whether res judicata applied. As a result, the claimant was allowed to continue with the new claims.
The claimant sought entitlement to a number of medical benefits. In addition to a MIG position, the insurer asserted that the claimant was barred from bringing a claim as notice to claim accident benefits was not provided within seven days (or reasonably thereafter) of the MVA, pursuant to sections 32 and 55. Adjudicator S.F. Mather reviewed the circumstances leading up to the claimant providing an application for accident benefits three months following the MVA and determined that the time it took to bring the claim was not unreasonable. Although the application was incomplete, Adjudicator Mather ruled it was reasonable to obtain the missing information on review of the overall claim. With respect to the medical benefits claimed, Adjudicator Mather ruled that the notice letters did not take a position on the MIG and did not provide medical reasons for the denial. As a result, the insurer was precluded from taking a MIG position, and therefore must pay for the treatment plans claimed. No discussion of whether the treatment was reasonable was needed, since the provisions make it clear an insurer shall pay for treatment it fails to provide notice to, until the notice is cured. Therefore the treatment plans claimed were deemed payable.
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416.507.1850
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850