Category: Minor Injury Guideline

Rai v. Aviva Insurance (17-002491)

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.

Applicant v. Aviva Insurance Canada (17-003557)

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.

Applicant v. RBC Insurance Company (16-002047)

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.

J.D. v. Aviva Insurance Canada (16-004175)

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.

Applicant v. Wawanesa Mutual Insurance Company (16-001732)

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.

H.L. v. Co-operators General Insurance Company (17-006816)

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.

N.F. v. Aviva Insurance Company of Canada (17-000456)

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.

Applicant v. Certas Home and Auto Insurance (16-002278)

The claimant sought entitlement to a number of treatment plans, both psychological and physical-based. The insurer asserted a MIG position. On review of the medical evidence, Adjudicator Paul Gosio determined the claimant established the injuries sustained were outside the MIG by virtue of a psychological report, which was not rebutted by the insurer. As a result, the psychological treatment plans were deemed reasonable and necessary, along with a chronic pain and one chiropractic plan.

I.A. v. Unifund Claims Inc (17-000785)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG position and also raised a limitation defense to one of the treatment plans. Adjudicator Billeh Hamud reviewed the denial letter of the insurer and found it to be clear and unequivocal. However, Adjudicator Hamud also noted that the claimant established a pre-existing injury that prevented recovery within the MIG; namely chronic pain from a previous MVA. Accordingly, the non-limitation barred treatment plans were found payable.

Applicant v. Unifund Claims Inc. (17-001129)

The claimant alleged that his injuries were non-minor and that he was entitled to various medical benefits. Adjudicator Ferguson rejected the claimant’s position. He held that the claimant suffered soft tissue injuries in the accident, and was not suffering psychological impairment as a result of the accident. The adjudicator also rejected the claimant’s position that his pre-existing injuries should remove him from the MIG. The adjudicator noted that the claimant’s experts did not provide evidence that the pre-existing injuries would prevent recovery under the MIG.