Category: Minor Injury Guideline

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.

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 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 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.