The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Truong held that the claimant had failed to demonstrate that he sustained a non-minor injury in the accident. She was particularly critical of the claimant’s failure to submit specific evidence in support of his claim.
The claimant sought entitlement to non-earner and medical benefits. The insurer denied the benefits and asserted a MIG position. On review of the medical evidence, Adjudicator Avvy Go held the claimant suffered a minor injury with no pre-existing injury and was therefore governed by the MIG. Moreover, the medical evidence did not support the claimant suffering a complete inability to carry on a normal life. Accordingly, the claims were dismissed.
The claimant sought removal from the MIG and entitlement to various medical benefits for physical therapy and psychological therapy. Adjudicator Markovits held that the claimant was suffering from an adjustment disorder with mixed anxiety and depressed mood, and that his injuries were therefore non-minor. In terms of the medical benefits sought, Adjudicator Markovits awarded all of the claimed physical therapy and orthopaedic assessment; he denied part of the proposed psychological treatment, a driving re-integration assessment, and a chronic pain assessment.
The claimant sought a determination that his impairments were outside of the MIG and entitlement to various medical benefits and costs of examinations. As a preliminary issue, the claimant requested to know the number of reports that each of the IE assessors had provided to the respondent for the last three years and the cost of each report. Adjudicator Paluch denied the claimant’s request for production. He failed to see how information about how many times a particular assessor has been retained by an insurer or how much the report cost would be relevant in assisting the claimant in satisfying that his injuries are not minor or that the proposed treatments are reasonable and necessary. The more appropriate forum to impugn the objectivity of an expert is at a live hearing, not a written preliminary issue hearing.
The claimant submitted four treatment and assessment plans to the insurer. The insurer held that the claimant had suffered minor injuries and that his treatment fell within the Minor Injury Guideline. Adjudicator Anwar explained in order to allege that an injured person has pre-existing medical injuries that required treatment in excess of the MIG limits, the injured person’s healthcare provider must provide specific evidence. First, the injured person must have a pre-existing medical condition that was documented prior to the accident. Second, there must be evidence that the pre-existing medical condition will prevent the person from achieving maximal recovery if the benefits are limited to the MIG cap. Adjudicator Anwar found that the claimant had not submitted sufficient and convincing evidence to prove that he suffered from pre-existing conditions, and was therefore not entitled to treatment beyond the MIG limits.
The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.
The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.
The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.
The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG position and noted one treatment plan to be limitations barred. Adjudicator Avvy Go noted the burden rested with the claimant and that the evidence tendered did not tie any specific impairment to the MVA. Moreover, the impairments were described as “mild or degenerative” in nature. The MIG was said to govern. The insurer noted that one treatment plan, while approved, lacked information requested under section 33 regarding a collateral benefits payer and as such was not payable until complied with. The claimant sought payment; however, Adjudicator Go noted the timing of the LAT application was beyond the 2 year period. The claimant was limitations barred from seeking payment.
The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG position. Adjudicator Rupinder Hans considered the medical evidence and determined that the claimant had met the evidentiary burden that the injuries sustained fell outside of the MIG. The treatment plans in dispute were deemed reasonable and necessary and therefore payable. Interest was also deemed payable on all unpaid and incurred treatment.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP