The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans were found not payable.
The claimant sought entitlement to medical benefits. The insurer asserted a MIG designation. On review, Adjudicator Sewrattan determined that the pre-existing back pain of the claimant would not prevent recovery under the MIG. The claimant’s injuries were deemed minor and the treatment plans were denied.
The claimant sought entitlement to four medical treatment plans. At the hearing the claimant also sought to add a claim for a special award and interest. On review, Adjudicator Bickley refused to allow the additional issues. After examining the medical evidence, one treatment plan was found reasonable and necessary. Because the treatment plan was originally partially approved up to MIG limits, the subsequent removal from the MIG precluded the insurer from taking the position the plan was unreasonable. The rest of the claims, however, were dismissed on the merits.
The claimant sought a determination that his impairments were outside of the MIG and entitlement to attendant care benefits. As a preliminary issue, the respondents sought to exclude the supplementary report of Dr. El-Hage, psychologist, and the sworn affidavit of the occupational therapist. Adjudicator Nemet granted the motion, as the material was written less than 30 days before the hearing and was clearly generated to address evidentiary deficiencies in the claimant’s case as set out in the respondent’s submissions. Further, the respondent would not have the chance to cross-examine the expert, as neither were being called by the claimant. The adjudicator found that the claimant’s psychological injuries fell outside of the MIG. The claimant’s evidence was that she required 45 hours per week of attendant care assistance, and that these services were provided by various family members. The adjudicator found that there was no reliable evidence by way of invoices, logs or any other corrobative evidence to what services, when, by whom and for how long were provided. He was not satisfied that the claimant had “incurred” the expenses as required by section 3(7)(e), noting that the evidence was consistent with the notion that the family members volunteered to help and that discussion about payment did not occur until much later. The adjudicator concluded that the claimant was not entitled to attendant care benefits, and dismissed the application.
The claimant sought removal from the MIG and entitlement to five treatment plans based on a spinal compression fracture identified two years after the accident. The insurer argued that the claimant had not proven that the compression fracture was related to the accident. Adjudicator Shapiro agreed with the insurer and concluded that the claimant had not met his onus of proof in demonstrating that the fracture was accident-related.
The claimant sought a determination that his impairments were outside of the MIG and entitlement to one treatment plan for a psychological assessment. Adjudicator Sewrattan found that the claimant’s injuries were predominantly minor and that his entitlement was subject to the MIG. In terms of psychological impairments, the adjudicator found that the diagnosis of mixed anxiety and depressive disorder made during the psychological assessment was too far removed from the test results produced. In terms of physical injuries, the adjudicator noted that the claimant’s submission that he suffered from chronic pain was based on a single clinical note from his new family doctor, with no explanation for the diagnosis. The Adjudicator concluded that the claimant was entitled to payment for the psychological assessment only if funds remained within the MIG.
The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG defence. On review of the evidence, Adjudicator Sewrattan determined the claimant’s psychological injury was as a result of the accident and not predominantly minor. The psychologically-based treatment plans were found payable, and the physically-based treatment plans were denied as not reasonable and necessary.
The claimant sought entitlement to NEBs and removal from the MIG. Adjudicator Belanger-Hardy denied all claims. First, she held that the claimant failed to adduce sufficient evidence of the details of his pre-accident lifestyle and activities to establish his eligibility to NEBs. Second, the claimant did not adduce sufficient evidence that he sustained a non-minor injury in the accident, or that he suffered a pre-existing medical condition that would prevent maximum medical recovery under the MIG. In particular, Adjudicator Belanger-Hardy wrote that the claimant mentioning “back pain” or “backache” to his physician on one pre-accident visit did not amount to compelling evidence of a pre-existing condition, nor did experiencing pre-accident cardiac conditions.
The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Hines found that the claimant did not submit sufficient evidence to support that he suffered a non-minor injury. She also held that the claimant did not adduce evidence explaining why Type 2 Diabetes or Hepatitis B would prevent the claimant from achieving maximum medical recovery under the MIG.
The claimant sought entitlement to medical and income replacement benefits. The insurer asserted a MIG position. Adjudicator Derek concluded the claimant had not proven he had injuries to warrant removal from the MIG, nor had a pre-existing condition impeding recovery within the MIG. Regarding IRBs, the claimant only relied on his disability certificate. The insurer’s IE reports were seen as a more valid depiction of the claimant’s functionality and the claim was dismissed.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP