Category: Minor Injury Guideline

T.S. v. Aviva General Insurance (17-000835)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Ferguson rejected the claimant’s allegations of psychological injury. He also rejected the submission that the claimant’s chronic pain was not covered by the definition of “minor injury.” Adjudicator Ferguson accepted that the claimant did suffer chronic pain syndrome as a result of the accident. However, Adjudicator Ferguson concluded based on the medical evidence that the claimant’s chronic pain was a clinically associated sequelae of his minor injuries. He was therefore restricted to $3,500 in medical benefits. The claimed treatment plans were denied

Y.X.Y. v. The Personal Insurance Company (16-000438)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Neilsen explained that ongoing pain alone was insufficient to remove the claimant from the “minor injury” definition. Rather, she had to prove chronic pain syndrome. The ongoing pain had to be accompanied by some functional impairment. She wrote that a diagnosis of chronic pain without any discussion of the level of pain, its effect on the person’s function, or whether the pain is bearable without treatment will not meet the claimant’s burden to show that the chronic pain is more than mere sequelae of the “minor injury” sustained in the accident. The medical evidence submitted by the claimant was insufficient to prove a non-minor injury, and Adjudicator Neilsen held that the claimant’s pain was mere sequelae of the minor injury. Adjudicator Neilsen also rejected the allegations of psychological injury based on the inconsistencies in the medical report and the claimant’s self-reporting. The only benefit awarded was $215 for a psychological assessment, which is provided for in the Minor Injury Guideline.

D.T. v. Wawanesa Mutual Insurance Company (16-000266)

The claimant sought reconsideration of the Tribunal’s decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant’s entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing condition; second, that the Tribunal considered improper surveillance footage; and, lastly, that the Tribunal erred in refusing her requests for an oral hearing and for the hearing to be recorded. Executive Chair Lamoureux denied the reconsideration request. She held that the Tribunal had properly reviewed the entire medical record when it determined that the claimant fell within the MIG. She noted that claimant’s counsel had provided the Tribunal with little guidance regarding the evidentiary record, and had failed in its duty to best present the claimant’s position. She further held that the Tribunal had properly addressed the claimant’s objections to the surveillance footage, and any new concerns raised in the reconsideration request were not permissible. Moreover, Executive Chair Lamoureux held that the claimant’s rights to procedural fairness were not affected by the Tribunal’s decisions to deny her requests for an oral hearing and for the hearing to be recorded.

D.T. v. Wawanesa Mutual Insurance Company (16-000266)

The claimant sought reconsideration of the Tribunal’s decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant’s entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing condition; second, that the Tribunal considered improper surveillance footage; and, lastly, that the Tribunal erred in refusing her requests for an oral hearing and for the hearing to be recorded. Executive Chair Lamoureux denied the reconsideration request. She held that the Tribunal had properly reviewed the entire medical record when it determined that the claimant fell within the MIG. She noted that claimant’s counsel had provided the Tribunal with little guidance regarding the evidentiary record, and had failed in its duty to best present the claimant’s position. She further held that the Tribunal had properly addressed the claimant’s objections to the surveillance footage, and any new concerns raised in the reconsideration request were not permissible. Moreover, Executive Chair Lamoureux held that the claimant’s rights to procedural fairness were not affected by the Tribunal’s decisions to deny her requests for an oral hearing and for the hearing to be recorded.

Applicant v. Security National Insurance Company (16-003024)

The claimant sought entitlement to medical benefits and removal from the MIG. He also argued that the insurer’s denials did not comply with section 38 of the SABS. Adjudicator Belanger-Hardy dismissed the claims. She held that the insurer’s denials provided sufficient information to comply with the SABS. She also held that the evidence submitted supported a finding of minor physical injuries, and insufficient evidence was submitted to support an accident-related psychological injury.

C.A. v. The Dominion of Canada General Insurance Company (16-004033)

The claimant sought further medical benefits and removal from the MIG. Adjudicator Hines concluded that the claimant’s injuries were minor injuries, and rejected the expert opinion of his assessors. Adjudicator Hines was critical of the claimant’s assessors for failing to be provided with full medical documentation, for relying largely upon the claimant’s self-reporting, and for ignoring contradictions. She also noted that the bulk of medical evidence supported a diagnosis of soft tissue injuries, and that the claimant had not sought treatment for over one year.

C.J. v. The Personal Insurance Company of Canada (16-002815)

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.

C.J. v. The Personal Insurance Company of Canada (16-002815)

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.

G.K. v. Wawanesa Mutual Insurance Company (16-004479)

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.

K.K. v. Aviva Insurance (16-000863)

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.