Category: Minor Injury Guideline

S.B. v. Aviva General Insurance (16-004395)

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.

G.D. v. The Personal Insurance Company (16-003190)

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.

Y.Y. v. Aviva Insurance (16-001997)

The claimant sought removal from the MIG and two medical benefits. Adjudicator Mather concluded that the claimant had not submitted sufficient evidence of a non-minor injury, or sufficient evidence of a pre-existing condition. The claims were dismissed.

D.D. v. The Dominion of Canada General Insurance Company (16-002750)

The claimant sought entitlement to medical, non-earner, and attendant care benefits. The insurer asserted a MIG position. Adjudicator Nicole Treksler was critical of the evidence tendered and noted the claimant did not specify which of the activities she was unable to perform after the MVA were important to her. Moreover, the claimant failed to provide clinical notes and records, or commission medical reports and, as a result, failed to meet the burden of proof to warrant removal from the MIG. Accordingly, all the claims were dismissed.

M.G. v. Primmum Insurance Company (16-002951)

The claimant was a pedestrian knockdown. She claimed entitlement to two treatment plans; one psychological and the other for physiotherapy. The claimant also objected to the insurer placing her within the MIG. After reviewing the medical documentation of each party, Adjudicator Chris Sewrattan concluded the claimant suffered a psychological impairment. She was removed from the MIG and only the psychological treatment plan was awarded. The treatment plan for physiotherapy was denied as not being reasonable and necessary.

B.W. v. Royal SunAlliance Insurance (16-001517)

The claimant sought entitlement to five treatment and assessment plans. The insurer denied the treatment based on a MIG determination. Adjudicator Johal dismissed all claims and upheld the MIG determination. Of note, while Adjudicator Johal found the claimant did suffer from issues of anxiety, depression, sleeping problems, and panic attacks prior to the accident, it was noted that “the presence of pre-existing conditions alone is not sufficient to remove the applicant from the MIG. The applicant bears the onus and must adduce evidence to demonstrate that the pre-existing condition prevents him from achieving maximal recovery within the MIG.”

E.F. v. RBC Insurance Company (16-001038)

The claimant sought entitlement to physiotherapy and an FAE. The insurer denied the treatment based on a MIG determination. Adjudicator Anwar considered the medical evidence submitted, including family doctor clinical notes and records, and determined the claimant did not prove entitlement to treatment beyond the MIG.

P.C. v. Wawanesa Mutual Insurance Inc. (16-000989)

The claimant sought entitlement to three treatment plans. The insurer denied the plans and maintained a MIG position. Adjudicator Truong reviewed the medical reports and found each to have competing views; as a result, a review of the clinical notes was undertaken. On review, the claimant was said to suffer from soft tissue injuries and associated sequelae; injuries governed by the MIG. The treatment plans were denied.

N.M. v. Certas Direct Insurance Company (16-001438)

The claimant sought entitlement to medical benefits. The insurer denied the benefits and held the claimant within the MIG. The claimant argued that a pre-existing condition of spina bifida warranted removal from the MIG. The claimant also advanced a chronic pain and psychological impairment argument. Adjudicator Rebecca Hines noted that the asserted pre-existing condition was not documented by a healthcare practitioner before the accident, per section 18(2). In any event, however, Adjudicator Hines noted that the conditions asserted were not proven to be barriers to recovery. The assertions of chronic pain and psychological impairment were found to be unsupported by medical evidence. The MIG was maintained and the treatment plans were denied.

Applicant (Minor) v. Wawanesa Mutual Insurance Company (16-000323)

The minor claimant sought removal from the MIG based on incomplete medical records and selective school records showing absenteeism. Adjudicator Mather rejected the claimant’s position and held that there was insufficient evidence to show that the relatively minor accident was related to the claimant’s school performance or causing any psychological difficulties.