Category: Minor Injury Guideline

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.

Applicant v. TD General Insurance Company (16-000134 and 16-000646)

Executive Chair Lamoureux was asked to reconsider two decisions in which the claimant was found MIG and found not entitled to NEBs. The applicant argued that “the entirety” of his evidence was “not considered at all.” Similarly, in his request for reconsideration of NEBs the applicant argued that his “evidence was not considered at all or put before the [Tribunal].” Executive Chair Lamoureux rejected both requests for reconsideration, noting that the adjudicator had considered evidence submitted by both parties, and that there was no requirement that the adjudicator mention each record or documents put before the Tribunal.

M.K. v. Dumfries Mutual Insurance Company (16-000501)

The claimant sought IRBs and removal from the MIG. Adjudicator Theoharis rejected the claimant’s case. She held that the claimant did not suffer impairments that would entitle her to IRBs or removal from the MIG. In particular, Adjudicator Theoharis relied upon surveillance showing the claimant engaging in multiple activities she said she could not do. Adjudicator Theoharis placed no weight on the s. 25 psychological report, as it took the claimant’s self-reporting at her own word. There was also no mention of psychological difficulties in the claimant’s family doctor’s notes.

L.C. v. Aviva Insurance Company of Canada (16-001387)

The claimant sought removal from the MIG and entitlement to a series of treatment plans.  Adjudicator Flude concluded that the applicant had suffered a predominantly minor injury. A post-accident MRI identified degenerative changes and nerve root compression. The applicant argued that the condition was pre-existing and entitled him to removal from the MIG. Adjudicator Flude disagreed and noted that the diagnosis was not made until 3 years after the accident and failed the requirement to be identified prior to the accident.

Applicant v. Aviva Insurance Canada (16-000098)

This was a reconsideration request by the insurer following a decision that the claimant sustained psychological injuries that fell outside of the MIG. Executive Chair Lamoureux held that the adjudicator had weighed all of the evidence and made clear findings. There was therefore no basis to overturn the initial decision.

H.C. v. Certas Direct Insurance Company (16-001285)

The claimant sought entitlement to income replacement benefits along with two treatment plans, costs, and a special award. Adjudicator Bass reviewed the medical evidence, along with surveillance submitted by the insurer. It was found that the claimant’s reports were “overly pessimistic in light of the surveillance evidence from only a few months later.” As a result, it was concluded that the claimant did not sustain a substantial inability to perform the essential tasks of his employment. The treatment plans claimed were also denied as Adjudicator Bass found the claimant’s injuries to be minor.

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