The claimant sought entitlement to medical benefits and removal from the MIG. Adjudicator Leslie concluded that the insurer had not complied with section 38 of the SABS in the denial timeline, and that the insurer was therefore prohibited from taking the position that the MIG applied. One of the claimed treatment plans was awarded.
The claimant sought entitlement to a number of medical treatment plans. The insurer asserted the claimant was governed by the MIG. The claimant raised an objection to the insurer’s notice letters. However, Adjudicator S.F. Mather determined the correspondence was compliant and that a medical reason was provided. On review of the medical evidence, Adjudicator Mather further concluded the MIG applied to the claimant and therefore the treatment plans sought were not payable as the MIG limits were exhausted.
The claimant sought NEBs, medical benefits, and removal from the MIG. The adjudicator found that the claimant did not satisfy the burden of being removed from the MIG. There was a causation issue as the claimant was involved in two separate accidents and the alleged injuries from each accident were similar. NEBs were denied on credibility issues and the failure to provide sufficient evidence of the details of the claimant’s pre-accident lifestyle.
The insurer sought reconsideration of the Tribunal’s decision on MIG because the claimant had been removed from the MIG two years prior. The Executive Chair rescinded the adjudicator’s decision regarding MIG because it was not an issue before the Tribunal in dispute.
The claimant sought IRBs at a rate above the weekly rate paid by the insurer. The claimant also sought removal from the MIG. Adjudicator Gottfried dismissed the claim for increased IRBs as the claimant had not provided any documentation to support increasing the weekly quantum. The adjudicator also noted that entitlement to ongoing IRBs does not mean one’s injuries are non-MIG. The claimant was restricted to MIG-level medical benefits
Following an accident, the self-employed claimant stopped operating his business in January 2016. Adjudicator Sewrattan concluded that the IRB calculation could not take into account business losses, as the claimant did not have business losses (as calculated by the Income Tax Act) after he ceased operations of his business. In terms of medical benefits, the adjudicator concluded that the claimant’s injuries did not fall in the MIG and wrote that pain reduction is a valid goal when assessing whether a treatment plan is reasonable and necessary.
The claimant sought removal from the MIG, and entitlement to two treatment plans. Arbitrator Truong concluded that the MIG applied despite various pre-existing conditions, previous motor vehicle accidents, and earlier psychological injuries.
The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Theoharis concluded that the claimant suffered from depression and anxiety, which entitled her to benefits above the MIG limits. However, Adjudicator Theoharis concluded that all treatment plans for physical treatment were not reasonable and necessary, as the claimant had met maximum medical improvement from a physical perspective.
The claimant sought removal from the MIG and entitlement to ACBs and various medical benefits. The claimant was removed from the MIG based on psychological grounds and awarded various assessments and psychological treatment. ACBs were denied. Adjudicator Lester noted that even if the claimant had been found to require personal assistance, the evidence did not satisfy the proof of an incurred expense.
The claimant sought entitlement to four treatment plans and removal from the MIG. As a preliminary issue, the insurer argued that two treatment plans were barred by the limitation period. Adjudicator An concluded that one treatment plan was statute barred, but that the claimant had applied to the LAT in a timely fashion for the second treatment plan. In terms of the MIG, Adjudicator An concluded that the claimant had sustained minor injuries in the accident, but had a pre-existing condition (severe degenerative disc disease) which would prevent recovery under the $3,500 cap. No evidence was submitted regarding the treatment plans; Adjudicator An therefore did not award them.
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Toronto, Ontario M5H 3S5
416.507.1850
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850