Category: Minor Injury Guideline

N.C. v. RBC General Insurance Company (16-000282)

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.

M.M. v. Wawanesa Mutual Insurance Company (16-000642)

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.

D.J. v. Aviva Insurance Canada (16-000098)

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.

B.U. v. Aviva Canada Inc. (16-000143)

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.

C.S. v. Unifund Assurance Company (16-000087)

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.

A.P. v. Aviva Canada (16-000045)

The claimant sought further IRBs and medical benefits out of the MIG. Vice Chair Flude held that the claimant did not suffer from a pre-existing condition, was not suffering chronic pain syndrome, and could perform the essential tasks of her employment. IRBs were denied and the claimant was restricted to MIG level benefits.

K.P. v. Aviva Canada Inc. (16-000046)

The claimant sought medical benefits outside of the MIG. Vice Chair Flude considered the list of injuries the claimant claimed to have sustained in the accident. He held that there was no evidence provided linking the injuries to the accident, or to show that the injuries did not fall under any of the “minor injury” elements. He concluded that the claimant’s injuries were predominantly minor injuries.

S.S. v. State Farm Mutual Automobile Insurance Company (16-000084)

The claimant sought removal from the MIG, and entitlement to a treatment plan for physical therapy. Adjudicator Theoharis concluded that the claimant had sustained a “minor injury” and did not suffer a pre-existing condition that would prevent him from being treated under the $3,500 limit. The claimed treatment plan was denied.