Category: Minor Injury Guideline

S.S. v. The Personal Insurance Company (19-004026)

Post author By tgp-admin
Post date August 28, 2020
No Comments on S.S. v. The Personal Insurance Company (19-004026)

The claimant sought entitlement to IRBs and removal from the MIG. Adjudicator Lake concluded that the claimant was not entitled to IRBs, but that his injuries fell outside of the MIG. With regard to IRBs, the claimant failed to prove that he was substantially unable to perform the essential tasks of his pre-accident employment. A note from the claimant’s family physician was not persuasive because the claimant had not attended the physician to get the note nor had he attended for six months. The claimant also was not attending for any physical treatment for his symptoms. Regarding the MIG, Adjudicator Lake accepted that the claimant suffered from psychological symptoms including anxiety.

B.S. v. Aviva Insurance Canada (19-001828)

Post author By tgp-admin
Post date August 26, 2020
No Comments on B.S. v. Aviva Insurance Canada (19-001828)

The claimant sought removal from the MIG and entitlement to physiotherapy and two assessments. Adjudicator Maleki-Yazdi found that the claimant’s injuries fell outside of the MIG and that the claimant was entitled to all three treatment plans. Additionally, she concluded that the insurer’s section 38 notices were deficient. All three denials were similarly worded and simply stated that there was no “compelling evidence that shows that your injuries do not fall within the Minor Injury Guideline.” No further details regarding the “compelling evidence” was provided. The adjudicator held that the denials were vague and did not provide the claimant with meaningful explanation for the denials to allow her to make an informed decision about whether to accept or dispute the decision. Subsequent denials following the IEs did provide meaningful explanation, but the insurer would have been required to pay for all incurred treatment up to the date of the proper denial.

J.T. v. Primmum Insurance Company (18-009043)

Post author By tgp-admin
Post date August 26, 2020
No Comments on J.T. v. Primmum Insurance Company (18-009043)

The self-represented claimant argued that he suffered a catastrophic impairment following a collision in a parking lot. The insurer’s position was that the claimant suffered a minor injury. Adjudicator Manigat concluded that the claimant suffered a minor injury and dismissed the catastrophic impairment determination. No medical evidence was provided by the claimant in support of his position, nor was an expert opinion provided. While an OCF-19 was completed by the family physician, no referral was ever made for further investigation. The IE reports found that the claimant suffered soft tissue injuries and the claimant did not provide any evidence of a pre-existing condition.

M.V. v. Aviva General Insurance Company (18-011523)

Post author By tgp-admin
Post date August 21, 2020
No Comments on M.V. v. Aviva General Insurance Company (18-011523)

The claimant sought entitlement to IRBs and removal from the MIG. Vice Chair Farlam concluded that the claimant was not entitled to IRBs and that his injuries fell within the MIG. The medical evidence provided showed only soft tissue injuries, and insufficient objective evidence was led regarding chronic pain or psychological impairment. There were also multiple inconsistencies with the claimant’s reporting that called into question the medical opinions based on the claimant’s self-reported symptoms. Regarding IRBs, the claimant himself said during IE assessments that he was not disabled from working from a psychological perspective, and no evidence from the family physician was submitted regarding the claimant’s ability to return to work.

C.G. v. The Guarantee Company of North America (17-007300)

Post author By tgp-admin
Post date August 13, 2020
No Comments on C.G. v. The Guarantee Company of North America (17-007300)

The claimant had a number of pre-accident injuries and impairments. She suffered an exacerbation of her conditions in the accident. She sought entitlement to NEBs, removal from the MIG, and two assessment costs. The insurer argued that the claimant’s impairments were not caused by the accident. Adjudicator Johal accepted that the accident did cause an exacerbation of pre-existing injuries that would otherwise have not occurred. She also concluded that the claimant suffered chronic pain as a result of the accident given that her pain persisted for more than six months, and her injuries therefore did not fall within the MIG; this conclusion was made without a specific diagnosis of chronic pain. The claimed psychological assessment was awarded, but the denied in-home assessment was not as the medical evidence suggested that the claimant remained independent with personal care. The claim for NEBs was also dismissed. The claimant failed to provide evidence that her post-accident life was significantly different than her pre-accident life.

C.G. v. The Guarantee Company of North America (17-007300)

Post author By tgp-admin
Post date August 13, 2020
No Comments on C.G. v. The Guarantee Company of North America (17-007300)

S.S.L. v. Certas Direct Insurance Company (19-004473)

Post author By tgp-admin
Post date August 12, 2020
No Comments on S.S.L. v. Certas Direct Insurance Company (19-004473)

The claimant sought removal from the MIG and entitlement to IRBs, two treatment plans for chiropractic services, and cost of examination. Prior to the hearing, the claimant withdrew her claims for the medical benefits and the costs of examinations. Adjudicator Norris held that the claimant could not dispute the MIG if no medical or rehabilitation benefits were in dispute. Adjudicator Norris concluded that the claimant was not entitled to IRBs because there was no compelling evidence to support her claim that she was disabled from working as an event planner. The evidence was clear that the claimant did not suffer physical or psychological impairment that would prevent her from completing her essential tasks of employment.

J.R. v. Aviva Insurance Company (19-006160)

Post author By tgp-admin
Post date July 22, 2020
No Comments on J.R. v. Aviva Insurance Company (19-006160)

The claimant disputed his MIG determination, as well as entitlement to attendant care benefits in the amount of $138.09 per month and various medical benefits. Adjudicator Boyce found the claimant to be unsuccessful on all of the disputed issues. The claimant’s argument for removal from the MIG centred around his psychological impairments, relying on a psychological pre-screen interview report. Adjudicator Boyce did not find the pre-screen report compelling because it included no preliminary diagnosis or suggestion that the claimant met DSM-V criteria. Further, the claimant’s family doctor records made no reference to accident-related psychological complaints. As the claimant’s injuries fell within the MIG, he was not entitled to attendant care benefits or the disputed non-MIG treatment plans.

F.S. v. The Dominion of Canada General Insurance Company (19-007563)

Post author By tgp-admin
Post date June 19, 2020
No Comments on F.S. v. The Dominion of Canada General Insurance Company (19-007563)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Johal found that three of the four medical benefits were barred by the limitation period. The denials were clear and unequivocal. Section 7 of the LAT Act did not apply because the claimant failed to show a bona fide intention to dispute entitlement within the limitation period or an explanation for the delay. Regarding the remaining disputes, Adjudicator Johal concluded that the claimant’s injuries fell within the MIG.

B.N. v. The Co-Operators Insurance Company (19-006455)

Post author By tgp-admin
Post date June 11, 2020
No Comments on B.N. v. The Co-Operators Insurance Company (19-006455)

The claimant sought removal from the MIG and entitlement to three treatment plans for psychology services and chiropractic treatment. This case also raised the issue of whether an insurer can properly deny medical benefits for a psychological assessment and psychological treatment without requiring the claimant to attend an in-person IE for a psychological assessment. With respect to the MIG, the claimant did not provide the required evidence from his health care providers to support that he had pre-existing conditions that would prevent him from achieving maximum recovery. In addition, the treatment plans and psychological report lacked credibility and the claimant’s psychological complaints were not medically supported. The adjudicator ruled that the claimant did not sustain more than predominately minor injuries. For this reason, the treatment plans were not reasonable or necessary. In determining whether the insurer provided proper medical reasons for denying the disputed treatment plans, Adjudicator Mather was satisfied that the insurer had made it clear to the claimant what medical evidence it was looking for to substantiate the claim. Adjudicator Mather held that the insurer provided a valid medical reason for denying the benefits for the psychological assessment and psychological treatment.

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