Category: Minor Injury Guideline

C.W. v. Aviva Insurance Company (19-002426)

Post author By tgp-admin
Post date June 3, 2020
No Comments on C.W. v. Aviva Insurance Company (19-002426)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Farlam found that the claimant sustained minor injuries in the accident. While the disability certificate noted COPD, mild stroke, right sciatica, low back pain, they appeared to be self-reported by the claimant, and there was no pre-accident medical records documenting the alleged pre-existing medical conditions. Adjudicator Farlam also considered the claimant’s arguments that section 38 of the SABS entitled him to payment of incurred medical benefits. The adjudicator accepted that one of the disputed treatment plans was responded to 10 days late. However, the claimant had not incurred any of the proposed treatment during that time frame, so the insurer was not liable to pay anything.

Z.X.C. v Belair Insurance Company (19-000314)

Post author By tgp-admin
Post date May 15, 2020
No Comments on Z.X.C. v Belair Insurance Company (19-000314)

The claimant disputed her MIG determination, as well as entitlement to various medical benefits and IRBs. Adjudicator Shapiro concluded that based on the medical evidence, the claimant suffered predominantly minor physical injuries – strains and sprains – as a result of the accident, and her injuries thus fell within the MIG. Adjudicator Shapiro also determined that the claimant was not entitled to IRBs as she had not proven the rate of the benefit, nor had she proven her basic entitlement to IRBs after March 24, 2017. While the claimant submitted that she provided ample documentation to calculate the rate of IRBs, Adjudicator Shapiro found that the claimant’s records conflict as to what her employment earnings were, and when she earned it, and that her hearing testimony lacked credibility to fill in the gaps. He also felt that the claimant sustained minor strains and sprains, as above, which did not cause her a substantial inability to perform her pre-accident position in any event.

R.E. v Aviva Insurance Company (19-000303)

Post author By tgp-admin
Post date May 11, 2020
No Comments on R.E. v Aviva Insurance Company (19-000303)

The claimant disputed his MIG determination, as well as entitlement to various medical benefits and IRBs. Adjudicator Boyce concluded that the claimant sustained predominantly minor injuries as defined by the SABS that were properly treated within the MIG, noting that the medical evidence relied upon was “incredibly underwhelming”. Adjudicator Boyce further concluded that the claimant was not entitled to IRBs, as he had not demonstrated a substantial inability to perform the essential tasks of his pre-accident employment and had not furnished evidence that his income qualifies under section 4(5) of the SABS. The claimant made no reference to any medical evidence confirming that he was incapable of performing the essential tasks of his pre-accident work, aside from the insurer’s IE reports, which were unhelpful to him as they determined that he did not meet the IRB test. More problematically, the claimant did not produce any financial documentation or even identify for the Tribunal what his pre-accident employment constituted, how many hours he worked per week, or what his tasks were.

S.P. v Aviva General Insurance Company (18-008876)

Post author By tgp-admin
Post date May 8, 2020
No Comments on S.P. v Aviva General Insurance Company (18-008876)

The claimant disputed her MIG determination, as well as entitlement to various medical benefits and IRBs. Adjudicator Helt found that the clamant did not suffer from chronic pain so as to remove her from the MIG, noting that the medical records failed to establish that she claimant complained of persistent chronic pain issues causing functional impairment or disability over the course of several appointments. Adjudicator Helt further found that the claimant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a result of the accident, given that the claimant returned to work immediately after the accident for a period of five weeks and provided conflicting statements and information to doctors regarding her post-accident level of functioning (contradicted by way of surveillance evidence) and her work status.

P.S. v. Aviva General Insurance Company (19-000891)

Post author By tgp-admin
Post date May 1, 2020
No Comments on P.S. v. Aviva General Insurance Company (19-000891)

The claimant sought removal from the MIG and entitlement to various medical benefits, and argued that the insurer failed to comply with section 38. Adjudicator Maleki-Yazdi held that the claimant’s injuries fell in the MIG. However, one of the disputed treatment plans was awarded because no denial was ever provided by the insurer. An OCF-23 that was submitted by the treatment provider at the request of the insurer did not “supersede” the treatment plan; the insurer was still required to either approve or deny the treatment plan within 10 days.

C.C. v Aviva Insurance Canada (19-003244)

Post author By tgp-admin
Post date April 27, 2020
No Comments on C.C. v Aviva Insurance Canada (19-003244)

This preliminary issue hearing was brought to determine whether the claimant was barred from seeking a determination that the injuries sustained in the accident were not subject to the MIG, as that issue had already been determined by the FSCO. Adjudicator Watt found that the claimant was barred from seeking a determination that her injuries fell outside the MIG, as there was no reason why the fresh evidence raised by the claimant at the hearing was not available to the Arbitrator at the FSCO hearing. Further, the “new evidence” mirrored the same complaints at the time of the FSCO hearing and did not conclusively impeach the original results. Adjudicator Watt found that res judicata applied to the current hearing and therefore the claimant could not proceed.

C.Z. v Security National Insurance Company (18-012296)

Post author By tgp-admin
Post date April 24, 2020
No Comments on C.Z. v Security National Insurance Company (18-012296)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to a psychological assessment. Adjudicator Johal concluded that the claimant was not entitled to either IRBs or removal from the MIG. The claimant failed to provided any evidence to support his submissions that he suffers a substantial inability to perform the essential tasks of his employment, and had chosen to pursue a degree in University in the Fall of 2016.

J.J.X. v. Aviva General Insurance (19-002558)

Post author By tgp-admin
Post date April 22, 2020
No Comments on J.J.X. v. Aviva General Insurance (19-002558)

The claimant sought a determination that his injuries were outside of the MIG, and entitlement to medical benefits proposed in three physiotherapy treatment plans, a chiropractic treatment plan, and a psychological assessment. The claimant also sought entitlement to non-earner benefits. Adjudicator Grant found that the claimant’s injuries were predominantly minor and fell within the MIG. He found there were no records from any family physician to support the physical injury claims made by the claimant, and the medical evidence that was submitted confirmed that the claimant’s injuries were minor. As the MIG limit of $3,500 in medical and rehabilitation benefits had already been exhausted, it was unnecessary to determine whether the treatment plans in dispute were reasonable and necessary. Adjudicator Grant also found that the claimant had not met his onus of establishing that he suffered a complete inability to carry on a normal life and was therefore not entitled to non-earner benefits. He noted the medical evidence produced showed that the claimant returned to substantially all of his pre-accident activities, including attending the gym twice per week, cooking, and returning to school within a few days of the accident.

M.A. v Aviva General Insurance Company (18-011678)

Post author By tgp-admin
Post date April 15, 2020
No Comments on M.A. v Aviva General Insurance Company (18-011678)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to various medical benefits. Adjudicator Grant found that the claimant’s injuries were predominately minor in nature and there was no evidence before the Tribunal to support the claimant’s submission that his psychological impairments remove him from the MIG. Adjudicator Grant also noted that the claimant had not satisfied at least three of the criteria set out by the American Medical Association Guidelines, so the claimant could not be found to suffer from chronic pain. In terms of entitlement to IRBs, Adjudicator Grant found that claimant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

W.E. v Aviva Insurance Company (18-011102)

Post author By tgp-admin
Post date April 13, 2020
No Comments on W.E. v Aviva Insurance Company (18-011102)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Conway concluded that pursuant to section 38(11)(1), the insurer failed to comply with section 38(8) in its denial, and was barred from applying the MIG to the disputed benefits. While the adjudicator ultimately concluded that the disputed medical benefit was not reasonable and necessary, the insurer was required to pay for amounts incurred by the claimant.

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