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A.A. v. Aviva General Insurance Company (18-009541)

  • February 25, 2020

The claimant applied for medical benefits, which the insurer denied on the basis that his injuries fell within the MIG and that the benefits were not reasonable and necessary. Prior to the first case conference, all issues in dispute were agreed to paid including interest, and the insurer removed the claimant from the MIG. The claimant sought to proceed with his claim for a special award as stand-alone issue. The insurer argued that the Tribunal did not have authority to issue an award where all the issues in dispute have been resolved prior to the hearing. Adjudicator Johal found that the claimant was entitled to a special award in the amount of 25 percent of the maximum award, totalling $2,316.68, on the basis that the insurer showed a pattern of lateness in responding to treatment plans, and continued to maintain that the MIG applied to the claimant’s injuries despite an IE report to the contrary.

Full decision here

TGP Analysis

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