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Applicant v Aviva General Insurance (17-003692)

  • August 23, 2018

The claimant argued that her injuries including chronic pain syndrome, psychological impairments, jaw injury, and post-traumatic headaches fell outside the MIG and sought medical benefits and the costs of examinations. Adjudicator Daoud held that the claimant suffered from minor injuries that fell within the MIG. The adjudicator found that claimant did not suffer from chronic pain syndrome, but rather soft tissue injuries and associated sequelae. She also concluded that while the claimant’s orthopaedic report diagnosed her with chronic pain syndrome, it provided no objective medical findings to support the diagnosis, did not address frequency and duration of pain, and failed to discuss post-accident activities and functional limitations. Further, the orthopaedic surgeon failed to review both the claimant’s family physician’s records and physiotherapy records. Adjudicator Daoud further held that the claimant’s psychological impairments fell within the MIG, as the claimant provided no objective medical opinion and the insurer’s IE report found no DSM-IV or DSM-V diagnosis. The claimant also failed to provide sufficient medical evidence demonstrating that her jaw pain was not a minor injury, as she only provided a diagnosis of TMJ pain from an orthopaedic surgeon, which was outside the scope of his specialty.

Full decision here

TGP Analysis

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  • FILED UNDER Minor Injury Guideline
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