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Applicant v. The Personal Insurance Company (17-007961)

  • October 9, 2018

The claimant applied to the LAT seeking a finding that his injuries fell outside the MIG, and seeking entitlement to various treatment plans. Adjudicator Driesel held that the claimant’s injuries fell within the MIG and he was therefore not entitled to the various treatment plans. The claimant sustained soft-tissue injuries to his back, shoulders, and knee. The adjudicator held that the claimant did not have a pre-existing condition that would take him outside the MIG. Despite the claimant having pre-existing right shoulder tendinopathy and possibly a skull hairline fracture, the adjudicator held that there was no medical opinion that explained how the pre-existing conditions were impacted by the MVA nor how the pre-existing conditions would prevent maximal recovery under the MIG. The adjudicator also held that the claimant did not have a psychological impairment, due to a lack of evidence. The claimant argued that the insurer was estopped from a MIG argument as it approved treatment beyond $3,500. The adjudicator held that treatment had not been approved beyond the MIG limit, as a previously approved treatment plan was transferred to a new clinic before the approved amount had been fully incurred.

Full decision here

TGP Analysis

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  • FILED UNDER Minor Injury Guideline
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