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.