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F.C. v. Aviva General Insurance (19-003936)

  • April 27, 2021

The claimant disputed her MIG determination and her entitlement to medical benefits. In regard to the MIG, Adjudicator Moten found the claimant’s prior injury to her coccygeal region prevented maximal recovery if she were limited to the $3,500 minor injury limits. Adjudicator Moten also found there was compelling evidence in the claimant’s health practitioners’ medical records to support that her pre-existing injury prevented from reaching maximum recovery under the MIG even though none of the evidence explicitly stated that conclusion. In regard to the disputed treatment plans for chiropractic treatment, Adjudicator Moten determined the claimant had satisfied her onus the proposed treatment was reasonable and necessary and she was entitled to payment of those treatment plans along with interest. However, Adjudicator Moten found the claimant had not shown the treatment plan for a psychological assessment was reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline
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