The claimant applied to the LAT disputing her entitlement to a chiropractic treatment plan. The issue in this dispute was the application of sections 38(5) and (6), and the MIG. The insurer denied the treatment plan in accordance with section 38(5) on the basis that the claimant was being treated within the MIG. Later, the insurer removed the claimant from the MIG and the claimant argued that once the insurer removed the claimant from the MIG, it failed to reconsider its denial of the disputed treatment plan and failed to make a determination regarding its reasonableness and necessity. The insurer argued that it was entitled to deny the plan pursuant to section 38(5) as this section allows an insurer to refuse to accept a treatment plan if the plan described goods and services during any period which the insured person is entitled to receive goods and services within the MIG. The insurer submitted an OCF-21 for this period showing that the claimant was treated within the MIG. Adjudicator Lake held that the claimant was treated within the MIG when the disputed treatment plan was submitted and therefore, section 38(5) applied and the LAT was prevented from reviewing the denial of the plan pursuant to section 38(6), regardless of the fact the insurer later removed the claimant from the MIG.
