N.M. v. Certas Direct Insurance Company (16-001438)

The claimant sought entitlement to medical benefits. The insurer denied the benefits and held the claimant within the MIG. The claimant argued that a pre-existing condition of spina bifida warranted removal from the MIG. The claimant also advanced a chronic pain and psychological impairment argument. Adjudicator Rebecca Hines noted that the asserted pre-existing condition was not documented by a healthcare practitioner before the accident, per section 18(2). In any event, however, Adjudicator Hines noted that the conditions asserted were not proven to be barriers to recovery. The assertions of chronic pain and psychological impairment were found to be unsupported by medical evidence. The MIG was maintained and the treatment plans were denied.