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N.M. v. Certas Home and Auto Insurance (17-002605)

  • March 6, 2018

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Goela found that the claimant was subject to the $3,500 limit under the MIG. The Adjudicator found that the claimant did not provide evidence of a pre-existing injury that would prevent her from a full recovery if limited by the MIG. The Adjudicator elaborated on many factors that indicated that the claimant’s injuries were minor. She explained that the diagnostic imaging reports did not provide any data that could point to a physical cause for the claimant’s pain. Also, while the claimant had self-reported to her chiropractor that he was in sharp and constant pain, this self reporting could not be reconciled with other data that consistently noted that the claimant had a normal range of motion. Next, while a chronic pain specialist believed that the claimant suffered depression and PTSD, this specialist was not a psychologist, and so his opinion on the claimant’s psychological impairments was outside his scope of expertise. The Adjudicator found that the claimant’s injuries were minor because the claimant could continue her current employment, with tasks adapted at her own discretion. Finally, the Adjudicator found that claimant did not have a pre-existing injury that entitled her to benefits beyond the MIG limit, because she did not provide evidence of a pre-existing injury that would prevent her from a full recovery if limited by the MIG.

Full decision here

TGP Analysis

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  • FILED UNDER Minor Injury Guideline
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