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P.Y. v Aviva General Insurance Company (17-003692)

  • September 16, 2019

The claimant sought reconsideration of the Tribunal’s decision based on there being new evidence that the claimant could not have reasonably obtained earlier and based on the insurer’s concession at the close of the proceedings that the MIG did not apply. Adjudicator Grieves granted the claimant’s reconsideration request. Adjudicator Grieves accepted that the new evidence, being a s. 25 psychological report, was not reasonably available to the claimant at the time of the hearing and would have affected the Tribunal’s result with respect to its MIG finding. Adjudicator Grieves also criticized the parties for not advising the Tribunal that the insurer had agreed at the close of proceedings to remove the claimant from the MIG, as this would have affected the Tribunal’s result. Adjudicator Grieves ordered that the matter be sent back to the Tribunal to determine the reasonableness and necessity of the disputed treatments plans as the claimant was now out of the MIG.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Minor Injury Guideline, Reconsideration
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