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R.P. v Aviva Insurance Canada (17-003500)

  • May 7, 2018

The claimant appealed Aviva’s MIG determination and sought medical benefits for chiropractic services, the completion of numerous OCF-3s, a social work assessment, and an orthopaedic assessment. The claimant also sought IRBs. Aviva opposed the claimant’s request to have a treating chiropractor qualified as an expert. Adjudicator Hines held that the claimant’s injuries were within the MIG and none of the OCF-18s or OCF-3s were reasonable and necessary. The adjudicator further held that the claimant was not entitled to IRBs. The adjudicator also held that the treating chiropractor was not qualified as an expert witness, but could give evidence in his capacity as a treating chiropractor. The adjudicator held that the claimant sustained soft-tissue injuries, which fell within the MIG. The adjudicator held that the chiropractor’s diagnosis of post-concussion syndrome/concussion was outside the scope of his expertise, and the adjudicator also found inconsistencies in the claimant’s evidence with respect to “loss of consciousness”. The adjudicator preferred Aviva’s IE report from a psychologist over the claimant’s report from a social worker with respect to psychological injuries. The adjudicator also held that the rates charged on the OCF-18s exceeded the amounts payable under the FSCO Guideline. The OCF-3s were not payable as particulars were not provided with respect to the claimant’s change in condition and updated OCF-3s were not requested by Aviva. Lastly, the adjudicator preferred Aviva’s multi-disciplinary report over the claimant’s evidence (OCF-3s) with respect to IRBs, and held that the claimant did not suffer a substantial inability to perform the essential tasks of a material handler or casino dealer.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, LAT Rules, Minor Injury Guideline
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