The insurer initially denied four treatment plans because it believed that the MIG applied and the treatment plans proposed treatment outside of the MIG. Section 38(5) provides that the insurer may refuse to accept a non-MIG treatment plan during the period that the claimant is entitled to receive treatment under the MIG. The claimant submitted that section 38(5) did not apply because she sustained an accident-related injury that fell outside of the MIG. The insurer submitted that it was not obligated to accept the injuries listed on an OCF-18 without compelling medical evidence. Adjudicator Norris found that the insurer’s denial were proper. The injuries described in the treatment plans were predominantly soft-tissue injuries and the claimant failed to provide compelling evidence of a pre-existing injury or non-minor injury with any of the four treatment plans. Considering this, the insurer’s denial was valid pursuant to section 38(5) of the Schedule and the claimant was obligated to submit a treatment confirmation form pursuant to section 40(2). Accordingly, pursuant to section 38(6), the insurer’s decision was not subject to review. According to section 38(5), the claimant must treat her injuries within the MIG until she provides compelling evidence of a non-minor injury or a pre-existing medical condition which would preclude her recovery if she is subject to the MIG.
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