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S.G. v. Aviva General Insurance (18-007668)

  • May 27, 2019

The claimant sought a determination that his impairments were outside of the MIG and entitlement to two treatment plans, one for psychological treatment and another for an orthopaedic assessment. Adjudicator Braun concluded that the claimant’s physical injuries were minor, but that he had sustained a psychological injury which exempted him from the MIG limit. The Adjudicator noted that both the claimant’s and the respondent’s assessors had concluded that the claimant sustained psychological impairments as a direct result of the accident. The fact that the specific diagnoses of the assessors differed did not matter. Despite the claimant’s psychological impairments, Adjudicator Braun found that the psychological treatment plan was not reasonable and necessary. He felt that the claimant’s post-accident activity level suggested that he had been able to achieve the goals of the treatment plan on his own, without psychological intervention. The Adjudicator also found the orthopaedic assessment was not reasonable and necessary, as there was no evidence to suggest that the claimant experienced any ongoing musculoskeletal pain or physical complications arising from the accident.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline
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