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S.T. v. Certas Direct Insurance Company (17-005871)

  • October 10, 2018

The claimant applied to the LAT seeking a finding that his injuries fell outside the MIG, and seeking entitlement to physiotherapy and a chronic pain assessment. Adjudicator Kepman held that the claimant’s diagnosis of chronic pain fell outside of the MIG. The claimant suffered from pre-existing shoulder pain 2 months pre-accident, which was exacerbated by the accident. While the insurer’s IE assessor found that the claimant’s injuries were within the MIG, the adjudicator focused on the assessor’s findings that the claimant continued to experience pain 2.5 years post-accident and was participating in various treatment to address the complaints, including steroid injections and physiotherapy. The adjudicator found the proposed chronic pain assessment reasonable and necessary but did not find the proposed physiotherapy reasonable and necessary as the claimant had received similar treatment in the past which was noted as not being helpful.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline
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