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The Applicant v. Wawanesa Mutual Insurance Company (16-002823)

  • October 2, 2017

The claimant submitted four treatment and assessment plans to the insurer. The insurer held that the claimant had suffered minor injuries and that his treatment fell within the Minor Injury Guideline. Adjudicator Anwar explained in order to allege that an injured person has pre-existing medical injuries that required treatment in excess of the MIG limits, the injured person’s healthcare provider must provide specific evidence. First, the injured person must have a pre-existing medical condition that was documented prior to the accident. Second, there must be evidence that the pre-existing medical condition will prevent the person from achieving maximal recovery if the benefits are limited to the MIG cap. Adjudicator Anwar found that the claimant had not submitted sufficient and convincing evidence to prove that he suffered from pre-existing conditions, and was therefore not entitled to treatment beyond the MIG limits.

Full decision here

TGP Analysis

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  • FILED UNDER Minor Injury Guideline
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