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Y.X.Y. v. The Personal Insurance Company (16-000438)

  • August 17, 2017

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Neilsen explained that ongoing pain alone was insufficient to remove the claimant from the “minor injury” definition. Rather, she had to prove chronic pain syndrome. The ongoing pain had to be accompanied by some functional impairment. She wrote that a diagnosis of chronic pain without any discussion of the level of pain, its effect on the person’s function, or whether the pain is bearable without treatment will not meet the claimant’s burden to show that the chronic pain is more than mere sequelae of the “minor injury” sustained in the accident. The medical evidence submitted by the claimant was insufficient to prove a non-minor injury, and Adjudicator Neilsen held that the claimant’s pain was mere sequelae of the minor injury. Adjudicator Neilsen also rejected the allegations of psychological injury based on the inconsistencies in the medical report and the claimant’s self-reporting. The only benefit awarded was $215 for a psychological assessment, which is provided for in the Minor Injury Guideline.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline, Attendant Care Benefits
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