Estella Muyinda

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain and functional impairment warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of chronic pain or functional impairment.

As the applicant remained subject to the MIG and the $3,500 funding limit had been exhausted, the claim for the chiropractic treatment plan and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained carpal tunnel syndrome as a result of the accident, which is not a predominantly minor injury, and removed him from the MIG.

The Tribunal granted entitlement to a $3,880.00 physiotherapy treatment plan and interest on overdue payments, but denied a $2,471.53 treatment plan due to lack of evidence.

The applicant's request for a special award under O. Reg. 664 was dismissed as the respondent's conduct was not found to be unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a concussion, removing her from the MIG.

However, the applicant's claim for a $915.00 treatment plan for optometric services was denied because the expense was incurred before the treatment plan was submitted, contrary to section 38(2) of the Schedule.

The applicant sought statutory accident benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline and lacked objective evidence of necessity.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, as she did not make specific submissions regarding the goals of the plans or how they would be met.

The application was dismissed, and claims for an award and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG on the basis of chronic pain.

The Tribunal found that the applicant failed to meet her burden of proving that her injuries warranted removal from the MIG, as she did not meet the criteria for chronic pain under the AMA Guides and lacked medical evidence of functional impairment.

As the MIG limits were exhausted, the disputed treatment plans were not considered, and the application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services and a psychological assessment.

The respondent insurer denied the treatment plans.

The adjudicator found that the applicant failed to meet her burden of proving the chiropractic treatment plan was reasonable and necessary, as the submitted evidence was not contemporaneous and lacked specific goals.

However, the adjudicator approved the psychological assessment, preferring the evidence of the applicant's assessors over the insurer's examiner, finding it necessary to evaluate the exacerbation of the applicant's pre-existing psychological conditions.

The applicant was also awarded interest on the overdue payment for the psychological assessment.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a psychological impairment that warranted removal from the MIG, relying on corroborating evidence from multiple psychological professionals over the respondent's section 44 assessor.

Consequently, the Tribunal approved the disputed psychological assessment and treatment plans as reasonable and necessary.

However, the Tribunal dismissed the claims for physiotherapy treatment plans, finding the physical injuries were minor and the plans were not proven reasonable and necessary.

Interest was awarded on overdue benefits.