Jeffrey A. Shapiro

The insurer sought reconsideration of a preliminary issue order that precluded the insured from proceeding with a catastrophic impairment hearing until the insurer conducted two insurer examinations (IEs).

The order included a term allowing the IEs to proceed by paper review if the parties could not agree on conditions for in-person assessments.

The insurer argued this term violated natural justice by placing it at a disadvantage.

The Tribunal denied the reconsideration, finding that the original adjudicator properly balanced the insurer's right to an IE against the potential harm to the insured, and that paper reviews are expressly permitted under the Schedule.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs) and medical benefits for chiropractic services.

The insurer terminated IRBs and denied further treatment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and he was able to return to work.

The Tribunal found the applicant's self-reporting to be unreliable, noting he had returned to work multiple times without disclosing it to the insurer or medical assessors.

Relying on independent medical examinations and surveillance evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and his injuries were treatable within the MIG.

The application was dismissed.