Christopher R. Dawson

The applicant was injured in a motor vehicle accident and notified the insurer shortly after.

The insurer provided an application for accident benefits (OCF-1), but the applicant did not submit the completed form until nearly two years later.

The insurer argued the claim was statute-barred due to the delay.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, noting the lack of medical documentation to support his claim of cognitive impairment and the insurer's fulfillment of its duty to inquire and assist.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a concussion and headaches, fell outside the Minor Injury Guideline (MIG).

As a preliminary issue, the adjudicator excluded the respondent's surveillance evidence due to late service, finding it prejudiced the applicant's ability to respond.

On the substantive issues, the adjudicator found insufficient medical evidence to support the concussion or persistent headache claims, concluding the injuries were predominantly minor.

Because the disputed treatment plans exceeded the $3,500 MIG limit, they were denied, and the application was dismissed.