Dr. Christopher Osinga

The applicant was involved in a motor vehicle accident and sought medical benefits for physiotherapy.

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

The applicant argued that a subsequent ultrasound revealing a partial rotator cuff tear took the injuries outside the MIG and that the respondent failed to provide proper notice under section 38(8) of the Schedule.

The Tribunal found that a partial tear is defined as a sprain and remains within the MIG.

The Tribunal also held that the respondent provided proper medical reasons for its denial based on an independent medical examination.

The application for benefits was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of non-earner benefits and four treatment plans.

The adjudicator found that the applicant's claim for non-earner benefits was time-barred under section 56(1) of the Schedule, as the application was filed more than five years after the respondent's clear refusal to pay.

Regarding the treatment plans, the adjudicator concluded that the applicant failed to prove his physical or psychological injuries fell outside the Minor Injury Guideline (MIG).

The adjudicator placed little weight on the applicant's psychological assessment conducted nearly five years post-accident, noting a lack of contemporaneous complaints to his family physician.

As the applicant had exhausted the $3,500 MIG cap, the disputed treatment plans were denied.

The respondent's request for costs was also dismissed.