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Accident benefits denied; childbirth recovery and pre-existing knee injury did not warrant removal from MIG.
The applicant sought accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing knee injury and the physical demands of recent childbirth.
The Tribunal found no medical evidence supporting removal from the MIG and concluded her injuries were predominantly minor.
The Tribunal also dismissed the claim for Income Replacement Benefits (IRBs), finding the applicant did not suffer a substantial inability to perform the essential tasks of her self-employment as a housekeeper, as she admitted to performing those tasks in her own home.
Claims for a chiropractic treatment plan and interest were also dismissed.
Once removed from the Minor Injury Guideline for psychological reasons, the $3,500 cap no longer applies to physical treatments.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy.
The respondent insurer initially limited her physical treatment to the Minor Injury Guideline (MIG) cap of $3,500.
The applicant was later removed from the MIG due to a psychological impairment.
The adjudicator held that once an insured is removed from the MIG for any reason, the $3,500 limit no longer applies to physical injuries, and the sole test is whether the proposed treatment is reasonable and necessary.
Relying on the recommendation of the respondent's own medical assessor, the adjudicator found the disputed physiotherapy treatment plans were reasonable and necessary.
The adjudicator declined to order an award for unreasonable delay, finding the insurer's incorrect interpretation of the MIG limits did not amount to bad faith.
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