Insurer ordered to fund treatment plans despite MIG limit due to defective denial notices.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to establish her injuries fell outside the MIG.
However, the Tribunal held that the respondent's denial notices for most of the treatment plans were defective under s. 38(8) of the Schedule because they failed to provide sufficient medical reasons.
As a result, the defective notices did not trigger the two-year limitation period, and the respondent was required to fund the disputed treatment plans once incurred, pursuant to s. 38(11).
Claims for an award and interest were dismissed.
OLATOntario Licence Appeal TribunalMar 13, 2024
