Dr. Alice Sau Han Kam

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) and the $3,500 funding limit had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing psoriatic rheumatoid arthritis, psychological conditions, and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence that her pre-existing conditions prevented her maximal recovery under the MIG, noting a lack of concurrent medical reporting of the accident.

The Tribunal also found insufficient evidence of accident-related functional impairment to support a chronic pain diagnosis.

As the MIG limit was exhausted, the disputed treatment plans were not payable, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant argued she should be removed from the MIG due to pre-existing conditions and chronic pain.

The Tribunal found the applicant failed to prove that her pre-existing conditions prevented maximal recovery within the MIG or that her chronic pain adversely affected her well-being and function under the AMA Guides criteria.

However, the Tribunal ordered the respondent to pay for a physiatry assessment because the respondent failed to provide proper medical reasons for its denial, triggering the consequences of s. 38(11) of the Schedule.

The remaining treatment plans were dismissed as they proposed treatment outside the MIG limits.

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied treatment plans for massage therapy and a chronic pain assessment, arguing the applicant's injuries were caused by pre-existing conditions and prior accidents.

The Tribunal found that the accident caused the applicant's neck, back, shoulder, and rib injuries, but not his hip complaints.

The Tribunal held that the insurer failed to provide a compliant denial notice for the massage therapy treatment plan within the required 10 business days under s. 38(8) of the Schedule.

As a result, the insurer was ordered to pay $384.05 for the period of non-compliance pursuant to s. 38(11).

The remainder of the massage therapy and the chronic pain assessment were denied as not reasonable and necessary.