The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied two treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical injuries were predominantly minor, and thus the September 1, 2015 chiropractic treatment plan was subject to the MIG limit.
However, for the September 12, 2016 psychological assessment plan, the Tribunal held that the insurer failed to comply with the notice requirements under section 38(8) of the Schedule, as its denial letters lacked specific medical reasons and failed to state that the MIG applied.
Consequently, under section 38(11), the insurer was prohibited from taking the position that the MIG applied to that plan and was ordered to pay for the psychological assessment.
The applicant's request for an award for unreasonably withheld payment was dismissed.
