Accident benefits claims dismissed due to unsigned treatment plans and failure to escape Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought payment for three treatment plans.
The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The arbitrator dismissed the claims on two grounds.
First, the treatment plans were not signed by the applicant or a regulated health professional, as strictly required by section 38(3) of the Statutory Accident Benefits Schedule.
Second, the applicant failed to provide compelling medical evidence that her injuries, including her ongoing chronic pain, fell outside the MIG.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesFeb 19, 2016