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Applicant removed from Minor Injury Guideline due to chronic pain syndrome; physiotherapy and attendant care assessment approved.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered from chronic pain syndrome, satisfying three of the six criteria under the AMA Guides, and was therefore removed from the MIG.
The Tribunal approved two physiotherapy treatment plans and partially approved an attendant care assessment, finding them reasonable and necessary.
However, claims for psychological treatment and assessments were dismissed due to a lack of corroborating evidence.
The applicant was awarded interest on the overdue benefits but denied an award under Regulation 664, as the insurer's conduct was not found to be unreasonable.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The respondent denied funding for various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical injuries, including ongoing pain, did not warrant removal from the MIG, as range of motion was normal and the applicant had returned to pre-accident activities.
The Tribunal also preferred the respondent's psychological assessment, finding no psychological injury.
As the applicant had exhausted the $3,500 MIG limit, the claims for further medical benefits and examinations were dismissed, along with claims for an award and interest.
No co-appearing lawyers found.
No judges found.