Once removed from the Minor Injury Guideline for psychological reasons, the $3,500 cap no longer applies to physical treatments.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy.
The respondent insurer initially limited her physical treatment to the Minor Injury Guideline (MIG) cap of $3,500.
The applicant was later removed from the MIG due to a psychological impairment.
The adjudicator held that once an insured is removed from the MIG for any reason, the $3,500 limit no longer applies to physical injuries, and the sole test is whether the proposed treatment is reasonable and necessary.
Relying on the recommendation of the respondent's own medical assessor, the adjudicator found the disputed physiotherapy treatment plans were reasonable and necessary.
The adjudicator declined to order an award for unreasonable delay, finding the insurer's incorrect interpretation of the MIG limits did not amount to bad faith.
OLATOntario Licence Appeal TribunalSep 14, 2022
