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Applicant's chronic pain and psychological impairments warranted removal from the Minor Injury Guideline; benefits awarded.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant sustained chronic pain and psychological impairments (including PTSD and driving phobia) that removed her from the MIG.
The Tribunal preferred the evidence of the applicant's treating practitioners and in-person assessors over the insurer's paper reviews and examinations.
The applicant was awarded all disputed medical and rehabilitation benefits, totaling over $10,000, plus interest on overdue payments.
Insurer's termination of benefits for misrepresentation was unjustified where the misrepresentation was not material.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB) and medical benefits.
The insurer terminated the IRB claim, alleging the applicant wilfully misrepresented her employment status by working after the accident while claiming to be disabled.
The arbitrator found that while the applicant did wilfully misrepresent that she had not worked on several specific days, the misrepresentation was not 'material' enough to justify terminating all benefits, as the insurer could simply deduct the earnings from the IRB.
The arbitrator awarded the IRB (less a deduction for days worked) and a medical benefit, but denied an attendant care assessment.
A special award of $2,000 was also ordered against the insurer for unreasonably withholding benefits, though the amount was tempered due to the applicant's own deceitful conduct.
No co-appearing lawyers found.
No judges found.