8 total
Applicant held within Minor Injury Guideline; claims for chronic pain and psychological impairments dismissed.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on chronic pain and psychological impairments.
The Tribunal found the applicant's injuries were predominantly minor, preferring the insurer's medical and psychological assessments which indicated no functional impairment and no accident-related psychological diagnosis.
As the applicant remained within the MIG, the disputed treatment plans were not payable.
Claims for an award and interest were also dismissed.
Applicant removed from MIG for psychological injuries; partial approval of treatment plans; non-earner benefits denied.
The Tribunal found the applicant's psychological impairments warranted removal from the Minor Injury Guideline (MIG).
The applicant's claim for non-earner benefits was dismissed as she did not demonstrate a complete inability to carry on a normal life.
Several treatment plans for physiotherapy, psychological services, and a chronic pain assessment were approved as reasonable and necessary, while others were denied for lack of contemporaneous medical evidence.
Claims for a special award and costs were dismissed.
Deficient notice of examination does not render subsequent medical report void ab initio if insured attends.
The applicant sought statutory accident benefits for chiropractic, physiotherapy, and biopsychosocial assessment treatment plans following a motor vehicle accident.
The respondent denied the benefits based on section 44 independent medical examinations.
The applicant argued the respondent's notices of examination were deficient under section 44(5) of the Schedule, rendering the resulting reports void ab initio and triggering mandatory payment under section 38(11).
The Tribunal found that while the notices for the physical treatments lacked sufficient reasons, the applicant's attendance at the assessments did not waive her rights, but the resulting reports were not void ab initio.
Because the ultimate denial letters complied with section 38(8) and the applicant provided no evidence that the treatments were reasonable and necessary, the claims were dismissed.
Applicant removed from Minor Injury Guideline due to pre-existing knee condition precluding recovery.
The insurer denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's pre-existing knee condition, which included degenerative osteoarthritis and meniscus tears, was exacerbated by the accident, precluding recovery within the MIG.
The Tribunal ordered the applicant removed from the MIG and approved the disputed treatment plans for chiropractic services, along with interest on overdue payments.
Application for accident benefits dismissed; applicant's injuries remained within the Minor Injury Guideline limits.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical injuries, including a right shin contusion, fell within the minor injury definition, and her pre-existing osteoarthritis did not preclude recovery.
The Tribunal rejected the applicant's psychological assessment as unpersuasive, preferring the insurer's examination and family doctor records which showed no psychological complaints.
As the applicant remained within the MIG and the $3,500 limit was exhausted, all disputed treatment plans, interest, and an award were denied.
Applicant's claim for removal from the Minor Injury Guideline dismissed due to lack of objective evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological impairments and soft tissue injuries warranted removal from the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing the injuries were predominantly minor.
The Tribunal found that the applicant failed to prove a psychological impairment, preferring the respondent's psychological assessment which indicated the applicant was 'faking bad' on validity testing.
The Tribunal also accepted the respondent's musculoskeletal assessment that the applicant sustained uncomplicated soft tissue injuries.
Consequently, the applicant remained within the MIG and was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant contended that she suffered from accident-related psychological impairments and chronic pain, warranting removal from the MIG.
The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from a psychological impairment or chronic pain with functional impairment that would remove her from the MIG.
As the disputed treatment plans were submitted on the basis that the injuries were outside the MIG, they were not payable.
The application was dismissed.
The respondent denied various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on chronic pain, psychological impairment, and pre-existing conditions.
The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted removal from the MIG, placing little weight on her expert's report due to a lack of contemporaneous medical support.
As the respondent had already approved the $3,500 maximum under the MIG, the disputed treatment plans were not considered, and the application was dismissed.
No co-appearing lawyers found.
No judges found.