Dr. Jay Sethi

The applicant sought statutory accident benefits following a motor vehicle accident.

The insurer denied treatment plans and non-earner benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove she sustained a psychological impairment warranting removal from the MIG.

However, the Tribunal held that the insurer's denial notices failed to provide sufficient medical reasons as required by sections 38(8) and 36(4) of the Schedule.

Consequently, the insurer was prohibited from relying on the MIG for the disputed treatment plans, and the treatment plans and non-earner benefits were payable due to the insurer's procedural non-compliance.