Insurer ordered to pay treatment plans despite MIG limit due to defective denial notices.
The applicant sought accident benefits following a 2015 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's injuries were predominantly minor and that he failed to prove chronic pain or psychological impairments that would remove him from the MIG.
However, the Tribunal held that the respondent failed to provide adequate medical and other reasons for denying the treatment plans, violating s. 38(8) of the Schedule.
Applying Ferawana and Zheng, the Tribunal ordered the respondent to pay for the disputed treatment plans, provided they were incurred before proper notice was given.
The claim for interest was denied.
OLATOntario Licence Appeal TribunalJan 15, 2021
