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Applicant's injuries remain within MIG, but insurer must pay certain assessments due to non-compliant denial notices.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant failed to prove chronic pain or psychological impairments warranting removal from the MIG, citing inconsistent self-reporting to assessors.
However, the Tribunal ordered the insurer to pay for social work, general practitioner, and psychological assessments because the insurer's denial notices contained boilerplate language and failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.
Application for accident benefits dismissed as res judicata; new medical evidence insufficient to waive doctrine.
The applicant sought statutory accident benefits following a 2016 motor vehicle accident.
In a prior Tribunal decision, it was determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant filed a second application seeking to remove herself from the MIG based on new medical reports.
The Tribunal dismissed the application, finding that the issue was barred by res judicata.
The Tribunal held that the new medical evidence did not conclusively impeach the original results, as the experts relied heavily on self-reporting and one expert lacked the appropriate orthopaedic qualifications.
The respondent's request for costs was denied.
Application for accident benefits dismissed; injuries confined to the Minor Injury Guideline.
The respondent denied the 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 her injuries warranted removal from the MIG, as the medical evidence confirmed only minor soft tissue injuries.
The Tribunal rejected the applicant's expert reports diagnosing chronic pain and psychological impairments, finding them unreliable and unsupported by contemporaneous medical records.
As the MIG limits were exhausted, the application for further medical and rehabilitation benefits was dismissed.
Accident benefits denied as injuries fell within MIG; late surveillance evidence excluded with costs.
The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
Procedurally, the Tribunal excluded surveillance evidence submitted late by the respondent in breach of a prior order, awarding $300 in costs to the applicant.
Substantively, the Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.
Consequently, the applicant's claims for medical and rehabilitation benefits beyond the $3,500 cap were dismissed.
No co-appearing lawyers found.
No judges found.