Applicant removed from Minor Injury Guideline due to full-thickness shoulder tear; assessments approved but award denied.
The applicant sought accident benefits following a 2019 motor vehicle accident.
The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant sustained a full-thickness rotator cuff tear requiring surgery as a result of the accident, which warranted removal from the MIG.
The Tribunal approved treatment plans for a chronic pain assessment and an orthopaedic assessment due to the applicant's ongoing pain and functional impairment.
However, a treatment plan for physiotherapy was denied for lack of supporting medical evidence.
The Tribunal also declined to order a special award under s. 10 of Reg. 664, finding that the insurer's incorrect MIG determination did not amount to unreasonable conduct.
OLATOntario Licence Appeal TribunalDec 11, 2024
