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Application for accident benefits dismissed; applicant's injuries fall within the Minor Injury Guideline and IRB repayment ordered.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits, arguing the injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant's injuries were predominantly minor and she did not establish a pre-existing condition, chronic pain, or psychological impairment to warrant removal from the MIG.
The claims for a chronic pain assessment, psychological assessment, and Income Replacement Benefits (IRBs) were dismissed.
The Tribunal also ordered the applicant to repay $1,227.49 in overpaid IRBs to the respondent, as she had returned to work without notifying the insurer.
Attendant care benefits awarded at $3,062.92 per month; claim for special award dismissed.
The applicant, who sustained a catastrophic impairment from a 2015 motor vehicle accident, sought $6,000 per month in attendant care benefits (ACBs), the cost of a cell phone and robotic vacuum, an award for unreasonable delay, and interest.
The Tribunal found the opinions of both parties' occupational therapists flawed and conducted its own assessment of the applicant's needs, awarding $3,062.92 per month in ACBs.
The Tribunal also approved $225 for the cell phone but denied the robotic vacuum.
The claim for a special award under s. 10 of Regulation 664 was dismissed as the applicant failed to prove the insurer acted unreasonably.
Interest was awarded on the overdue benefits.
Application for accident benefits dismissed as res judicata barred relitigating the Minor Injury Guideline determination.
The applicant sought statutory accident benefits following a 2018 motor vehicle accident.
In a previous 2020 decision, the Tribunal found the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant brought a second application seeking removal from the MIG based on alleged new medical evidence and claiming entitlement to additional treatment plans.
The Tribunal held that the doctrine of res judicata barred the applicant from relitigating the MIG issue, as the new medical reports did not constitute fresh evidence that would conclusively impeach the original result.
The Tribunal also found the respondent provided proper notice of denial for the disputed treatment plans.
The application was dismissed.
Applicant remains in MIG, but insurer ordered to pay incurred treatment costs due to defective denial notices.
The Tribunal found the applicant failed to prove her injuries fell outside the Minor Injury Guideline (MIG), rejecting claims of chronic pain syndrome and psychological impairment.
However, the Tribunal held that the insurer failed to provide compliant denial notices under section 38(8) of the Schedule for both a physiotherapy treatment plan and a chronic pain assessment.
As a result, the insurer was prohibited from relying on the MIG for the periods of non-compliance and ordered to pay the incurred costs plus interest.
The applicant's claim for a special award was dismissed.
No co-appearing lawyers found.
No judges found.