Applicant's injuries fall within the MIG, but defective denial notices trigger insurer liability for certain treatment plans.
The applicant sought statutory accident benefits following a 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 physical injuries were predominantly minor and that he failed to establish a pre-existing condition or psychological impairment warranting removal from the MIG.
However, the Tribunal found that the respondent failed to comply with the notice requirements under section 38(8) of the Schedule for several treatment plans.
As a result, the respondent was ordered to pay for physiotherapy services incurred during the period of non-compliance and for psychological services due to a defective denial notice that merely referenced a section 44 report without providing it to the applicant.
OLATOntario Licence Appeal TribunalJul 28, 2023
