Dr. N. Clements

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were predominantly minor, relying on medical reports attributing his back pain to a subsequent work-related injury.

However, the Tribunal held that the respondent failed to comply with the notice requirements under s. 38(9) of the Schedule when denying the psychological assessment and treatment plans, as it did not explicitly state that the MIG applied.

Consequently, under s. 38(11), the respondent was prohibited from taking the position that the MIG applied to the psychological claims and was ordered to pay those benefits.

The Applicant sought ongoing weekly income benefits and medical/rehabilitation benefits following a rear-end motor vehicle accident.

The Insurer had terminated benefits based on surveillance evidence showing the Applicant performing heavy lifting, which contradicted his presentation during medical assessments.

The Arbitrator found the Applicant lacked credibility and that his ongoing complaints were primarily attributable to pre-existing obesity, severe sleep apnea, and degenerative back changes, rather than the accident.

The Applicant's claims for ongoing benefits and a special award were dismissed.

The Insurer's claim for repayment of benefits was also dismissed, as the Applicant did not materially contribute to the overpayment through error or fraud.