Dr. Pugen

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied treatment plans for physiotherapy and a functional abilities evaluation, arguing the injuries fell within the Minor Injury Guideline.

Just prior to the arbitration hearing, the insurer approved the treatment plans with interest.

The applicant sought a special award under s. 282(10) of the Insurance Act for unreasonable delay.

The arbitrator found that the insurer unreasonably withheld benefits by failing to provide complete medical information to its assessors and selectively relying on reports that supported termination.

A special award of $2,510.98, representing 25% of the entitled amount, was ordered.

The applicant was injured in a motor vehicle accident and sought payment for a psychological assessment and physiotherapy services.

The respondent insurer denied the treatment plans on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 cap under the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her chronic pain, fibromyalgia, and psychological impairments were caused by the accident or removed her from the MIG.

The application was dismissed, and the applicant was denied the claimed benefits, interest, and costs.