2 total
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans for physiotherapy and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the medical evidence, including the applicant's own orthopaedic assessment, established that the injuries were predominantly minor soft tissue injuries.
The applicant failed to provide compelling evidence of a pre-existing medical condition or psychological impairment that would remove him from the MIG.
Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.
Insurer ordered to pay ongoing IRBs, medical benefits, and a $25,000 Special Award for unreasonable delay.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer.
The insurer terminated her income replacement benefits and denied medical and rehabilitation benefits, maintaining for nearly three years that her injuries fell within the Minor Injury Guideline (MIG).
The arbitrator found that the applicant suffered a substantial inability to perform her pre-accident employment and, post-104 weeks, a complete inability to engage in suitable employment due to chronic pain.
The arbitrator granted the claimed income replacement benefits, medical benefits, and costs of examinations.
Furthermore, the arbitrator awarded a $25,000 Special Award against the insurer, finding that it had unreasonably delayed and denied benefits by relying on patently flawed medical reports and ignoring credible evidence of the applicant's chronic pain.
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