Joshua Pugen

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied several treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant sustained predominately minor injuries and failed to provide compelling evidence of a pre-existing condition or psychological impairment that would prevent maximal recovery within the MIG.

The application for benefits was dismissed, and the respondent's request for costs was also denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic services.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 cap.

The Tribunal found that the applicant's soft tissue injuries fell within the definition of minor injuries under the Schedule.

The applicant failed to provide objective medical evidence of chronic pain or a pre-existing condition that would prevent maximal recovery under the MIG.

Consequently, the Tribunal held the applicant was not entitled to treatment beyond the MIG cap, and dismissed the claims for the disputed treatment plans and interest.

The respondent's request for costs was also denied.

Following a successful arbitration for statutory accident benefits, the applicant sought expenses of $22,076.18.

The insurer disputed the quantum.

The arbitrator reviewed the claimed legal fees and disbursements, reducing the hourly rate to the Legal Aid rate and disallowing administrative tasks.

The arbitrator also disallowed expert witness fees for a chiropractor and a social emotional assessor, finding their evidence unnecessary or irrelevant, but allowed the fees for the applicant's family doctor.

The applicant was awarded $7,704.47 in total expenses.

The applicant was injured in a motor vehicle accident and sought accident benefits, including an attendant care assessment and a psychological assessment.

The insurer initially denied the assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and there was insufficient medical documentation.

The arbitrator found that the applicant had compelling pre-existing conditions, including a prior brain injury and psychiatric diagnoses, which took him outside the MIG.

The arbitrator held that the requested assessments were reasonable and necessary to determine the applicant's entitlement to benefits.

Furthermore, the arbitrator ordered the insurer to pay a special award of $1,083.42, finding that the insurer had unreasonably delayed and withheld payments despite having sufficient information about the pre-existing conditions early on.