3 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 various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on chronic pain and a psychological impairment.
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain with functional impairment or a psychological condition, noting significant gaps in medical treatment and a lack of corroborating evidence in the family physician's records.
The Tribunal concluded the injuries were predominantly minor, dismissing the application for the disputed treatment plans and an award.
Insurer's failure to provide updated medical reasons after removing applicant from MIG renders treatment plans payable.
The applicant sought various statutory accident benefits following a motor vehicle accident.
The respondent initially denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
After the applicant was removed from the MIG, the respondent failed to provide updated denial notices with medical reasons for several treatment plans.
The Tribunal applied the Divisional Court's decision in Suarez, holding that the defective notices could not be cured, and ordered those treatment plans payable once incurred.
The Tribunal also evaluated the substantive reasonableness and necessity of the remaining treatment plans, granting entitlement to psychological and occupational therapy based on the applicant's exacerbated pre-existing conditions, while denying further physical therapy and neurological assessments.
The claim for a special award was dismissed as the insurer's reliance on its assessors was not unreasonable.
Application for accident benefits dismissed; injuries deemed minor due to lack of objective evidence for chronic pain or psychological impairment.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision.
The insurer denied various medical benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed chronic pain and psychological impairments warranted removal from the MIG.
The Tribunal found the applicant's evidence of chronic pain and psychological impairment to be inconsistent, heavily reliant on self-reporting, and contradicted by independent medical examinations showing symptom amplification.
The Tribunal concluded the injuries were predominantly minor, and since the $3,500 MIG limit was exhausted, the disputed treatment plans and expenses were not payable.
No linked lawyers found.
No linked judges found.