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Applicant subject to Minor Injury Guideline; late denial notice entitles applicant to briefly incurred chiropractic expenses.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on a pre-existing psychological condition, relying on a late-filed psychological assessment.
The Tribunal gave no weight to the assessment, finding it unreliable and unsupported by contemporaneous medical records.
The Tribunal held the applicant's injuries were predominantly minor and subject to the MIG limit.
Claims for a non-earner benefit and an assistive device were dismissed.
However, the Tribunal found the insurer provided a late denial notice for a chiropractic treatment plan, entitling the applicant to the portion of the plan incurred between the 11th business day and the date of the denial notice.
Minor settlement approval adjourned for further evidence on potential catastrophic impairment designation and fee agreement.
The applicant, a minor, sought court approval under Rule 7.08 for a $22,500 full and final settlement of her statutory accident benefits claim with the respondent insurer.
The minor sustained physical and severe psychological injuries after being struck by a vehicle as a pedestrian.
The court adjourned the application, finding the evidentiary record insufficient to determine whether the settlement was fair and reasonable, particularly regarding whether the minor's psychological injuries might meet the threshold for a catastrophic impairment designation.