2 total
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to chronic pain and orthopedic assessments.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a chronic pain impairment or a psychological condition caused by the subject accident that would warrant removal from the MIG.
The Tribunal also found that the respondent's denial notices complied with the requirements of s. 38(8) of the Schedule.
As the applicant remained subject to the MIG, the disputed treatment plans were not payable and the application was dismissed.
Application for statutory accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, including physiotherapy, educational training, an orthopaedic assessment, and an occupational therapy in-home assessment.
The respondent insurer denied the treatment plans, citing a lack of detailed breakdowns, non-compliance with the Professional Services Guideline, and the availability of OHIP coverage for the orthopaedic assessment.
The Tribunal found that the applicant failed to demonstrate on a balance of probabilities that the disputed treatment plans were reasonable and necessary.
The Tribunal also found that the respondent's denial letters complied with section 38(8) of the Statutory Accident Benefits Schedule.
The application was dismissed.
