Nader Fathi

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

The respondent insurer denied a $2,200 treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairment.

The Tribunal found insufficient evidence of a pre-existing condition preventing maximal recovery, no diagnosis of chronic pain, and rejected the psychological impairment claim due to inconsistencies in the applicant's self-reporting.

The application was dismissed as the injuries were deemed predominantly minor.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $1,765.20 for a chronic pain assessment.

The respondent insurer denied the claim based on a paper review by a physiatrist who opined that further psychological treatment alone was sufficient.

The Tribunal found the applicant's evidence, including assessments from treating practitioners and a chronic pain assessment report, to be more persuasive than the insurer's paper review.

The Tribunal held that the chronic pain assessment was reasonable and necessary, and awarded the cost of the examination along with interest on the overdue payment.

The respondent's procedural defence regarding an unsigned treatment plan was dismissed as the insurer had waived the requirement by scheduling an examination.