Licence Appeal Tribunal File Number: 22-009313/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Flordeliza Marcelo
Applicant
and
The Personal Insurance Company
Respondent
DECISION
ADJUDICATOR: Nick Iannazzo
APPEARANCES:
For the Applicant: Yoni Silberman, Counsel
For the Respondent: Yann Grand-Clement, Counsel
HEARD: by Way of Written Submissions
OVERVIEW
1Flordeliza Marcel, the applicant, was involved in an automobile accident on August 29, 2019, and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Insurer, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Are the applicant’s injuries predominantly minor as defined in section 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline (“MIG”) limit? The parties agree the MIG limits have not been exhausted and their submission shall identify the amounts remaining.
ii. Is the applicant entitled to $941.21 ($980.26 less $39.05 approved) for physiotherapy services, proposed by Lapsley Physiotherapy in a treatment plan dated May 25, 2022?
iii. Is the applicant entitled to $6,723.50 for a Neuropsychology Assessment, proposed by Omega Medical Associates Inc in a treatment plan dated July 18, 2022?
iv. Is the applicant entitled to $2,200.00 for Chronic Pain Assessment purposed by Dr. Steve Blitzer in a treatment plan dated August 2, 2022?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant has not demonstrated that her accident-related impairments warrant removal from the MIG. The applicant is entitled to treatment up to the MIG limit.
4As no benefits are payable, the applicant is not entitled to interest nor to an award under s. 10 of Reg. 664.
ANALYSIS
The Minor Injury Guideline (MIG)
5Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury. Section 3(1) defines a “minor injury” as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
6An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG or, under s. 18(2), that they have a documented pre-existing medical condition combined with compelling evidence that the condition will prevent them from achieving maximal recovery from the minor injury if they are subject to the limit or limited to the goods and services authorized under the MIG. The Tribunal has also determined that chronic pain with functional impairment or a psychological impairment may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
7The applicant submits that she is entitled to treatment outside the MIG limit because she sustained a head injury and has chronic pain, and that her pre-existing medical condition will prevent her from achieving maximal recovery if kept within the MIG.
8For the following reasons, I find that the applicant has not met her burden of proving that her accident-related impairments require treatment beyond the MIG based on a head injury, chronic pain, or because of a pre-existing medical condition.
Did the applicant sustain a head injury that removes her from the MIG?
9The applicant submits that she suffered a head injury that excludes her from the MIG.
10The applicant relies upon the ambulance call report stating that she lost consciousness, had no memory of the accident, and complained of pain to her forehead, left side of her neck and right knee. The applicant was taken to the Scarborough and Rouge Hospital Emergency Department and a CT scan of her head was taken. Dr. Eugene Yeung from the hospital reported the following “left frontal cerebral contusion” and “linear high density gyral area 2 cm in length involving the superior frontal region left centrum semiovale level”, “incidental minor basal ganglia calcification”, “minor carotid calcifications”, and “posterior left scalp soft tissue swelling”.
11The applicant submits that based upon definitions in two medical dictionaries (i.e. Stedman’s Medical Dictionary, 28th Edition (Lippincott Williams & Wilkins, 2013); Dorland’s Illustrated Medical Dictionary, 32nd Edition (Saunders, 2011)) and a reference to an excerpt from a medical article (i.e. David Kurland et al., “Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review” Journal of Neurotrauma 29:19-31 (January 1, 2012)) a brain contusion is a serious form of traumatic brain injury and therefore the applicant should be excluded from the MIG.
12The applicant submits that her family doctor, Dr. El-Kateb, diagnosed a concussion, and her daughter, in her affidavit, stated that she observed cognitive changes in her mother after the accident. The applicant relies upon reports of neck pain and soreness to Avinnash Sookmangal, Registered Physiotherapist, from September 12 to November 19, 2019. The applicant also received massage therapy from Sherma Villarosa, Registered Massage Therapist, from October 24, 2019 to March 21, 2022, and Ms. Villarosa noted hypertonicity at her neck.
13The applicant also relies upon the treatment plan dated July 18, 2022 by Dr. Lara Davidson, Psychologist, proposing a neuropsychology assessment. To support the treatment plan, the applicant requested and obtained a letter dated November 18, 2022 from Dr. Lisa Becker and Dr. Harold Becker, where they opined that the left frontal cerebral contusion “represents intracranial pathology as a result of the accident” and “taken together, file records indicate that Ms. Marcelo sustained a traumatic brain injury as a result of the accident”. The applicant further submits that under criterion 4 for a catastrophic impairment, her “intracranial pathology” includes “intracranial contusions”, so her injuries are so serious that they are recognized as catastrophic, and the respondent should have had the applicant assessed for catastrophic impairment.
14The respondent submits that the applicant failed to satisfy her burden of proof. The applicant suffered soft tissue issues that disappeared within three months of the accident. Head related complaints to her family doctor stopped after a few weeks from the accident. There was never a formal diagnosis of a concussion by her family doctor nor by anyone else, and she was never referred to a specialist for head-related complaints. The respondent submits that the medical literature referred to by the applicant is irrelevant, and an attempt at diagnosing a brain injury that her family doctor never did. Regarding the submissions pertaining to catastrophic impairment, the respondent submits they should be ignored as catastrophic impairment is not an issue in dispute.
15The respondent submits that the treatment plan prepared by Dr. Lara Davidson, Psychologist, is not evidence. Furthermore, Dr. Davidson is a Psychologist and therefore not qualified to diagnose a brain injury. The respondent submits that the letter from Doctors Becker should be given no weight as it is not supported by the medical records and is not objective medical evidence since the clinic they work for will benefit financially from providing services to the applicant beyond the MIG.
16Lastly, the respondent submits that the daughter’s affidavit should be given no weight since she is not a doctor, and the affidavit is not objective medical evidence.
17For the reasons that follow, I find that the applicant did not suffer from a head injury that removes her from the MIG.
18Firstly, a “minor injury” as defined in section 3(1) expressly includes a “contusion”. The word “contusion” is not limited in the Schedule. In other words, a contusion includes all types of contusions, including a brain contusion. The CT scan showed, and Dr. Leung opined that there was a cerebral contusion. Accordingly, I find that the applicant’s cerebral contusion is a “contusion” within the meaning of “minor injury”.
19Secondly, I find that the applicant’s family doctor, Dr. El-Kateb, did not diagnose the applicant with a concussion. The applicant submits that she met with Dr. El-Kateb on September 3, 2019, and in her notes she recorded “was diagnosed with Concussion”, and thereby suggesting that the doctor diagnosed her with a concussion. However, it is important to point out that this note is found under the heading “Chief Complaint:” where the patient’s complaints are listed. Furthermore, immediately before “was diagnosed with Concussion” the doctor recorded “pt stated that she loss consciousness and was brought to ER (Rouge Valley)”. In my view, the most reasonable interpretation of these two notes, under the heading “Chief Complaint”, is that the applicant told the doctor that she lost consciousness, was brought to the ER, and was diagnosed with a concussion. The use of the words “was diagnosed” indicates that someone in the past diagnosed her with a concussion. For these reasons, I find that Dr. El-Kateb did not diagnose the applicant with a concussion.
20Thirdly, having found that Dr. El-Kateb did not diagnose a concussion, and instead that the applicant reported that someone previously had done so, it is noteworthy that I was not pointed to evidence that someone else had diagnosed her with a concussion before September 3, 2019, nor thereafter, for that matter. Also, the applicant submitted that the Ambulance Call Report recorded that she lost consciousness in the accident, but upon review of the Report there is no such statement. The Report states “Initial report from scene stated that all parties were awake and alert. Pt states she does not know what happened. Oriented to person, time and place. Pt. does not have incident memory. Properly worn seatbelt.”
21Fourthly, after September 19, 2019 (approximately three weeks from the accident), the applicant does not report any further head related issues to Dr. El-Kateb despite seeing her on a regular basis.
22Fifthly, I am not persuaded that the notes of Avinnash Sookmangal, Registered Physiotherapist, and Sherma Villarosa, Registered Massage Therapist, support the finding of a concussion or concussion symptoms. Ms. Sookmangal’s notes from September 12 to November 19, 2019 record that the applicant reported pain to the cervical spine but it improved over time. By October 10, 2019 the applicant started reporting decreasing pain and by December 2, 2019 she reported no more pain to her cervical spine. Regarding Ms. Villarosa’s notes where she made a finding of hypertonicity, the applicant does not direct me to any notes as to whether there was pain, and if so, what type and to what degree. Overall, I do not find this compelling evidence of a concussion or concussion symptoms, especially considering the lack of corroboration from the family doctor, Dr. El-Kateb. As noted earlier, the applicant did not report any head related issues to Dr. El-Kateb after September 19, 2019.
23Sixthly, the letter dated November 18, 2022 from Dr. Lisa Becker and Dr. Harold Becker opining that the applicant sustained a traumatic brain injury is not persuasive. Doctors Becker rendered their diagnosis 3 years and 2 months after the accident. They never examined the applicant but instead rendered their opinion based upon a review of a “medical brief”, but the letter does not tell us what was in the “medical brief”. They refer to the CT scan which Dr. Leung described was a cerebral contusion. They then interpret the cerebral contusion to represent an intracranial pathology, and conclude “Taken together, file records indicate that Ms. Marcelo sustained a traumatic brain injury as a result of the accident.” I am not persuaded by the letter from Doctors Becker and their diagnosis because they do not explain what was in the medical brief and they have not explained why their diagnosis should be preferred over Dr. Leung’s finding of a cerebral contusion. Accordingly, I place little weight upon the diagnosis from Doctors Becker.
24Seventhly, I am not persuaded by the applicant’s submission that she suffered a traumatic brain injury by referring to, and putting together, different medical definitions and an excerpt from one medical journal article to expand the definition of a cerebral contusion so as to take her out of the MIG. The CT scan showed, and Dr. Leung opined that the applicant had a cerebral contusion, and as I have already found a cerebral contusion is a “contusion” within the meaning of “minor injury” as defined in section 3(1).
25Eighthly, I am not persuaded by the applicant’s submission that her injuries should be recognized as catastrophic by taking a diagnosis in Doctors Becker’s letter and then referring to part of the definition of “traumatic brain impairment” under criterion 4. As I stated earlier, I place little weight upon the diagnosis of Doctors Becker. And in any event, if the applicant submits that she should be recognized as catastrophic, so as to be outside the MIG, she should have directed me to compelling medical evidence of a catastrophic impairment diagnosis.
26Lastly, I find the affidavit of the applicant’s daughter of very limited value. This affidavit is not objective medical evidence. The daughter is not a medical professional, and the affidavit was dated May 31, 2023, over 3 years and 9 months after the subject accident. Furthermore, the noted observations by the daughter are very brief and general. Accordingly, I place very little weight on this evidence.
27For the above reasons, I find that the applicant has not proven on a balance of probabilities that she sustained a head injury that removes her from the MIG.
Does the applicant have chronic pain that warrants removal from the MIG?
28The applicant made a number of different submissions as to what constitutes chronic pain that warrants removal from the MIG.
29The applicant submitted that based upon certain Tribunal decisions, including T.S. v. Aviva General Insurance Canada 2018 CanLII 83520 (ON LAT), chronic pain is a condition that persists for three to six months, and an actual diagnosis of chronic pain syndrome is not required to be removed from the MIG.
30However, in the applicant’s reply, the applicant then submitted that the only definition of chronic pain that the Tribunal is bound by is the one set by the Supreme Court of Canada in Nova Scotia (Workers’ Compensation Board) v. Martin; Nova Scotia (Worker’s Compensation Board) v. Laseur, 2003 SCC 54, where chronic pain was generally defined as “…pain that persists beyond the normal healing time for the underlying injury or is disproportionate to such injury, and whose existence is not supported by objective findings at the site of the injury under current medical techniques…”.
31The applicant then submitted in her reply that the Tribunal has repeatedly held that an applicant is only required to demonstrate ongoing pain, accompanied by functional impairment or disability, and relied upon several Tribunal decisions including Mubarek v. Aviva Insurance Company, 2023 CanLII 123467 (ON LAT) and Shea v. Perth Insurance, 2024 CanLII 133 (ON LAT). In addition, the applicant submitted that according to Khan v Economical Insurance Company, 2023 CanLII 93030 (ON LAT) the American Medical Association Guides to the Evaluation of Permanent Impairment, 6th Edition (“AMA Guides”) are not a definitive test to determine if someone suffers from chronic pain. However, the applicant then submitted that if she was assessed by the AMA Guides she would nevertheless meet the definition of chronic pain.
32The respondent submitted that the Tribunal has repeatedly relied upon the six criteria set out in the AMA Guides to assist it in determining whether an applicant is suffering from chronic pain. According to the AMA Guides, at least three of the six criteria are required for a diagnosis of chronic pain, and the applicant does not satisfy any of the criteria.
33I am not persuaded by the applicant’s submission that the Tribunal is bound by the definition of “chronic pain” from Martin and Laseur. The applicant did not refer to any jurisprudence stating that the Tribunal is bound by that definition. Furthermore, Martin and Laseur are distinguishable. They were Charter cases and pertained to a specific definition of “chronic pain” found in the Nova Scotia Workers’ Compensation Act, S.N.S. 1994-95, c.10, as amended, and the Functional Restoration (Multi-Faceted Pain Services) Program Regulations, N.S. Reg. 57/96. The Supreme Court of Canada was not defining “chronic pain” for the purposes of automobile benefits in Ontario under the Schedule, and therefore I find that the Tribunal is not bound by Martin and Laseur.
34The applicant’s submission that merely having pain for 3 to 6 months is sufficient to take an applicant out of the MIG is overly simplistic, and not an accurate interpretation of the Tribunal jurisprudence. T.S. v Aviva described chronic pain as “ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual’s well-being”. And the applicant even acknowledged that the Tribunal has repeatedly held that an applicant is required to demonstrate ongoing pain, accompanied by functional impairment or disability, and refers to Tribunal decisions such as Mubarek v. Aviva Insurance Company and Shea v. Perth Insurance.
35Although I am not bound by other Tribunal decisions, I find that the Tribunal’s decisions can be read to establish that ongoing chronic pain that functionally impairs an individual may warrant removal from the MIG. I agree with the applicant that a formal diagnosis of chronic pain is not necessary. Although the Tribunal is not bound by the AMA Guides, the Tribunal has found the use of the AMA Guides helpful in assessing and ascertaining whether someone’s pain is affecting their functional capacity.
36Based upon the reasons that follow, I find that the applicant has not proven on a balance of probabilities that she suffers from chronic pain that impairs her functionality.
37The applicant submits that as a result of the accident she suffered a head injury and injuries to her neck, shoulders, back, knees, and legs. She reported her injuries and pain to her family doctor, Dr. El-Kateb, on September 3, 13 and 19, 2019. She attended physiotherapy with Mr. Avinnash Sookmangal, registered physiotherapist, from September 2019 to November 19, 2022. The applicant relies upon Mr. Sookmangal’s report dated October 22, 2021 where he notes the applicant’s diagnoses of cervical sprain/strain/joint dysfunction (neck), thoracic sprain/strain/joint dysfunction (mid back), and lumbar strain/strain/joint dysfunction (lower back).
38The respondent submits that the applicant failed to show that she suffers from chronic pain which limits her functionality as a result of the accident. She returned to work within less than two months after the accident. Mr. Sookmangal’s report dated October 22, 2021 was prepared over 2 years after the accident and appears to have been prepared solely for the purpose of litigation. The report does not diagnose the applicant with chronic pain but rather soft tissue injuries that fall within the definition of the MIG.
39Firstly, I am not persuaded by the applicant’s evidence that she suffers from chronic pain that impairs her functionality because her family doctor does not corroborate the reports of pain that she made to her physiotherapist. The accident was on August 26, 2019, and the applicant saw her family doctor on September 3, 13 and 19, 2019 and reported pain, but despite seeing her family doctor on a regular basis thereafter, the applicant does not point to any clinical notes and records where she reported pain again.
40Secondly, the applicant returned to work on October 21, 2019 which is less than two months after the accident. There is no evidence from the employer that her work duties had to be modified nor did the applicant report to her family doctor any pain or any impact upon her work. The only evidence submitted that her pain impacted her work is her self-reporting to Mr. Sookmangal, which I do not find persuasive because it is not corroborated by her family doctor nor employer.
41Thirdly, although a formal diagnosis is not necessary for a finding of chronic pain, it is noteworthy that the applicant did not point to any evidence of ever being told that she should see a pain specialist, whether by her family doctor or the treatment providers.
42Fourthly, I find that the AMA Guides are helpful in assessing and ascertaining whether someone’s pain is affecting their functional capacity. For the reasons that follow, I find that the applicant has not established on a balance of probabilities that the chronic pain functionally impairs her.
43The AMA Guides require at least three of the following criteria be met:
i. Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances;
ii. Excessive dependence on health care providers, spouse, or family;
iii. Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain;
iv. Withdrawal from social milieu, including work, recreation, or other social contacts;
v. Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs; and
vi. Development of psychological sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors.
44In the applicant’s reply she made submissions regarding criterion (ii), (iv), (v) and (vi) of the AMA Guides. Regarding criterion (ii) the applicant submitted that she depended excessively on health care providers as evidenced by attending physiotherapy from September 12, 2019 to April 28, 2022 and massage therapy from October 24, 2019 to March 21, 2022. Regarding criterion (iv) she submitted that, while she continues to work, she has withdrawn from social milieu, specifically as it pertains to recreational pursuits and family. She relies upon her daughter’s affidavit and upon her reporting to Dr. Lara Davidson that she is less social and avoids social gatherings. Regarding criterion (v) she submitted that her post-accident injuries have limited her work duties as they increase her pain symptoms because of weakness, reduced postural strength and endurance. She cannot sit in a seated position at work for prolonged periods. She also submitted that sweeping, mopping and cleaning are limited due to pain symptoms, weakness and reduced postural endurance, and that she is unable to perform heavy lifting or heavy exertion activities. Regarding criterion (vi) she submitted that she developed psychological sequelae, such as increased irritability, withdrawal from social situations and gatherings, emotional distress and discomfort with her pain. She relies on the treatment plan dated July 19, 2022 by Dr. Lara Davidson, Psychologist, where she reported the psychological sequelae.
45The respondent submits that the applicant has not presented any evidence to satisfy any of the AMA Guides’ criteria.
46In reference to the AMA Guides’ criteria, I find that:
i. The applicant did not make any submissions that she is abusing prescription medication or other substances. Accordingly, I find that this criterion is not met.
ii. The applicant attended health care providers from September 12, 2019 to April 28, 2022 and massage therapy from October 24, 2019 to March 21, 2022. The applicant also saw her family doctor on a regular basis. The applicant’s daughter stated in her affidavit that for several weeks after the accident her mother needed a lot of help from her, but there is no statement that it continued thereafter. I am not persuaded that attending treatment, receiving family assistance for several weeks, and seeing her family doctor constitutes excessive dependence upon her health care providers and family, and therefore I find that this criterion is not met.
iii. The applicant did not make submissions that she is experiencing secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain. Accordingly, I find that this criterion is not met.
iv. Almost two years after the accident, the applicant reported to Dr. Laura Davidson, Psychologist, that she was less social and will avoid social gatherings. Her daughter stated in her affidavit, prepared 3 years and 9 months after the accident, that her mother was withdrawn and reluctant to attend family gatherings. Also, her daughter stated that the applicant, prior to the accident, enjoyed the outdoors and spending time with her grandchildren. I am not persuaded that the applicant has submitted compelling evidence of withdrawal from social milieu. Firstly, the applicant returned to work within two months after the accident. Secondly, Dr. Davidson recorded what the applicant reported to her almost two years after the accident, but the applicant did not make similar reports to her family doctor nor any of the treatment providers. Thirdly, upon review of the daughter’s affidavit, it does not state that the applicant stopped or reduced her outdoor activities, or stopped or reduced spending time with her grandchildren, or stopped attending family gatherings. Accordingly, I find that this criterion is not met.
v. The applicant did not cite evidence that her physical capacity is insufficient to pursue work, family or recreational needs. Firstly, the applicant returned to work within two months of the accident. Secondly, I was not pointed to evidence that the applicant is not living independently. Thirdly, despite the applicant reporting some pain with some activities, she did not cite evidence that she was not physically capable of fulfilling her work, family and recreational needs. Accordingly, I find that this criterion is not met.
vi. The psychological sequelae reported by the applicant to Dr. Laura Davidson, Psychologist, almost two years after the accident is not corroborated by the family doctor. Despite seeing Dr. El-Kateb on a regular basis after the accident, the applicant did not point me to any clinical notes and records of her family doctor where she reported similar symptoms. Accordingly, I find that this criterion is not met.
47I find that the applicant has not met at least three of the criteria of the AMA Guides.
48For the foregoing reasons, I find that the applicant has not proven on a balance of probabilities that she suffers from chronic pain with a functional impairment such that she should be removed from the MIG.
Does the applicant have a pre-existing medical condition that warrants her removal from the MIG?
49As noted earlier, to be removed from the MIG on the basis of a pre-existing condition, the applicant must satisfy the requirements set out in section 18(2) of the Schedule.
50Section 18(2) of the Schedule provides that insured persons with minor injuries who have a pre-existing medical condition may be exempted from the $3,500.00 limit on benefits. In order to do so, the insured person must satisfy the following requirements:
i. Their health practitioner must determine and provide compelling evidence that the insured person has a pre-existing medical condition that was documented by a health practitioner before the accident; and
ii. Their health practitioner must determine and provide compelling evidence that the insured person’s pre-existing medical condition will prevent the insured person from achieving maximal recovery from the minor injury if the insured person is confined to the limit under the MIG.
51The applicant submits that her pre-existing medical conditions, included a diagnosis of dyslipideia, hyperlipidemia, osteoporosis, leg pain/fatigue, leg swelling, left knee pain, and lower back pain. She reported back pain to her family doctor, Dr. El-Kateb, dating back to 2016, and she recommended massage and physiotherapy due to back pain, and the applicant attended physiotherapy from October to December 2016.
52The respondent submits that the applicant suffered dyslipidea and osteoporosis prior to the subject accident but she has not cited medical evidence showing how her pre-existing medical conditions were impacted by the subject accident and that any of the pre-existing medical conditions merit treatment outside of the MIG.
53I find that the applicant has established that she has a documented pre-existing medical condition. However, I find that the applicant has not met the second part of the test because she has not shown that there is an opinion from a health practitioner accompanied by compelling evidence that her pre-existing medical condition will prevent her from achieving maximal recovery within the MIG.
54For the foregoing reasons, I find that the applicant has not proven on a balance of probabilities that she should be removed from the MIG because of a pre-existing medical condition.
Is the applicant entitled to physiotherapy, a psychological assessment and a chronic pain assessment?
55Since I have found that the applicant remains within the MIG, the applicant is entitled to treatment up to the MIG limit.
Interest
56As there are no benefits owing, no interest is payable.
Award
57The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
58As I have found that there are no payment of benefits owing, there is no basis upon which to consider an award in this matter. Accordingly, I find that the applicant is not entitled to an award.
ORDER
59I find that the applicant has not demonstrated that her accident-related impairments warrant removal from the MIG. The applicant is entitled to treatment up to the MIG limit. As no benefits are payable, the applicant is not entitled to interest nor to an award under s. 10 of Reg. 664.
Released: November 21, 2024
Nick Iannazzo
Adjudicator