Licence Appeal Tribunal File Number: 23-012053/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:
Sandy Jackman
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Maria Makarova, Paralegal
For the Respondent:
Kevin Mitchell, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Sandy Jackman, the applicant, was involved in an automobile accident on September 21, 2021, 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, Intact Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2I note that this claim was initially handled by ClaimsPro. The respondent took over priority of the claim on September 12, 2022.
ISSUES
3The 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?
ii. Is the applicant entitled to medical benefits proposed by Mackenzie Medical Rehabilitation Centre (“Mackenzie Medical”) as follows:
i. $3,795.50 for chiropractic treatment in a treatment plan dated October 8, 2021;
ii. $2,023.03 for chiropractic treatment in a treatment plan dated May 20, 2022;
iii. $1,525.83 for chiropractic treatment in a treatment plan dated July 15, 2022;
iv. $1,194.38 for chiropractic treatment in a treatment plan dated August 16, 2022; and
v. $2,851.68 for chiropractic treatment in a treatment plan dated October 21, 2022?
iii. Is the applicant entitled to a medical benefit in the amount of $2,200.00 for a chronic pain assessment, proposed by Princeton Hills Medical Assessments, in a treatment plan dated October 24, 2022?
iv. Is the applicant entitled to a non-earner benefit (“NEB”) of $185.00 per week for the period from October 19, 2021, to September 21, 2023?
v. Is the applicant entitled to interest on any overdue payment of benefits?
vi. Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?
4I note that with respect to the dates of the treatment plans prepared by Mackenzie Medical, the dates listed in the Case Conference Report and Order (“CCRO”) are incorrect. I have therefore amended the issues above with the dates indicated on the treatment plans in dispute that were included in the parties’ submissions.
RESULT
5I find that the applicant’s accident-related injuries are outside of the MIG as she suffers from chronic pain.
6I find that the applicant is entitled to the treatment plans for chiropractic services and a chronic pain assessment, plus interest.
7I find that the applicant is not entitled to a NEB.
8I find that the respondent is not liable to pay an award under s. 10 of Reg. 664.
PROCEDURAL ISSUE
The respondent’s submissions are not referenced by page number and the Document Brief is not tabbed
9The applicant in her reply submissions raises several procedural objections to the respondent’s submissions and document brief. The applicant submits that they were not in accordance with the formatting and reference requirements of the CCRO, dated April 25, 2024. The applicant submits that the respondent’s submissions contain no specific references by page number and if there is reference to a page number, the pages do not correspond to the referenced evidence. In addition, the applicant submits that the respondent’s Document Brief is not tabbed, and the tabs outlined in the respondent’s index are not page numbered. The applicant requests that the Tribunal not consider any of the respondent’s submissions that do not comply with the Tribunal’s filing requirements.
10The CCRO provides that the hearing adjudicator has the discretion to determine whether to consider submissions that do not comply with the Tribunal’s filing commitments.
11I find that the respondent’s document brief is tabbed and bookmarked in a manner that permitted me to easily navigate the documents referenced. I find that technical or format issues, such as a lack of page numbers, did not result in any prejudice to the applicant, and did not prevent the Tribunal from considering the merits of the respondent’s submissions.
12However, I did find that the references to page numbers in respect to the multidisciplinary Insurer’s Examination (“IE”) report dated June 29, 2022, did not correspond to the referenced evidence. This made it increasingly difficult to find the evidence referred to by the respondent in its submissions. It is not the role of the Tribunal to go searching for the evidence that a party is referencing.
13Despite this issue, I have considered the respondent’s submissions and evidence because the applicant did not raise any concerns of prejudice as a result of these submissions, and I was still able to assess the parties’ submissions.
ANALYSIS
14I find that the applicant has met her onus and demonstrated that her accident-related impairments warrant removal from the MIG.
15Section 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) of the Schedule defines a “minor injury” as “one or more of a strain, sprain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”
16An 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) of the Schedule, that they have a documented pre-existing condition combined with compelling medical evidence stating that the condition precludes maximal medical recovery if they are kept within the confines of the MIG. The Tribunal has also determined that chronic pain with functional impairment or a psychological condition may warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
17In this matter, the applicant submits that she should be removed from the MIG based on her pre-existing medical conditions, which she argues were exacerbated by the accident and would preclude maximal recovery. She further submits that she should be removed from the MIG based on her accident-related injuries which include carpal tunnel syndrome, chronic pain, post-concussion syndrome, depression, and insomnia.
(a) The applicant is not removed from the MIG on the basis of a pre-existing medical condition
18I find on a balance of probabilities, that the applicant does not suffer from a pre-existing medical condition that would warrant removal from the MIG.
19The applicant submits that she should be removed from the MIG based on her pre-existing left hip pain, low spinal curvature convex to the left, left bicipital tendinitis, limited range of motion in the neck, and chronic neck and back pain, which were exacerbated by the accident. She submits that her pre-existing conditions hinder her ability to achieve maximum medical recovery within the MIG framework.
20While I find that the applicant has provided sufficient documentation to support a pre-existing condition, the applicant has not met her onus of providing evidence from a health practitioner that a pre-existing medical condition will prevent her from achieving maximal medical recovery if she is subject to the MIG limits. I find that the applicant has not pointed me to any medical opinion or directive supporting her position. I therefore find that the applicant has not met the two-part test under s. 18(2) of the Schedule.
21For the reasons set out above, I find that the applicant has not proven on a balance of probabilities that she suffers from a pre-existing medical condition that would prevent maximal medical recovery if she is subject to the MIG and therefore she is not removed from the MIG on this basis.
b) The applicant is removed from the MIG on the basis of chronic pain
22I find that the applicant has demonstrated that she suffers from a chronic pain condition that warrants removal from the MIG.
23Chronic pain conditions are not included in the minor injury definition. In order to establish that the applicant has a chronic pain condition, she must demonstrate that her pain causes a functional impairment which adversely affects her well-being. A diagnosis of chronic pain, absent evidence of an ongoing functional impairment due to pain, is insufficient to establish a non-minor injury.
24The applicant submits that she has chronic pain with functional limitations. She submits that as a result of the accident, she sustained injuries to her left shoulder, left arm, left hip, left ankle, and upper back. She relies upon the clinical notes and records (“CNRs”) of Dr. Nilav Bhowmik, chiropractor at Mackenzie Medical, which support her reported complaints of neck pain, left shoulder pain, lower back pain and left hip pain and support her functional limitations.
25The applicant relies upon the CNRs of Dr. Naseeruddin Syed, family physician, where she complained about low back pain radiating to her left hip and left shoulder pain since the accident. The applicant refers to the CNRs dated May 18, 2022, October 12, 2022, November 25, 2022, and June 12, 2023. She specifically notes in the CNR dated November 25, 2022, that Dr. Syed diagnosed her with chronic pain post-accident.
26The applicant also submits that she was attending Rexdale Chiropractic Centre (“Rexdale”) prior to the accident to treat her ongoing low back pain and continued to attend at this clinic following the accident to treat her neck, shoulders, thoracic, low back pain, and headaches. She paid out of pocket for this treatment.
27The applicant further submits that the November 24, 2022, IE report prepared by Dr. Eric Silver, general practitioner, supports her functional limitations. The applicant submits that Dr. Silver’s examination confirmed her functional limitations including the following:
i. Inability to perform housekeeping and cooking with same pace as before the accident;
ii. Inability to exercise at the gym with the same intensity;
iii. Limited by pain ability to sit prolonged period of time; and
iv. Reduced sensation throughout the left upper extremity and throughout the left foot.
28The applicant submits that Dr. Silver concluded that, “the ongoing nature of the applicant’s pain is beyond what would normally be expected as such injuries typically resolve within approximately three months” and that, “the prognosis for a full resolution of pain complaints is guarded due to the ongoing nature of her complaints more than one-year post-accident”. The applicant argues that this opinion supports that she has failed to recover from her accident-related injuries within the MIG policy limit and that her pain has persisted.
29The applicant relies upon the Tribunal decisions in Rodrigues v. Wawanesa Mutual Insurance Company, 2022 CanLII 117087 (ON LAT), where the Tribunal found that chronic pain is understood to be “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. A simpler definition for chronic or persistent pain is pain that continues when it should not”. The applicant submits that she has ongoing, prolonged pain and documented functional limitations which have significantly affected her well-being, limited her ability to engage in activities such as housekeeping and home maintenance, exercising and riding her bicycle, as before the accident. She is excessively dependent on medication and healthcare providers.
30The respondent submits that the $3,500.00 MIG limit has been exhausted. The respondent argues that any diagnosis of chronic pain (pre-existing or otherwise) does not affect the applicant’s functionality. It submits that her admitted functionality in 2021-2022, as set out in the records of Rexdale, belies any of the noted differential diagnosis made by her family doctor on June 12, 2023. It argues that her claim for excessive reliance on medication is not supported and her continued attendance at treatment is for other injuries not sustained in the accident. The respondent relies upon the IE report of Dr. Isa Mohammed, family physician, dated April 29, 2022; the multidisciplinary IE reports of Dr. Mohammed, physician; Veena Mehta, occupational therapist; and Dr. Amena Syed, psychologist, dated June 29, 2022; and the two IE reports of Dr. Silver, dated December 2, 2022, that support that the applicant’s injuries are minor and there is no objective evidence of physical impairment.
31In reply, the applicant submits that the respondent has disregarded the applicant’s chronic pain condition and findings of reduced functionality. The applicant further submits that the respondent also disregards Dr. Silver’s findings on the applicant’s limited functionality which is specifically set out in her submissions. Further, the applicant disagrees with the respondent’s submission that she stopped attending for treatment in November 2022 as the CNRs of Rexdale demonstrate that she continued to attend treatment regularly, even in 2024, for her accident-related injuries.
32I find that the applicant has provided sufficient evidence to support that she suffers chronic pain as a result of the accident.
33I find upon review of the medical evidence, that the applicant consistently complained to various medical practitioners, including the respondent’s assessors, of persisting pain in multiple areas of her body. Specifically, the emergency records, CNRs of Dr. Syed, family doctor, CNRs of Mackenzie Medical, CNRs of Rexdale and the IE reports, indicate that the applicant’s complaints have continued, since the accident, and well beyond the three-month period projected for healing.
34I further find that the applicant’s evidence establishes, that, on a balance of probabilities, her chronic pain has caused functional impairment, adversely affecting her well-being.
35Considering the affected areas of chronic pain reported to various physicians, primarily her low back, left hip, and left shoulder, I find the applicant’s functioning was impaired. On November 25, 2022, Dr. Syed diagnosed the applicant with chronic pain and on June 12, 2023, Dr. Syed concluded that the applicant’s complaints of low back and left hip pain were aggravated by movement and relieved with rest. On October 8, 2021, Dr. Bhowmik, chiropractor at Mackenzie Medical indicated in the Disability Certificate, that the applicant’s “injuries suffered in the accident limit the patient from turning the neck, reaching overhead, bending, kneeling, twisting, lifting and with prolonged postures, thus affecting her pre-accident activities of daily living (“ADL’s).” He reconfirmed his findings again in the Disability Certificate, dated October 21, 2022. I find his findings are supported in the CNRs of Mackenzie Medical. I further find that CNRs of Rexdale confirm that she continued to attend for treatment following the accident, for which she paid out of pocket for this treatment. I find that these CNRs support that she did not stop treatment in November 2022, as suggested by the respondent.
36I give little weight to the IE report of Dr. Mohammed. I find that Dr. Mohammed acknowledged that the applicant continues to experience residual pain, but he found that there was no objective accident-related pathology. However, despite his conclusion he noted that the applicant had several functional restrictions. He notes that that although the applicant manages to get most of her chores done, some modification is needed, and difficulty is typically great. With regard to her neck and left shoulder pain she reported pain which is constant and exacerbated with any activity. With regard to her lower back pain, she reported constant pain, which is aggravated with physical activity, sitting down for extended periods, driving, and when standing for extended periods. She further reported intermittent numbness and tingling symptoms in the lower extremities, only on the left side. She also reported continuing left ankle pain. I find that Dr. Mohammed’s report supports that the applicant reported ongoing functional limitations and difficulties.
37I also find that Dr. Silver’s IE report, dated November 24, 2022, supports the applicant’s complaints of ongoing pain and limited functionality. While he states that she is able to do all of her pre-accident cooking and housekeeping activities, he notes that she uses pacing when performing cooking and housekeeping tasks that aggravate her left shoulder and back pain. He notes that she has returned to the gym but does not exercise at the same intensity and that her lower back and left hip pain is aggravated after 5 minutes of bike riding. He further notes that she is able to drive a vehicle but has pain in the lower back with extended sitting. I find Dr. Silver’s conclusion that her prognosis for a full resolution of pain complaints is guarded due to the ongoing nature of her complaints more than one-year post-accident, supports the applicant’s position that her pain complaints have continued without improvement since the accident.
38I find that the applicant has provided persuasive evidence, not only indicating that she has developed chronic pain, from her physical, accident-related injuries, but that the pain adversely affected her everyday movements/functioning to some extent, and that she was not on a balance of probabilities, at maximum medical recovery.
39For the reasons set out above, I find that the applicant has proven on a balance of probabilities that she suffers from chronic pain with a functional impairment and therefore she is removed from the MIG on this basis.
The applicant is entitled to medical and rehabilitation benefits
(a) The applicant is entitled to the treatment plans for chiropractic treatment
40I find that the applicant is entitled to the treatment plans for chiropractic treatment.
41To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify that the goals of treatment are reasonable, how the goals would be met to a reasonable degree, and that the overall costs of achieving them are reasonable.
42The applicant claims entitlement to five treatment plans for physical treatment at Mackenzie Medical, dated October 8, 2021, May 20, 2022, July 15, 2022, August 16, 2022, and October 21, 2022.
43The applicant submits that the treatment plans in dispute propose several modalities, including chiropractic treatment, physiotherapy, massage therapy and functional exercise. The goals of the treatment are pain reduction, increase range of motion, increase strength, and return to activities of normal living. The applicant submits that based on her ongoing chronic pain, along with functional impairments, it is evident that the goals of the proposed treatment are valid, and the treatment plans are reasonable and necessary. She further submits that the treatment recommendations are supported by the CNRs of her family physician dated May 18, 2022, and November 25, 2022, as well as the CNRs from Mackenzie Medical and Rexdale.
44With respect to the treatment plans dated October 8, 2021, May 20, 2022, and August 16, 2022, the applicant submits that the respondent did not provide her with denial letters and therefore it is in non-compliance with s. 38(8) of the Schedule. She claims entitlement to these treatment plans pursuant to s. 38(11) of the Schedule.
45The respondent submits that the applicant’s injuries are predominantly minor and therefore she is not entitled to the treatment and assessment plans in dispute. Specifically, with respect to the treatment plan dated October 8, 2021, the respondent submits that the applicant was advised by ClaimsPro in its letter dated November 1, 2021, that it was unable to consider the treatment plan because her application was incomplete. It further relies upon its letter dated March 24, 2022, which subsequently denied the treatment plan and requested an IE. By letter dated May 3, 2022, the respondent submits that the treatment plan was denied based on the IE report of Dr. Mohammed, dated April 29, 2022. The respondent submits that the treatment plans subsequently submitted on behalf of the applicant were also denied based on the IE report of Dr. Mohammed and the denial letters were provided to the applicant.
46With respect to the treatment plan dated October 21, 2022, by letter dated November 7, 2022, the treatment plan was denied, and the applicant was advised that a s. 44 assessment was required with Dr. Silver. The respondent submits that Dr. Silver concluded that the treatment plan was not reasonable and necessary. Following receipt of this report dated December 2, 2022, the respondent advised the applicant by letter that the treatment plan was not reasonable or necessary.
47I do not accept the applicant’s submission that the respondent failed to provide denial letters in respect to the treatment plans dated October 8, 2021, May 20, 2022 and August 16, 2022. Upon review of the respondent’s submissions, proper denial letters were provided to the applicant in respect to these treatment plans. The applicant is therefore not entitled to the remedy in s. 38(11) for these treatment plans.
48I find that the applicant has proven on a balance of probabilities that the treatment plans in dispute are reasonable and necessary. Having found that the applicant suffered chronic pain with functional limitations as a result of the accident, I find that the applicant has proven that she required ongoing treatment post-accident. This is further supported by the recommendations of her family physician to continue with treatment which are made contemporaneous to the treatment plans submitted. In addition, the CNRs of Rexdale support that she continued to attend for treatment at her own expense from the date of the accident until at least May 31, 2024, which supports her need for ongoing treatment.
49As stated above, I give little weight to Dr. Mohammed’s report. Dr. Mohammed notes that the applicant began attending for therapy within 1-2 weeks of the accident and currently attends once per week. The applicant reported constant neck, shoulder, low back, left ankle pain. He further concluded that “I do not discount the fact that Ms. Jackman continues to experience residual pain”. I find that his conclusion that she does not require any further treatment because her injuries are soft tissue in nature does not address the fact that she was attending treatment at the time of the assessment or that she continued to report ongoing residual pain.
50Similarly, I find the IE report of Dr. Silver, dated December 2, 2022, concludes that his assessment findings were consistent with myofascial pain in the cervicothoracic and left scapular region, left lumbar spine, and left hip flexor muscles. He further states that the prognosis for a full resolution of pain complaints is guarded due to the ongoing nature of her complaints more than one-year post-accident. I find that other than stating that he believes she has reached maximum medical benefit from facility-based therapies, he does not provide any reasons why he has reached this conclusion, while also stating that she has ongoing complaints. He makes no recommendations for other investigations, consultations, or treatments.
51For the reasons set out above, I find on a balance of probabilities that the applicant has proved that she is entitled to the treatment plans for chiropractic treatment, in dispute.
(b) The applicant is entitled to the treatment plans for a chronic pain assessment
52I find that the applicant is entitled to the treatment plan for a chronic pain assessment.
53The applicant claims entitlement to $2,200.00 for a chronic pain assessment, proposed by Princeton Hills Medical Assessments, in a treatment plan dated October 24, 2022. The goals of the treatment plan were to facilitate pain reduction, increase pain free range of motion and to return to activities of normal living.
54The applicant submits that the chronic pain assessment is reasonable and necessary as she continued to experience pain and functional limitations which required a comprehensive assessment and further treatment recommendations. She relies upon the IE report of Dr. Silver, which confirmed that her symptoms persisted and that she had not achieved full recovery with the treatment provided to date.
55The respondent submits that the treatment plan was denied by letter dated November 8, 2022. It relies upon the IE report of Dr. Silver, dated December 2, 2022, in support of its denial.
56I find that the timeline of the applicant’s injuries’ improvement, or lack thereof, demonstrates that she continues to suffer from pain. Therefore, I find it reasonable and necessary for the applicant to undergo a chronic pain assessment to assess her condition and receive recommendations for further management and treatment of her ongoing condition. I further agree with the applicant that she is entitled to be assessed by an assessor of her choice as the respondent had the opportunity to have her assessed by the physicians of its choice. As set out above, I give little weight to the report of Dr. Silver in support of the denial of this treatment plan.
57For the reasons set out above, I find on a balance of probabilities that the applicant has proved that she is entitled to the treatment plan for a chronic pain assessment.
The applicant is not entitled to a NEB
58I find that the applicant is not entitled to a NEB.
59The applicant claims entitlement to a NEB in the amount of $185.00 per week from October 19, 2021, to September 21, 2023.
60The applicant submits that she provided the respondent with two Disability Certificates, dated October 8, 2021, and November 3, 2022, both of which support her entitlement to a NEB. She submits that the respondent failed to respond to her application for a NEB, as no response letter was provided to her claim for NEBs, as per s. 36(3) of the Schedule. She further submits that the respondent failed to provide a response to her claim for NEBs or provide a s. 44 report addressing the NEB.
61The respondent submits that it responded to the applicant’s claim for NEBs and advised her of the denial and the dates of the Multidisciplinary IEs to assess her entitlement. By letter dated July 7, 2022, it advised the applicant that based on these assessments, she was not entitled to a NEB. A copy of these letters and the report are provided in the respondent’s submissions.
62The applicant in her reply submissions states that the respondent has failed to provide evidence supporting that it responded to the NEB claim. The applicant submits that these documents are new to the applicant, and she was not in possession of the report addressing NEB prior to the commencement of this dispute. The applicant further submits that the respondent has not indicated how these documents were submitted to the applicant or her representative and no fax confirmations were provided by the respondent. The respondent did not produce any adjuster notes indicating that the s. 44 reports were sent to the applicant or her legal representative. The applicant submits that as she was not provided with the response, s. 36(6) of the Schedule is applicable and the NEB is payable. She therefore submits that she is not required to establish that she suffered a complete inability to carry on her normal life.
63I find that the respondent has proven on a balance of probabilities that it responded to the applicant’s claim for a NEB. I find that the respondent advised the applicant that her claim for NEBs was denied, and she was required to attend s. 44 assessments, as set out in the letters attached to its submissions. I further find that notices were provided to the applicant of the dates of the assessments. I find that the applicant must have received these letters and notices of the assessments because she attended the assessments. I find that with respect to the denial letter dated July 7, 2022, this letter was sent to the applicant at the same address as the previous letters scheduling the s. 44 assessments. I therefore do not accept that she did not receive this denial letter as the applicant has not provided any explanation as to why she would receive all other letters from the respondent except for this one. In addition, having attended the assessments, the applicant would have known that the reports were pending had she not received a response from the respondent within a reasonable amount of time.
64As I have found that s. 36(6) of the Schedule does not apply, it is then necessary to consider whether the applicant has proven on a balance of probabilities that she suffered a complete inability to carry on a normal life. I find that the applicant has only relied upon the s. 36(6) argument in her submissions and has not provided any further submissions with respect to her entitlement.
65For the reasons set out above, I find that the applicant has not proven on a balance of probabilities that she is entitled to a NEB.
Interest
66Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that the applicant is entitled to the treatment plans in dispute, interest is payable in accordance with s. 51 of the Schedule, from the date payment became overdue to the date that payment was made.
Award
67The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 percent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
68The applicant submits that she is entitled to an award because the respondent failed to provide denial letters in respect to the treatment plans in dispute and in respect to the applicant’s claim for a NEB. She further submits that the respondent failed to adjudicate the claim in good faith by maintaining its position with respect to the MIG and failing to address her pre-existing medical conditions.
69The respondent submits that as ClaimsPro initially handled this claim before it accepted priority of the claim on September 12, 2022, it should not be exposed to a special award for any substandard handling of the claim by ClaimsPro. In addition, it submits that there is no factual or legal basis for such an award in all the circumstances, as the applicant has failed to prove that the respondent unreasonably withheld or delayed payments.
70As I have found that the respondent did provide denial letters and responded to the applicant’s claim for a NEB, no award is justified on this basis. With respect to the applicant’s claim that the respondent did not act in good faith due to its position on the MIG, I also do not find an award is justified on this basis. I find that the applicant has not directed me to any evidence that the respondent disregarded compelling evidence which resulted in the respondent unreasonably withholding or delaying payment of any benefits. I further find that the respondent is entitled to rely on its expert reports and to follow the recommendations in these reports. I find that, despite giving less weight to some of these reports in reaching my decision, the respondent’s reliance on these reports does not meet the standard of unreasonable conduct necessary to justify an award.
71For the reasons set out above, I find no award is payable.
ORDER
72For the reasons set out above, I find:
i. The applicant is removed from the MIG as she suffers from chronic pain;
ii. The applicant is entitled to the treatment plans for chiropractic services and a chronic pain assessment, plus interest;
iii. The applicant is not entitled to a NEB; and
iv. The respondent is not liable to pay an award under s. 10 of Reg. 664.
Released: September 11, 2025
__________________________
Melanie Malach
Adjudicator