Applicant fails to prove his injuries place him outside MIG - CJ v The Personal 16-002815

October 06, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

CJ v The Personal 16-002815

Date of Decision: July 31, 2017
Heard Before: Adjudicator Rebecca Hines

MIG: injuries do not fall outside MIG


CJ was injured in a car accident on February 24, 2014.  He applied for accident benefits to the Personal but when the claims were denied CJ applied for dispute resolution services to the LAT.

Following the case conference, Personal approved a treatment plan dated June 18, 2017, in the amount of $2,200.00 for physiotherapy.  To date, $3,275.00 has been approved of the $3,500.00 MIG limit.

PROCEDURAL ISSUE:

Acording to the case conference adjudicator’s order the parties agreed to a hybrid hearing.  The parties were to file written submissions and documentary evidence.  At the teleconference hearing neither party had any witnesses available for cross-examination.  The sole-purpose of the teleconference hearing was for cross-examination on affidavit evidence.  Since neither party had their witnesses available for the teleconference hearing and to ensure procedural fairness to both sides, the Arbitrator decided that both parties would rely on their medical reports.

Issues:

  1. Did CJ suffer predominantly minor injuries as a result of the February 24, 2014 motor vehicle accident?
  2. If CJ’s injuries fall outside of the MIG, is he entitled to the following treatment plans for medical benefits and an examination expense recommended by Marcin Danda of IAM Intelligent Approach:
    1. $2,400.00 for physiotherapy denied by Personal on December 8, 2015;
    2. $700.04 for physiotherapy denied by Personal on June 26, 2015; and
    3. $1,950.00 for a psychological assessment denied by Personal on October 21, 2014.

RESULT:

  1. The treatment plans for medical benefits and examination expenses are not reasonable or necessary.

The Arbitrator reviewed the law, the evidence and the definition of minor injury.

After reviewing the parties’ submissions and documentary evidence and hearing the parties’ oral submissions, The Arbitrator found that CJ suffered predominantly minor injuries.  CJ did not provide compelling evidence of a pre-existing medical condition that would remove him from the MIG.  Nor did CJ provide sufficient evidence that his accident related injuries were not minor.

Posted under Accident Benefit News, Automobile Accident Benefits, Car Accidents, LAT Case, LAT Decisions, Minor Injury Guidelines, Physical Therapy

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About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us toll-free at 1-866-414-4878.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.

Practice Areas

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  8. Drunk driving accidents
  9. Concussion syndrome
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  3. Disability insurance claims
  4. Slip and fall injury
  5. Fractures or broken bone injury
  6. Pedestrian accidents
  7. Chronic pain
  8. Truck accidents
  9. Amputation and disfigurement

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