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Applicant's Injuries All Fall Within MIG - TW v Unifund LAT 17-001129

December 05, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

TW v Unifund Claims Inc., LAT 17-001129 2017 CanLII 77341 (ON LAT)

Decision Date: November 8, 2017
Heard Before: Adjudicator Christopher A. Ferguson

MIG and BENEFIT ENTITLEMENT: all medical evidence points to injuries within MIG; applicant fails to show any injuries fall outside MIG;


TW was in a car accident on September 21, 2015 and sought SABs from Unifund. When the benefits were denied and mediation failed, TW applied for arbitration at the LAT.

Issues:

  1. Are TW’s injuries predominately minor as defined by section 3(1) of the Schedule?
  2. Is TW entitled to receive a medical benefit in the amount of $2,512.00 for a physiotherapy treatment in a treatment plan dated October 19, 2015?
  3. Is TW entitled to receive a medical benefit in the amount of $1,311.20 for a physiotherapy treatment in a treatment plan dated December 29, 2015?
  4. Is TW entitled to receive a medical benefit in the amount of $2,669.04 for a psychological treatment in a treatment plan submitted on March 22, 2016?
  5. Is TW entitled to payment for the cost of examinations in the amount of $1,979.84 for a psychological assessment in a treatment plan dated January 14, 2016?
  6. Is TW entitled to payment for the cost of examinations in the amount of $1,297.79 for a functional ability assessment in a treatment plan dated November 17, 2016?
  7. Is TW entitled to interest on any overdue payment of benefits?

RESULT

  1. TW’s injuries are predominantly minor as defined by the Schedule and fall within the MIG because:
    1. They fit the definition of minor injury prescribed by the Schedule, and
    2. there is no compelling evidence of a pre-existing medical condition that would remove TW from the MIG.
  2.  TW’s injuries and classification of those injuries within the MIG mean that he is not entitled to payment of the disputed benefits set out in his application.
  3. No interest is payable to him by Unifund.

Unifund argues that all of TW’s injuries fall within the MIG prescribed by the Schedule..

If Unifund’s position is correct, then TW is subject to the $3,500.00 limit on benefits and  any determination of whether the claimed benefits are reasonable and necessary will be unnecessary because TW has not argued that any portion of the $3,500.00 maximum benefit remains available for payment if he is in the MIG.  

The onus is on TW to prove his injuries fall outside the MIG. TW’s physical injuries are consistently reported by all of the medical experts as strains and sprains of the shoulder, lumbar spine and knee, and headaches.  TW does not provide any diagnosis of chronic pain syndrome nor does he address whether or not his headaches are clinically associated sequelae to the aforementioned injuries.

On the basis of the medical evidence the Adjudicator found that TW’s injuries fall predominately within the definition of “minor injury”.

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

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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.

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