Injuries Do Not Fall Outside the MIG - YY v Aviva Insurance, 2017 CanLII 33668 (ON LAT)

June 30, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

YY v Aviva Insurance, 2017 CanLII 33668 (ON LAT)

Date of Decision: May 5, 2017
Heard Before: Adjudicator Susan Mather

MIG: Applicant has sustained injuries but the injuries fall within the MIG


Y.Y.  was involved in car accident on February 1, 2015 and sought benefits pursuant to the SABs, however when Aviva denied YY’s claim for an attendant care assessment and medical benefits for chiropractic treatment. Aviva denied the benefits as YY’s injuries fall within the MIG and are subject to a $3,500.00 limit. In the alternative, Aviva takes the position that, even if YY did sustain injuries of an extent to take him out of the MIG, the assessment and treatment proposed are not reasonable or necessary.

YY disagreed with this decision and applied to the LAT for arbitration.

Issues:

  1. Did YY sustain an impairment within the meaning of the Schedule?
  2. Do YY’s injuries fall within the Minor Injury Guideline (MIG)?
  3. If the answer to issue two is no:
    1. Is YY entitled to receive a medical benefit in the amount of $1,146.58 for other goods and services of a medical nature, recommended by Integral Health Group, denied by Aviva on April 02, 2015?
    2. Is YY entitled to receive a medical benefit in the amount of $4,008.22 for chiropractic services recommended by Integral Health Group, denied by Aviva on April 2, 2015?
  4. Is YY entitled to interest on the overdue payment of benefits?

RESULT

  1. YY sustained an impairment within the meaning of the Schedule.
  2. YY’s injuries fall within the MIG.
  3. Since the answer to issue two is yes:
    1. YY is not entitled to receive a medical benefit in the amount of $1,146.58 for the attendant care assessment recommended by Integral Health Group, denied by Aviva on April 2, 2015?
    2. YY is not entitled to receive a medical benefit in the amount of $ 4, 008.22 for chiropractic services recommended by Integral Health Group, denied by Aviva on April 2, 2015?
  4.  YY is not entitled to interest on overdue benefits.

The Arbitrator reviewed the law and the evidence and was satisfied that based on the medical reports YY sustained an impairment within the meaning of the Schedule. YY met the burden of proof with respect to her injuries.

With regard to the MIG question, the Arbitrator noted that the Schedule defines MIG, and establishes a framework for the treatment of minor injuries. The burden of proof for establishing entitlement to benefits outside the MIG falls upon the YY. Based on the evidence the Arbitrator was not satisfied that YY has met the burden of establishing that he has sustained injuries which entitle him to more than $3,500 in medical benefits.

 

 

Posted under Accident Benefit News, Minor Injury Guidelines, Personal Injury

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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.

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