Applicant removed from MIG on basis of psychological impairment resulting from accident - Applicant v RBC LAT 16-002047

February 08, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Applicant v RBC LAT 16-002047

Decision Date:  November 22, 2017
Heard Before: Adjudicator Sandeep Joha

MIG AND ENTITLEMENT TO BENEFITS: Applicant removed from MIG on basis of psychological impairment resulting from accident

The applicant was injured in car accident on September 5, 2015 and sought benefits pursuant SABs. When RBC denied the benefits claim the applicant submitted an application to the LAT.

Issues:

1. Did the applicant sustain an impairment within the meaning of the Schedule as a result of the accident?
2. Is the applicant entitled to receive a medical benefit in the amount of $3,621.38 for medical services in a treatment plan dated March 16, 2016?
3. Is the applicant entitled to receive a medical benefit in the amount of $3,129.38 for psychological services in a treatment plan dated February 1, 2016?
4. Is the applicant entitled to the cost of an exam for a psychological assessment in the amount of $2,200.00 in a report submitted on January 14, 2016?
5. Is the applicant entitled to an award under section 10 of Regulation 664 to the Insurance Act for unreasonably withholding or delaying the payment of benefits?
6. Do the Applicant’s injuries fall within the MIG?

Result:

1. The applicant has established on a balance of probabilities that his injuries fall outside of the MIG because of his psychological injuries.  The applicant’s depression and anxiety do not fall within the definition of “minor injury.”
2. Having found that the applicant’s injuries are outside of the MIG:
   1. The treatment plans listed above are reasonable and necessary;
   2. The applicant is entitled to the cost of an examination for a psychological assessment in the amount of $2,200; and,
   3. The applicant is not entitled to an award under section 10 of Regulation 664 as RBC did not unreasonably withhold or delay the payment of benefits to the applicant.

The Arbitrator reviewed the law and the MIG and noted the respondent is required to pay to the applicant medical and rehabilitation benefits if the applicant sustained an impairment as a result of the accident and the benefits are reasonable and necessary expenses that have been incurred by or on behalf of the applicant as a result of the accident. He also noted the onus is on the applicant to prove the treatment is reasonable and necessary and that that the onus of establishing entitlement beyond the MIG limits rests with the claimant. 

The Arbitrator reviewed the evidence and determined that the applicant’s psychological injuries are not within the definition of the MIG.

The Arbitrator further reviewed the treatment plans and noted that as the applicant is out of the MIG because of his psychological impairment, he is able to access benefits greater than the $3,500 limit imposed by the MIG if he shows that each treatment plan is reasonable and necessary.

Upond reviewed the assessments the Arbitrator preferred the applicant’s reports and determined that the recommended plans are reasonable and necessary. Having found that the applicant is entitled to the medical benefit for psychological treatment dated February 1, 2016, the Arbitrator found the cost of examination for a psychological assessment to be reasonable and necessary.

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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 at 1-519-742-7774.

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.