Applicant Suffers Chronic Pain and Falls Outside MIG - FH and Certas Direct Insurance Company, 2018 CanLII 39445 (ON LAT 17-003735 )

June 16, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

FH and Certas Direct Insurance Company, 2018 CanLII 39445 (ON LAT 17-003735 )

Date: March 8, 2018
Heard Before: Adjudicator Chris Sewrattan

MIG and MEDICAL BENEFITS: applicant claims benefits outside MIG; applicant makes case she suffers from chronic pain

FH was injured in a car accident on August 11, 2015 and sought payment for SABs from Certas who denied payment for a number of the benefits because it believes that FH should be treated within the MIG. FH appeals for payment to the LAT.

Issues:

1. Are FH’s injuries subject to treatment within the MIG?
2. Is FH entitled to receive a medical benefit in the amount of $194.03 for physiotherapy treatment pursuant to a Treatment and Assessment Plan submitted on December 2, 2015?
3. Is FH entitled to receive a medical benefit in the amount of $2,075.48 for physiotherapy treatment pursuant to a Treatment and Assessment Plan submitted on February 11, 2016?
4. Is FH entitled to the cost of examination in the amount of $2,200.00 for psychological assessment pursuant to a Treatment and Assessment Plan submitted on April 26, 2016?
5. Is FH entitled to receive a medical benefit in the amount of $2,075.48 for physiotherapy treatment pursuant to a Treatment and Assessment Plan submitted on June 10, 2016?
6. Is FH entitled to the cost of examination in the amount of $2,200.00 for chronic pain assessment pursuant to a Treatment and Assessment Plan submitted on June 24, 2016?
7. Is FH entitled to receive a medical benefit in the amount of $1,762.90 for physiotherapy treatment pursuant to a Treatment and Assessment Plan submitted on November 8, 2016?
8. Is FH entitled to an award for unreasonably withheld or delayed payments under Regulation 664?
9. Is FH entitled to interest on any overdue payment of benefits?
10. Is FH entitled to costs under Rule 19?

Result:

1. FH suffers from Chronic Post Traumatic Pain Syndrome, an injury that is not predominantly minor. As a result, FH is not subject to the MIG.
2. FH entitled to each of the Treatment Plans in dispute. FH has proven that they are reasonable and necessary. FH is entitled to interest in accordance with s. 51 of the Schedule.
3. FH is not entitled to an award under s. 10 of Regulation 664 because Certas’ decision to confine his treatment to the MIG was not unreasonable.
4. FH is not entitled to costs under Rule 19 because the conduct about which she complains occurred outside of the Tribunal’s proceeding.

Discussion:

The Adjudicatro reviewed the totality of the medical evidence and determined that she has proven on a balance of probabilities that as a result of the accident she suffers from Chronic Post Traumatic Pain Syndrome, and that this impairment is the product on an injury that is not predominantly minor. As a result, FH is not subject to the MIG.

The MIG is significant because it has a payment limit of $3,500. That applicant has already reached that limit. If FH is subject to the MIG, she will not be entitled to payment for any of the disputed benefits.

FH has proven that she suffers from Chronic Post Traumatic Pain Syndrome, and that this impairment is the product on an injury that is not predominantly minor. FH is not subject to the MIG

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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.