Chronic Pain is Grounds for Removal from MIG -18-000770 JR v RSA, 2019 CanLII 9631 (ON LAT)

May 06, 2019, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Chronic Pain is Grounds for Removal from MIG -18-000770 JR v RSA, 2019 CanLII 9631 (ON LAT)

Date of Decision: January 23, 2019
Heard Before: Billeh Hamud, Adjudicator

MIG and CHRONIC PAIN – is the applicant subject to the limits set out in the MIG for treatment; does the applicant suffer from chronic pain; does chronic pain remove the applicant from the $3500 treatment limit set out in the MIG;

BACKGROUND

JR was injured in car accident on June 26, 2016 and sought benefits from RSA for several treatment and assessment plans and payment for examinations. RSA denied JR’s claims because it determined that all of JR’s injuries fit the definition of “minor injury”. JR applied to the LAT for resolution of the dispute.

ISSUES

1. Are JR’s injuries predominantly minor injuries as defined in the Schedule, subject to treatment within the MIG?
2. Is JR entitled to receive a medical benefit for the following:
   1. $3,626.25 for physiotherapy treatment set out in a treatment plan
   2. $1,977.05 for physiotherapy treatment recommended November 3, 2016,
   3. $1,384.70 for physiotherapy treatment December 5, 2016
3. Is JR entitled to payment for the following examinations:
   1. $2,960.00 for chronic pain assessment recommended in a treatment plan dated September 8, 2017.
4. Is JR entitled to interest for the overdue payment of benefits?

       In his submissions, JR withdrew his claims for income replacement benefits.

RESULT

The Adjudicator found that JR has proven on a balance of probabilities that, as a result of the accident, he suffers from chronic pain syndrome and this impairment is a result of an injury that is not predominately minor. As a result, JR is not subject to the MIG.

1. JR is entitled to each of the treatment plans in dispute. JR has proven that they are reasonable and necessary. JR is entitled to interest in accordance with s. 51 of the Schedule.
2. JR is entitled to the cost of a chronic pain assessment.

ANALYSIS

The Adjudicator reviewed the thorough medical evidence and the definitions set out in the MIG. The onus is on JR to show that his/her injuries fall outside of the MIG.

JR has proven on a balance of probabilities that as a result of the accident, he suffers from chronic pain syndrome and this impairment is as a result of an injury that is not predominately minor. As a result, JR is not subject to the MIG. His chronic pain syndrome is well documented and established with all of his medical assessors. The adjudicator preferred the evidence that JR’s chronic pain is not a “clinically associated sequelae” to his injuries and that JR’s “pain symptoms have persisted long after the expected time for normal healing and recovery” and that he experienced “psychological distress, sleep disturbances, cognitive impairments, declining work performance and has adopted a sedentary lifestyle”. Based on the duration and impact of JR’s chronic pain on his activities of daily living, the chronic pain is not a “clinically associated sequelae” to his injuries.

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 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.