Pedestrian establishes injuries fall outside of MIG - VC and RBC - 17-000081 v RBC General Insurance Company, 2017 CanLII 59504 (ON LAT)

October 20, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

VC and RBC - 17-000081 v RBC General Insurance Company, 2017 CanLII 59504 (ON LAT)

Date of Decision: August 31, 2017
Heard Before:  Adjudicator Rupinder Hans

MIG: insured establishes that injuries fall outside MIG; insured awarded rehab benefits in excess of MIG; interest awarded

VC was was a pedestrian who was struck on the right side of her body and injured in a car accident on October 15, 2014. VC applied for benefits under the SABs. RBC initially paid for rehabilitation benefits but denied payment for two treatment plans related to chiropractic services.  The denial was based upon RBC’s position that VC’s injuries were predominately minor injuries and treatment of them fell within the Minor Injury Guideline (MIG).

VC appeals to the LAT for approval of the medical benefits, interest on the outstanding benefits, and a determination that her entitlement to benefits is not subject to the Guideline.  

Issues:

1. Do VC’s injuries fall within the MIG?
2. Is VC entitled to receive a medical benefit in the amount of $180.00 for chiropractic services, recommended in a treatment plan dated February 10, 2015, denied by RBC on February 24, 2015?
3. Is VC entitled to receive a medical benefit in the amount of $1,280.00 for chiropractic services, recommended in a treatment plan dated May 20, 2015, denied by RBC on May 24, 2015?
4. Is VC entitled to interest for any overdue payment regarding the claimed benefits?

RESULT

1. Based upon a review of the evidence and submissions presented, the Adjudicator found that VC’s injuries fall outside the Guideline, and that she is entitled to the medical benefits as set out in the two treatment plans because the expenses incurred are reasonable and necessary.  VC is also entitled to interest on the incurred medical benefits

VC met her burden of proof and established that her injuries are not minor. The Adjudicator reviewed the law, the evidence and specifically the MIG. Upon review of the medical evidence the adjudicator found VC’s physical injuries as a result of the car accident are not minor and she is not subject to the MIG.

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.