Psychological Impairment Falls Outside MIG - Applicant v Certas LAT 16-002287

December 12, 2017, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Applicant v Certas LAT 16-002287 2017 CanLII 77359 (ON LAT)

Decision Date: 2017-11-09
Heard Before: Adjudicator Paul Gosio

MIG and ENTITLEMENT TO BENEFITS: applicant provides convincing evidence that some of the injuries fall outside the MIG; applicant fails on other injury claims; insurer fails to rebut applicant’s medical report

The applicant was injured in a car accident on December 13, 2013.  Shortly after the accident, the applicant began to experience lower back, neck and shoulder pain as well as headaches.  He did not seek medical treatment right away but instead chose to slow down at work and limit his family and social responsibilities.  Two months post-accident, the pain persisted.  The applicant then decided to go see his family doctor who noted a neck strain and recommended physiotherapy.  The applicant continued to work despite feeling pain. 

On December 20, 2014, the family doctor completed a disability certificate in which he diagnosed the applicant with a neck strain, lower back strain and a shoulder strain in connection with the motor vehicle accident.  On December 15, 2014, the applicant began physiotherapy treatment which provided some short-term relief but the pain persisted.         

The applicant sought benefits under the SABs but was denied payment of the benefits by Certas when he approached the monetary limit under the MIG. The applicant applied to the LAT for arbitration.

Issues:

1. Do the applicant’s injuries fall outside of the Minor Injury Guideline?
2. Is the applicant entitled to receive a medical benefit in the amount of $1,260.95 for physiotherapy services, as recommended by High Tech Physiotherapy in a treatment plan dated April 13, 2015?
3. Is the applicant entitled to receive a medical benefit in the amount of $2,551.61 for physiotherapy services, as recommended by Revive Health Centre in a treatment plan dated May 14, 2015?
4. Is the applicant entitled to receive a medical benefit in the amount of $2,033.62 for physiotherapy services, as recommended by Revive Health Centre in a treatment plan dated May 14, 2015?
5. Is the applicant entitled to receive a medical benefit in the amount of $1,415.21 for chiropractic services, as recommended by Revive Health Centre in a treatment plan dated November 30, 2015?
6. Is the applicant entitled to the cost of an examination in the amount of $2,000.00 for a chronic pain assessment, as recommended by Revive Health Centre in a treatment plan dated June 20, 2016?
7. Is the applicant entitled to interest on any overdue payment of benefits?

 Result:

1. The applicant has met his onus of establishing on a balance of probabilities that his injuries fall outside the confines of the Minor Injury Guideline (“MIG”) due to his psychological impairment.
2. The applicant is entitled to the cost of examination for a chronic pain assessment and the OCF-18’s dated April 13, 2015 and November 30, 2015 as they are reasonable and necessary. 
3. The applicant is also entitled to interest on these payments in accordance with section 51 of the Schedule. 
4. The OCF-18s dated May 14, 2015, are reasonable and necessary and is therefore not entitled to either of the medical benefits.

 The applicant bears the onus of establishing, on a balance of probabilities, that he falls outside the confines of the MIG and that he is entitled to the medical benefits in dispute.   The applicant asserts that both his physical and psychological injuries take him outside the confines of the MIG.  The Adjudicator reviewed the medical evidence and found that only his psychological impairments take him outside the confines of the MIG on the basis that he suffers from Somatic Symptom Disorder with severe depression and Posttraumatic Stress Disorder.

Certas did not provide the Tribunal with any evidence to rebut the applicant’s assessment reports. 

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.