The Applicant claimed entitlement to physiotherapy costs beyond the $3,500 Minor Injury Guideline (MIG) limit, arguing that pre-existing conditions and chronic pain removed him from the MIG.
The Tribunal found that the Applicant did not meet his burden to show that his injuries fell outside the MIG. While the Applicant had documented pre-existing conditions (including diabetes, osteoarthritis, hypertension, and pericardial effusion), there was no compelling medical evidence showing these conditions would prevent maximal recovery if treatment were limited to the MIG, as required by s. 18(2) of the SABS.
The Tribunal also rejected the claim of chronic pain with functional impairment, finding that the medical evidence showed improvement over time, inconsistent symptom reporting, and no diagnosis of chronic pain. A causation issue arose regarding the Applicant’s left shoulder injury.
The Tribunal found the medical evidence and inconsistent reporting supported the conclusion that the rotator cuff tear sustained by the Applicant was more likely caused by lifting a heavy suitcase rather than the motor vehicle accident, and therefore was not accident-related.
The Tribunal found the Applicant was not entitled to the disputed physiotherapy treatment plan and further held that the insurer’s denial of the treatment plan complied with s. 38 of the SABS. The Applicant was not entitled to interest and the Application was dismissed.
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