The Applicant sought funding for psychological and physiotherapy treatment as well as psychological and orthopedic assessment plans, arguing that he suffered from chronic pain and psychological impairments that warranted removal from the MIG. The Tribunal rejected several procedural objections raised by the insurer as the Adjudicator preferred to decide the issues in dispute on their merits.
The Applicant argued that his symptoms were consistent with Post-Traumatic Stress Disorder (PTSD), chronic pain, adjustment disorder, and sleep disturbances which were outside the definition of a minor injury. Accordingly, he argued that he should be removed from the confines of the MIG. The Adjudicator found that the Applicant did not establish chronic pain with functional impairment. The Applicant relied on a psychological report completed by Dr. Kershner diagnosing PTSD and sleep disorder. The Adjudicator assigned limited weight to that report because the assessment was conducted in English without an Arabic interpreter, despite documented language difficulties; the report lacked clear documentation of records reviewed; and the diagnosis relied heavily on self-reporting with no review of medical evidence and testing with possible language barriers. The Adjudicator gave more weight to the S.44 IE assessment of Dr. Bradbury because an interpreter was present to ensure accuracy of their communication. Dr. Bradbury did not provide any accident-related psychological diagnosis and concluded there was no psychological basis for removal from the MIG. The Adjudicator stated that this was not to say that the Applicant does not suffer from any psycho-social symptoms, however, the Applicant had not established that these were anything more than associated sequalae of his minor injury. The Tribunal ultimately found that the Applicant failed to establish a psychological impairment which would warrant a MIG removal.
The Tribunal found that since the Applicant was subject to the MIG, an analysis of whether the proposed plans were reasonable and necessary was unwarranted and there were no overdue benefits to which interest applies pursuant to s. 51 of the SABS. In addition, the Tribunal found that since there were no benefits payable that were unreasonably withheld or delayed, Definity was not liable to pay an award.
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