MIG Update – December 13, 2021

Applicability of MIG When MIG Limits Not Exhausted

Does an Applicant have the onus of demonstrating that they sustained an impairment that justifies removal from the MIG even when the MIG limits have not been exhausted?

This week, the Tribunal considered this question in a case where the Applicant had still not exhausted the MIG limits 2.5 years post accident.


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Factor: MIG Limits Not Exhausted

In Karabulut v. Economical (20-008392), an August 3, 2018 accident, Karabulut sustained a WAD-II, cervical, shoulder and lumbosacral strain and sprains, as well as a knee contusion, with an expected disability of 9-12 weeks. His dispute was over a denied treatment plan dated April 30, 2019 in the amount of $1,982.44 for massage therapy. At the time Karabulut still had $1766.81 remaining in his MIG limits.

Economical took the position that Karabulut bears the onus both:

1. Demonstrating that his impairments warrant treatment beyond the MIG limits

2. Proving that the treatment plan in question was reasonable and necessary.

The Tribunal agreeing with Economical held:

    • The denial of the sole treatment plan in dispute was not based on the MIG, but rather based on the s. 44 report of Dr. Dharamshi, that the treatment was not reasonable and necessary because Karabulut sustained soft-tissue injuries and had achieved maximal medical recovery from facility-based treatment.
    • At the time the OCF-18 was submitted, it appears that Karabulut still had more than half of the funds under the MIG available to him.
    • Karabulut relies solely on OCF forms and Economical’s s. 44 report to prove his claim, arguing in submissions that he continues to experience accident-related pain that he identifies as chronic and that a previous accident in 2013 prevents his recovery under the MIG. There was no corroborating evidence that established his injuries required treatment beyond the MIG.
    • Karabulut did not rebut Economical’s IE with any contemporaneous medical evidence in support of ongoing pain as a result of the accident nor that he incurred the treatment plan
    • As a result the treatment plan was not reasonable and necessary or partially payable up to the MIG limits

If you Have Read This Far…

Our MIG Monday series discusses the multitude of factors to consider when evaluating a risk position on MIG cases. The Tribunal has ruled on the MIG in 24% of the decisions so far. Each case is nuanced, but with similar factors.

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