Reason Code


Additional Compendium Filters Are Now Here!

Search efficiency and value are our top priority. With this in mind, you will now see:

  1. Reason codes added to search filters as a further layer of information that describes why a decision is made in a certain way
  2. Search result to display associated items in dispute, along with the For/Against Outcome and Reason Code for each line item


Reason Code Definitions


# Reason Code Definition: When the Adjudicator considers/references/finds/prefers
  Reason A cause, explanation, or justification for an action or event for either party as described by the Adjudicator
1 Adverse Inference A legal inference, adverse to the concerned party, made from a party’s silence or the absence of requested evidence
2 Applicant’s Affidavit The Applicant’s written testimony is relied upon/preferred in reaching a decision
3 Applicant’s Assessor Preferred The conclusion of the Applicant’s assessor is preferred
4 Applicant’s Evidence Preferred Applicant’s Evidence of a non-medical nature (e.g. witness, accountant, family member)
5 Applicant’s Medical Records/CNRs When the Applicant’s medical records/CNRs/progress report from clinic are relied upon in reaching a decision
6 Causation If the Applicant’s injuries/impairment arose as a direct result of the accident
7 Compliance A party did or did not comply with the relevant section of the legislation; e.g, the Respondent did not comply with a denial notice (s.38(8)) and the Appplicant is therefore removed from the MIG; Could also be a reason in granting an award
8 Credibility The believeability of the evidence/testimony of a party/witness; e.g. lack of consistency with the Applicant’s self-reporting)
9 Credibility of Assessor The conclusion of the assessor does not match the findings of the assessment
10 Duplicative Proposed treatment/assessment duplicates the one(s) that has already been submitted/approved
11 Entitlement Interest is granted on overdue payments having determined entitlement
12 Evidence Not Heard Applies to null issues where evidence was not heard/addressed because the issue is void/withdrawn; e.g. the Applicant was found to be within the MIG and a determination on the subsequent disputed benefits was unnecessary as determined by the Adjudicator
13 Failure to continuously adjust Applies to findings of an award; when an award is granted on the basis that the Respondent failed in its obligation to continuously adjust the claim
14 Fees/Maximum Fees Allowable Entitlement is found/not found based on the maximum fees allowable in accordance with the Professional Services Guideline
15 Insufficient Evidence Not enough evidence provided to support position
16 Jurisdiction The Tribunal’s power to make a decision
17 MIG Conceded The Applicant is entitled to the remaining amount because they can no longer rely on the MIG, or the MIG was subsequently conceded.
18 No Evidence Submitted No evidence provided to support submissions
19 Procedural Fairness Prejudice to a party outweighs those to the other party
20 Respondent’s Assessor Preferred The conclusion of the Respondent’s assessor is preferred
21 Respondent’s Evidence Preferred Respondent’s Evidence of a non-medical nature (e.g. witness, accountant, family member)
22 Statutory Interpretation Relevant statutes and or interpretation; e.g. Definition of Accident/Automobile decisions
23 Totality of Evidence All evidence from both parties point the Tribunal to the same conclusion. This to be considered as evidence of a medical nature.
24 Treatment progress/recovery An individual’s response to treatment as recorded/reported in determining entitlement
25 Unreasonably delay/withholding Applies to findings of an award; when an award is granted on the basis that the Respondent took unreasonable steps in delaying/withholding payment of benefits
  Reconsideration Reason codes:  
1 Error of Fact or Law Whether or not the Tribunal made a significant error of fact or law in reaching their decision. It is reasonable to assume that the Tribunal would have reached a different decision had the error not been made.
2 False/Misleading Evidence The Tribunal heard false or misleading evidence during the trial, which likely affected the decision.
3 Jurisdiction Whether or not the Tribunal acted within their Jurisdiction when rendering a decision
4 New Evidence When New Evidence is provided to support submissions. This evidence could not reasonably have been obtained earlier, and would likely have changed the result of the trial.
5 No Evidence Submitted No evidence provided to support submissions
6 Procedural Fairness Whether or not the Tribunal violated the rules of natural justice and/or procedural fairness


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