MIG Update – October 19, 2020
Factor: MIG Escapes & Access to ‘Reasonable and Necessary Treatment’
In 18-012548 v Aviva, the timeline involves a February 2017 loss, where the Applicant’s chiropractic and massage treatment in April 2017 was denied based on the November IEs. Subsequently, the Applicant was removed from the MIG on psych and the previously denied chiropractic treatment was found to have met the ‘reasonable and necessary’ test.
The Tribunal’s finding turned on:
- The removal from the MIG due to psychological impairment is not “segmental” but is the reason to breach the $3,500 threshold and access to further reasonable and necessary treatment
- Prior to the MIG removal, the Applicant had access to only one treatment plan for physical injuries, as her psychological assessment and treatment consumed the remainder of the MIG funds available
- The subject chiropractic treatment was found reasonable and necessary, as ongoing pain complaints and its relevance to her psychological impairment were documented by the psych IE
In 18-002368 v Pafco, the timeline involves a September 2017 loss, where the Tribunal found the psychological assessments in 2018 established injuries sufficient to remove the Applicant from the MIG. However, the chiropractic, massage and acupuncture treatment requested in November 2017 was found not to have met the ‘reasonable and necessary’ test.
The Tribunal’s finding turned on:
- Removal from the MIG does not automatically entitle an applicant to all treatment plans requested
- IE found the Applicant’s soft-tissue injury should resolve itself within 8-12 weeks, hence proposed treatment is not reasonable and necessary
- The Applicant has failed to present evidence linking his injuries and impairments to the treatment he is seeking
- The Applicant must demonstrate how the treatment he requesting is reasonable and necessary based on his injuries
In celebration of AB LAT Free Day, continue to receive complimentary Outcome Analysis Reports (OAR) throughout the month of October.