Arruda and Western Assurance Company, FSCO A13-003926

Released July 7, 2015 | Full Decision

This decision by Arbitrator Jeffrey Shapiro makes clear that a diagnosis of chronic pain syndrome can remove an insured from the Minor Injury Guideline (the “MIG”).

The arbitration concerned a motor vehicle accident which occurred on May 5, 2012. The insured sustained soft tissue and psychological injuries and was placed in the MIG. After depleting the maximum funding thereunder, she applied for further treatments, which her insurer denied.

The insured’s was diagnosed with chronic pain syndrome 20 months post accident. Finding that the insurer did not discharge its “…ongoing duty to assess and reassess a claim as new information is available…,”[1] Arbitrator Shapiro accepted her argument and decided she should be removed from the MIG. He explained that the insurer could not rely on independent examinations which occurred one year prior to the new diagnosis to keep the insured in the MIG.


[1] Cowans v Motor Insurance Company, FSCO A09-003237, October 15, 2010

 

Read the full decision on the OTLA Document Bank

Michael Ettedgui
Written by

Michael practices exclusively in the field of personal injury law at Campisi LLP.

Michael was called to the Bar in 2014. He received his law degree from Osgoode Hall Law School, where he participated in various programs geared towards access to justice and practical legal education. In particular, Michael volunteered with unrepresented litigants at family court and was the student co-ordinator of Osgoode Hall's Pro Bono Students Canada chapter.

When he is not working, Michael enjoys spending time with his wife and three young children.