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