a) Speed access to rehabilitation for persons who sustain minor injuries in auto accidents;
b) Improve utilization of health care resources;
c) Provide certainty around cost and payment for insurers and regulated health
d) Be more inclusive in providing immediate access to treatment without insurer approval
for those persons with minor injuries as defined in the SABS [Statutory Accident Benefits Schedule].
But what are these changes, and how might they affect you if you are in an auto accident?
Prior to 1990, insurance benefits for automobile accidents were resolved through tort action, resulting in a high number of costly, time-consuming lawsuits. In 1990, Ontario lawmakers enacted the Ontario Motorist Protection Plan, which both restricted the ability to sue and established accident benefits. Similar laws followed, honing the process and establishing the limits for potential benefits in case of an accident. In 2010, the Minor Injury Guideline (MIG) was developed to be used by insurance companies and healthcare professionals, creating a 12-week healthcare program designed to reduce the risk of chronic pain, enable the victim to manage their condition. Further, it establishes limits on insurance payouts allowed for the victim.
The MIG establishes that injuries deemed “minor” must fit the following description:
“a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae [after-effect of the injury]. This term (minor injury) is to be interpreted to apply where a person sustains any one or more of these injuries.”
For all injuries of this severity, a $3,500 cap on payments was introduced.
But what if a pre-existing condition prevents the victim from fully recovering from a minor injury? This question was addressed in a complaint against the Belair Insurance Company Inc. In his decision, the arbitrator ruled that the claimant was within his rights to claim housekeeping, attendant care, medical, and rehabilitation expenses beyond the $3,500 cap due to a pre-existing condition that prevented the usual course of recovery. However, he also noted that “credible medical evidence” of a pre-existing condition was required to support any future claimants cases.
In February of this year, changes to the MIG were applied in reference to the pre-existing condition provision. Whereas before the changes came into affect, claimants were only required to have presented compelling evidence from their doctor that a condition was in place prior to an accident; now, formal documentation by a health practitioner dated prior to the accident is required in order for the victim to escape the MIG.
Minor Injury Guideline
Call Mackesy Smye for help. Whether or not your injuries have been deemed minor, you are entitled to the health care you need to recover.
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