Escaping the dreaded Minor Injury Guideline (MIG) can make a big difference to the treatment options available to motor vehicle accident victims. However, a recent decision shows how difficult it can be for accident benefit claimants to show that their injuries fall outside the MIG, which limits medical and rehabilitation expenses to just $3,500.
The Licence Appeal Tribunal (LAT) ruling involved an 84-year-old man who had already exhausted the MIG limit dealing with a wide array of medical complaints following his injury in a 2017 motor vehicle accident. Although the LAT adjudicator acknowledged the man’s struggles since the crash, he upheld the insurer’s MIG designation, refusing to sanction an additional $9,000 in benefits to cover physiotherapy and psychological services recommended by treatment providers.
Despite the disappointing outcome for this man, his case provides some useful guidance for accident benefit claimants looking for possible routes out of the MIG.
MIG basics
Almost since the introduction of Ontario’s no-fault system in the 1990s, the provincial government has been chipping away at the benefits available to injury victims. Since 2010, when the MIG was introduced as part of a major reform of the system, the province’s Statutory Accident Benefits Schedule has broken down coverage into three distinct categories.
The first deals with catastrophically impaired individuals, providing $1 million in coverage to those with life-changing injuries.
In the middle, a $65,000 cap applies to medical, rehabilitation, and attendant care costs for claimants with non-catastrophic injuries.
At the bottom of the pile, the MIG imposes a limit of just $3,500 for minor injuries, defined as one or more of a “sprain, strain, whiplash, associated disorder, contusion, abrasion, laceration or subluxation,” including any “clinically associated sequelae to such as injury.”
How do I get out of the MIG?
Although it is often invoked by insurers to deny claims, the injuries that fall under the MIG don’t always feel minor to the person suffering from them. Indeed, the LAT case detailed damage relating to the claimant’s cervical, thoracic and lumbar spine, ribs, and sternum. He was also diagnosed with Sacroiliac joint and bilateral rotator cuff syndrome, as well as headaches and dizziness.
Faced with so many ailments, it’s easy to see why this claimant — like many others — was motivated to have the injuries categorized as non-catastrophic. $3,500 doesn’t go very far these days, so the jump to a $65,000 cap on benefits takes the pressure off the search for appropriate treatment.
Fortunately, there are several ways to escape the MIG:
- Bone fracture: A broken bone in any part of the body is one of the most straightforward ways to automatically get out of the MIG since fractures are not covered by the definition
- Pre-existing injuries: Insured people can also be removed from the MIG if they are able to show that any pre-existing injuries or conditions would hinder their recovery if they’re forced to stay within the $3,500 limit
- Chronic pain: LAT jurisprudence indicates that accident-related chronic pain may warrant removal from the MIG if it causes functional impairment
- Psychological impairment: Anxiety, depression or other psychological impairments must have arisen as a result of the accident for a claimant to escape the MIG.
How a personal injury lawyer helps
If you feel that your case should fall outside the MIG, it’s important that you provide evidence to back up your claim. A personal injury lawyer experienced in motor vehicle accident matters knows exactly what adjudicators are looking for in terms of reports or assessments from medical providers, and can help you marshal the evidence in support of your position.
The elderly man at the heart of the LAT case wanted to be removed from the MIG for several reasons, including pre-existing conditions, chronic pain, and psychological impairment. However, the adjudicator was not convinced, concluding that there was not enough evidence linking the man’s current level of pain or psychological complaints to his accident.
For applicants who ultimately end up stuck in the MIG, a tort claim may prove their saving grace. Those who choose to launch a corresponding case for damages in court may be able to recoup out-of-pocket expenses for additional treatment and therapy not covered by their accident benefits insurer.
Speak to A Personal Injury Lawyer in Oakville Today
If you have been injured in an accident and would like to speak to a personal injury lawyer in Oakville about your situation, we would be happy to assist.