The Objective of the MIG
The precursor to the License Appeals Tribunal, the Financial Services Commission of Ontario, explains that the objectives of the MIG are three-fold:
- Speedy treatment – the MIG allow for speedier access to rehabilitation services and treatment without prior approval from the insurance company, provided the insured person has sustained an injury defined in MIG as a “minor injury;”
- Improve resource utilization – legislators intend the guidelines to “improve utilization of health care resources;” and
- Cost certainty – insurers and health care professions will have more certainty about the costs and payments they will have to make for injured persons, allowing for better planning and cost reduction.
Consistent with these objectives, the MIG, a part of the Schedule, sets out the goods and services (i.e. medical and rehabilitation benefits) that will be paid for by an insurer if an insured person has sustained a “minor injury”.
Minor Injury Definition
The MIG defines as “minor injury” as one or more of a:
- sprain;
- strain;
- whiplash-associated disorder;
- contusion;
- abrasion;
- laceration or subluxation; and
- any clinically associated sequelae.
More specifically:
- sprain means an injury to one or more tendons or ligaments, including a partial but not a complete tear;
- strain means an injury to one or more muscles, including a partial but not a complete tear;
- subluxation means a partial but not a complete dislocation of a joint.
An insured person’s impairment comes within this MIG if the impairment is predominantly a minor injury.
Monetary Limit
Under section 18(1) of the Schedule2, the sum of the medical and rehabilitation benefits payable in respect of an insured person who sustains an impairment that is predominantly a minor injury shall not exceed $3,500 for one accident.
Impairments that do not come within the MIG
Injuries which are not predominantly a minor injury, such as fractures, concussions, any injury requiring surgery, amputations or chronic pain3, do not come within the MIG. As these injuries are more severe, they are more appropriately classified as non-catastrophic impairments or catastrophic impairments depending on their severity.
Only in extremely limited instances...is the person's impairment to be determined not to come within this Guideline. |
Moreover, an insured person's impairment does not come within the MIG if the insured person's impairment is predominantly a minor injury but, based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that was documented by a health practitioner before the accident and that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3,500 limit referred to in section 18(1) of the Schedule.
Compelling evidence is to be provided using the Treatment and Assessment Plan (OCF-18) with attached medical documentation, if any, prepared by a health practitioner. The existence of any pre-existing condition will not automatically exclude a person's impairment from this Guideline.
Only in extremely limited instances, where compelling evidence provided by a health practitioner satisfactorily demonstrates that a pre-existing condition that was documented by a health practitioner before the accident, and that will prevent a person from achieving maximal recovery from the minor injury for the reasons described above, is the person's impairment to be determined not to come within this Guideline.4
For example, in MM v. Wawanesa the claimant argued that her pre-existing health problems should take her outside of the MIG. The accident in question occurred in 2013 and she had been involved in motor vehicle accidents in 2009 and 2012 in which she suffered from back injuries and psychological problems. The adjudicator found that the pre-existing medical records did not document any substantial health problems and that no one concluded that her pre-existing health problems prevented her from achieving maximal recovery within the MIG. Accordingly, she was not classified as being outside the MIG.
1 Superintendent's Guideline No. 02/11 and Superintendent's Guideline No. 01/14
2 Section 18(1) of the O. Reg. 34/10: Statutory Accident Benefits Schedule - Effective September 1, 2010
3 17-000835 v v. Aviva General Insurance Canada, 2018 CanLII 83520 (ON LAT)
4 MM v. Wawanesa 2016 CanLII 93132 (ON LAT)
