Head Injury and Minor Injury Guideline Removal

The Minor Injury Guideline (MIG) is part of Ontario’s Statutory Accident Benefits Schedule (SABS). The Minor Injury Guideline is a framework that guides the treatment and benefits available to victims of motor vehicle accidents who sustain minor injuries.

The objectives of the MIG are, among others, to provide speedy access to rehabilitation and provide certainty around cost and payment by negating the need for insurer approval. However, many insurers use the MIG in an attempt to reduce their payouts and overall costs.

In Kolanski v. TD Insurance Meloche Monnex, 2021 CanLII 30824 (ON LAT), TD Insurance attempted to do exactly that. However, the LAT found their position untenable and ruled in favour of the applicant.

The Case

On November 3, 2017, the applicant (Kolanski) was involved in a motor vehicle accident. Immediately following the accident, the applicant was sent to the emergency department of the nearest hospital. While there, she was diagnosed with a head injury.

Approximately one week after the occurrence of the accident, the applicant visited her family physician. Her physician diagnosed her with concussion syndrome and a head injury, concluding that both were sustained as a result of her motor vehicle accident. She was also diagnosed with whiplash and cervical spine strain as a result of the accident. For these injuries, she was referred for rehabilitation.

As per her right under the Statutory Accident Benefits Schedule, the applicant pursued benefits from her insurer, TD Insurance.

The Issues

TD Insurance denied the application for benefits. This denial was based on the determination that her injuries did not fall under the definitions provided in the Minor Injury Guideline.

The applicant appealed this decision to the License Appeal Tribunal (LAT). The issues were heard by Adjudicator Theresa McGee. The issues were four-part.

The first issue concerned whether or not the applicant sustained predominately minor injuries as defined under the Schedule. The second was a question of whether or not the applicant was entitled to a medical benefit in the amount of $2,282.32 for chiropractic treatment. The third issue was a question of whether or not the applicant was entitled to a medical benefit in the amount of $2,200.00 for a Psychological Assessment. The final issue was whether or not the applicant was entitled to interest on any overdue payment of benefits.

The Result

The Adjudicator ruled that the accident-related injuries sustained by the applicant actually exceeded the Statutory Accident Benefits Schedule’s definition of a minor injury. For that reason, the Minor Injury Guideline did not apply.

The Adjudicator determined that the applicant had established that the medical benefits which were in dispute were both reasonable and necessary. The applicant had provided the medical evidence to support the head injury, and this injury exceeded the definition of a minor injury. As such, TD’s position that the Minor Injury Guidelines should be applied was untenable.

Not only was TD liable to pay the benefits with interest, but the applicant was also entitled to medical and rehabilitation benefits up to a maximum of $65,000. However, that would depend on whether or not the applicant could establish that they are reasonable and necessary as a result of the accident.

Have You Been Injured in a Motor Vehicle Accident?

Insurers sometimes attempt to use the Minor Injury Guideline as a way to curb their cost and payment responsibilities. But, as we can see from this case, they’re not always successful in this endeavour.

If you’ve sustained a minor injury in an accident, it is helpful to have an experienced lawyer review your case. Do not settle for less than what you deserve. Contact Sharma Law today.

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