Category: Minor Injury Guideline

Applicant v. The Co-operators (16-004674)

The claimant sought removal from the MIG, entitlement to various medical benefits, and entitlement to the cost of an accounting report. The insurer raised a preliminary issue regarding the claimant’s non-attendance at various insurer examinations. Adjudicator Treksler held that the claimant was suffering from chronic pain syndrome and psychological impairment. However, she awarded only some of the claimed medical benefits. Four treatment plans were denied due to the claimant’s failure to attend insurer examinations, and one was denied because it was incurred before a treatment plan was submitted. The cost of the accounting report was denied because the adjudicator concluded that the claimant’s entitlement to income replacement benefits was straightforward, and an accounting report was not reasonable and necessary.

Applicant v. Waterloo Insurance (17-001265)

The claimant sought removal from the MIG and entitlement to four treatment plans. A number of procedural issues were first addressed. Adjudicator Ferguson rejected the claimant’s objection to the insurer’s expert report being considered by the Tribunal because the issue was not raised until the claimant’s reply submissions. The adjudicator rejected the insurer’s objection about the claimant’s written materials being too long, the insurer’s objection about late medical documents, and the insurer’s objection about the lack of Acknowledgement of Duty form by the claimant’s experts. He reasoned that excluding the impugned records or opinions would prevent him from making a fair and proportional determination on the merits of the case. In terms of the claims, Adjudicator Ferguson held that the claimant suffered a “minor injury” in the accident, and that he did not have any pre-existing conditions warranting removal from the MIG. He noted that none of the claimant’s experts were professionally qualified to make psychological diagnoses, there were no medical reports formally making a diagnosis, and the practitioners supporting a chronic pain diagnosis had no expertise in the area.

G.C. v. Wawanesa Mutual Insurance Company (17-001855)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Truong held that the claimant had failed to demonstrate that he sustained a non-minor injury in the accident. She was particularly critical of the claimant’s failure to submit specific evidence in support of his claim.

Applicant v. Aviva Insurance (17-002240)

The claimant sought entitlement to non-earner and medical benefits. The insurer denied the benefits and asserted a MIG position. On review of the medical evidence, Adjudicator Avvy Go held the claimant suffered a minor injury with no pre-existing injury and was therefore governed by the MIG. Moreover, the medical evidence did not support the claimant suffering a complete inability to carry on a normal life. Accordingly, the claims were dismissed.

Applicant v. Motor Vehicle Accident Claims Fund (17-000665)

The claimant sought removal from the MIG and entitlement to various medical benefits for physical therapy and psychological therapy. Adjudicator Markovits held that the claimant was suffering from an adjustment disorder with mixed anxiety and depressed mood, and that his injuries were therefore non-minor. In terms of the medical benefits sought, Adjudicator Markovits awarded all of the claimed physical therapy and orthopaedic assessment; he denied part of the proposed psychological treatment, a driving re-integration assessment, and a chronic pain assessment.

D.A. v. The Personal Insurance Company (17-001941)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to various medical benefits and costs of examinations. As a preliminary issue, the claimant requested to know the number of reports that each of the IE assessors had provided to the respondent for the last three years and the cost of each report. Adjudicator Paluch denied the claimant’s request for production. He failed to see how information about how many times a particular assessor has been retained by an insurer or how much the report cost would be relevant in assisting the claimant in satisfying that his injuries are not minor or that the proposed treatments are reasonable and necessary. The more appropriate forum to impugn the objectivity of an expert is at a live hearing, not a written preliminary issue hearing.

The Applicant v. Wawanesa Mutual Insurance Company (16-002823)

The claimant submitted four treatment and assessment plans to the insurer. The insurer held that the claimant had suffered minor injuries and that his treatment fell within the Minor Injury Guideline. Adjudicator Anwar explained in order to allege that an injured person has pre-existing medical injuries that required treatment in excess of the MIG limits, the injured person’s healthcare provider must provide specific evidence. First, the injured person must have a pre-existing medical condition that was documented prior to the accident. Second, there must be evidence that the pre-existing medical condition will prevent the person from achieving maximal recovery if the benefits are limited to the MIG cap. Adjudicator Anwar found that the claimant had not submitted sufficient and convincing evidence to prove that he suffered from pre-existing conditions, and was therefore not entitled to treatment beyond the MIG limits.

J.C.C. v. Aviva Insurance Company of Canada (16-000663)

The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.

M.F.Z. v. Aviva Insurance Canada (16-000517)

The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.

M.F.Z. v. Aviva Insurance Canada (16-000517)

The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer’s notice was deficient. She agreed that the insurer’s failure to properly follow section 38(8) in regard to one treatment plan prohibited the insurer from relying on the MIG for all future treatment plans. However, Executive Chair Lamoureux did reduce the quantum of the treatment plan payable to one of the claimants to the amount incurred between the insurer’s defective notice and the date the insurer sent the claimant a cured notice.