Category: Minor Injury Guideline

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.

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.

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.

C.F. v. Aviva Insurance Canada (16-002373)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG position and noted one treatment plan to be limitations barred. Adjudicator Avvy Go noted the burden rested with the claimant and that the evidence tendered did not tie any specific impairment to the MVA. Moreover, the impairments were described as “mild or degenerative” in nature. The MIG was said to govern. The insurer noted that one treatment plan, while approved, lacked information requested under section 33 regarding a collateral benefits payer and as such was not payable until complied with. The claimant sought payment; however, Adjudicator Go noted the timing of the LAT application was beyond the 2 year period. The claimant was limitations barred from seeking payment.

V.C. v. RBC General Insurance Company (17-000081)

The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG position. Adjudicator Rupinder Hans considered the medical evidence and determined that the claimant had met the evidentiary burden that the injuries sustained fell outside of the MIG. The treatment plans in dispute were deemed reasonable and necessary and therefore payable. Interest was also deemed payable on all unpaid and incurred treatment.

P.I. v. Aviva Insurance Company (16-001320)

The claimant sought entitlement to further medical benefits and removal from the MIG. Adjudicator Sewrattan concluded that the claimant had not proven an ongoing psychological injury or physical injury that fell outside of the “minor injury” definition. There was also insufficient evidence submitted by the claimant to prove that injuries arising from an earlier motor vehicle accident would prevent maximal recovery under the $3,500 minor injury limits. Entitlement to the claimed medical benefits was denied.

P.J. v. Continental Casualty Insurance Company (16-004272)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG defense. On review of the evidence, Adjudicator Nicole Treksler ruled the claimant’s injuries, including chronic pain, were outside of the MIG. The treatment sought was deemed payable. The claimant also sought costs for the insurer failing to provide log notes as requested. Costs were denied as the claimant did not sufficiently substantiate the claim under Rule 19.1.

N.K. v. Unica Insurance Inc. (17-001473)

The claimant sought removal from the MIG and entitlement to medical benefits. Adjudicator Ferguson held that the claimant suffered a concussion and post-concussion syndrome, which were not minor injuries. The claimant was therefore removed from the MIG. The sought medical benefits were denied because the claimant and his treatment providers had not explained how the proposed treatment would address and treat the concussion and post-concussion injuries.