The Minor Injury Guideline (the “MIG”) establishes a framework for the treatment of alleged minor injuries in a statutory accident benefits claim. Available medical and rehabilitation benefits for predominantly minor injuries is limited to $3,500.00. However, in certain situations, an accident victim may be removed from the MIG and have access to a maximum of $65,000.00.
Traditionally, it has been understood that disputing a MIG designation cannot be a standalone issue. In other words, the issue of MIG would be accompanied by denial of a specific benefit, such as a Treatment and Assessment Plan. The recent Licence Appeal Tribunal decision of TA and TD Insurance Meloche Monnex1 has, however, called this into question.
The traditional understanding has been canvassed in detail in A.S. v Aviva Insurance Canada,2 where the Tribunal addressed the following as a preliminary issue:
Does the Tribunal have jurisdiction to determine whether the MIG applies in the absence of an underlying dispute relating to entitlement to a benefit which is itself dependent upon a determination of whether the MIG applies?
The Tribunal found that it did not have jurisdiction to determine whether the MIG applies as a standalone issue. In other words, an underlying dispute relating to entitlement to a benefit which is itself dependent upon a determination of whether the MIG applies, such as a treatment or rehabilitation benefit, is necessary.
The Adjudicator commented, as follows:
There is […] no provision in the Schedule that entitles an insured to apply for a MIG determination. As there is no entitlement to apply for a MIG determination under the Schedule, a denial of a MIG determination is not a denial of an entitlement under the Schedule that gives rise to a dispute over which the Tribunal has jurisdiction. Although the issue of whether the MIG applies is routinely decided by the Tribunal, the Tribunal decides that issue as a threshold issue in an application where entitlement to benefits provided for in the Schedule is in dispute.
This approach was recently followed by the Tribunal in SSL and Certas Direct Insurance Company.3 In that case, the Applicant had withdrawn treatment and assessment plans from the issues in dispute, leaving behind issues of the Applicant’s placement in the MIG, income replacement benefits, and interest.
The Tribunal agreed with the Insurer that it lacked jurisdiction to hear the issue of whether the Applicant’s injuries were minor because the MIG is a guideline and not a standalone issue entitled to an independent determination under the Schedule.
The Tribunal decision of TA and TD Insurance Meloche Monnex was released shortly following the decision in SSL and Certas Direct Insurance Company and demonstrated an opposing conclusion. In that case, the issues were, once again, MIG designation, income replacement benefits, and interest. Adjudicator Farlam reviewed the evidence and rendered a determination regarding the Applicant’s placement in the MIG, where no medical or rehabilitations benefits were at issue.
Given that the decision is recent, it is unclear how the Tribunal might apply it moving forward. If followed, it presumably opens the door for disputes regarding removal from the MIG, without any involvement of disputed medical or rehabilitation benefits.
1 2020 ONLAT 19-004279/AABS
2 2019 CanLII 51335 (ON LAT)
3 2020 ONLAT 19-004473/AABS