the minor injury guideline (mig) & catastrophic injury in ontario motor vehicle accidents

THE MINOR INJURY GUIDELINE (MIG) &

CATASTROPHIC INJURY IN ONTARIO MOTOR

VEHICLE ACCIDENTS A Primer on the Minor Injury Guideline (MIG)

and Catastrophic Impairment Designation in Accident Benefits

Daria Kagan Personal Injury Lawyer in Toronto, Ontario

The Threshold and Deductible in Motor Vehicle Accident Cases in Ontario www.kaganlaw.ca 2

In 1990, the Ontario Motorist Protection Plan (Bill 68) created no-fault auto

insurance in Ontario. With the passage of this law, car accident victims were no

longer able to sue for minor injuries but would instead recover Accident

Benefits(a.k.a. no-fault benefits) from their own auto insurers. Since then,

through various legal developments, a framework was established to streamline

howauto insurers process Accident Benefits claims. The most recent updates to

this framework are the Minor Injury Guideline (MIG), released in 2010, followed

by a revised MIG that took effect in November of 2011.

The MIG created asimplified, cookie-

cutter system of classifying many kinds of

injuries as minor injuries and it

drastically reduced the Accident Benefits

available to those people whose injuries

fall within the MIGs broad definition of

minor injury.

What benefits are available from Accident Benefits?

What Accident Benefits are available to you, and how much, depends on:

whether your auto insurance policy is a standard policy or

contains optional, additional coverage for extra Accident Benefits

whether you meet the various tests for each type of benefit


how severe your injuries are, specifically:

whether your injuries are so severe that you to meet the test

of Catastrophic Impairment, in which your access to

benefits increases in amount and type of benefits available

whether your injuries fall under the MIGs definition of

Minor Injury, in which case your access to benefits is

drastically reduced

Non-Minor Injury: If your injuries neither fall under the MIG, nor are

they catastrophic, then your injuries would be classified as non-minor

injury and the Accident Benefits available to you from your auto insurer

would include:

Medical-Rehabilitation Benefits up to a limit of$50,000

(optional coverage limit is $100,000)

Attendant Care Benefits up to a limit of$36,000 (optional

coverage limit is $72,000)

Income Replacement Benefits up to $400/week(70 % of net

weekly income up to a limit of $400; increased coverages of up to

$600, $800 and $1000 per week are optional)

Caregiver Benefits are not available unless you have optional

coverage, in which case this is limited to $250/week for the first


person in need of a caregiver and $50/week for each additional

person

Housekeeping& Home Maintenance Benefits are not available

unless you have optional coverage, in which case this is limited to

$100/week

Minor Injury Guideline (MIG): If your injuries fall under the MIGs

definition of minor injury, the Accident Benefits available to you (listed

above under Non-Minor Injury) will be reduced as follows:

Medical-Rehabilitation Benefits reduced to a limit of $3,500

No access to Attendant Care Benefits

Catastrophic Impairment: If your injuries are severe enough to meet

the test of Catastrophic Impairment, the Accident Benefits available to you

will increase as follows:

$1 million in Medical-Rehabilitation Benefits

$1 million in Attendant Care Benefits

Caregiving Benefits of $250 per week for the first person in need

of a caregiver and $50 for each additional person

Housekeeping Benefits of $100 per week


What determines if I fall within the MIG and how can I get out of the

MIG?

A minor injury is defined by the MIG to include:

strain or sprain of muscles, tendons, ligaments, including partial but

not total tearing

whiplash (except if this includes spinal dislocations or signs of nerve

damage)

cuts, bruises, lacerations

partial but not total joint dislocation

If your auto insurer decides that your

injuries fall within the MIG, and you

disagree, you need to:

1. provide your auto insurer with medical documents supporting that

your injuries do not fall within the minor injury definition,

or

2. provide compelling evidence from a healthcare provider that you

are excluded from the MIG because of a pre-existing injury or

illness that prevents healing within a normal time frame.

Convincing your auto insurer that your injuries do not fall under MIG can

be challenging if you dont have an experienced personal injury lawyer by

your side. It is your lawyers job to assist you with this and to get you out

of MIG where appropriate.

Convincing your auto insurer that your injuries do not fall under MIG can

be challenging if you dont have an

experienced personal injury lawyer by your

side.


How is a Catastrophic Impairment determined?

The definition of Catastrophic Impairment includes:

amputation

permanent loss of the use of a limb

paraplegia

quadriplegia

blindness in both eyes

certain types of brain impairment

severe impairment due to mental or behavioral disorders

a combination of impairments that result in at least 55 percent

impairment of the whole person

What happens if the Accident Benefits insurance company refuses

to pay my benefits?

If youve been seriously injured in a car

accident and your Accident Benefits

insurer refuses to pay benefits to which

you are entitled, you need an

experienced personal injury lawyer on

your side. One of our lawyers would be

happy to speak with you, free of

charge, to assess the benefits you may be entitled to.


At Kagan Law Firm P.C., we have an Accident Benefits team dedicated to

ensuring our clients take full advantage of the benefits available to them. When

an Accident Benefits insurer cuts-off or denies benefits, we fight to enforce our

clients rights and make the insurer pay.

The different types of Accident Benefits are described below:

Income Replacement Benefit: to compensate for lost income after

an accident

Non-Earner Benefit: available if you do not qualify for Income

Replacement Benefit but suffer a complete inability to carry on a

normal life

Medical & Rehabilitation Benefit: for costs of drugs and non-OHIP

funded health care such as physiotherapy, massage, chiropractic

care, etc.

Attendant Care Benefit: for costs of an aide or attendant to assist

you or costs of a long-term care facility

Housekeeping & Home Maintenance Benefit: to replace the

home care tasks which you used to perform before the accident but

are unable to resume after the accident


Caregiver Benefits: if you used to be a caregiver to someone you

live with but are unable to resume that role due to your catastrophic

injuries from an accident

Expenses Benefit: to reimburse you certain expenses incurred due

to an accident, such as the costs of buying a back or neck brace, or

to reimburse you for clothing or eye glasses damaged in the accident

Death and Funeral Benefits: for a family member fatally injured in

an accident


About the Author

Daria Kagan

Daria has spent her career representing injured and disabled people. Her practice is dedicated exclusively to securing assistance, resources and compensation for injured and disabled people and their families.

Daria has successfully argued and enforced her clients rights at the Superior Court of Justice, the Ontario Court of Justice,

the appellate courts of the Divisional Court and the Ontario Court of Appeal as well as a variety of administrative tribunals, including The Financial Services Commission of Ontario.

Daria is a member of the Law Society of Upper Canada, the Ontario Trial Lawyers Association, the Toronto Lawyers Association, the Halton County Law Association and the Halton Hills Chamber of Commerce. She has spoken and organized presentations at conferences sponsored by these and other organizations, most recently, those of The Advocates Society and the Canadian Institute.

Daria enjoys volunteering with the Ontario Justice Education Network and she routinely provides mentorship and training to health care and rehabilitation clinics in order to equip them with the tools and up-to-date information they need to better assist their patients in accessing the benefits they need.

Kagan Law Firm PC www.kaganlaw.ca Toll Free: 1 855 734 0007 Telephone: 416 734 0007 Fax: 416 734 0008 Email: [email protected] 3300 Bloor St. W. (Sun Life Financial Centre) Centre Tower 10th Floor, Suite 3080 Toronto, ON M8X 2X3

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