Minor Injury Guideline Refresher

The Financial Services Commission of Ontario (FSCO) initially released the Minor Injury Guideline (MIG) in June 2010, and then followed up with a revised MIG that took effect November 2011. Overall, the MIG provides a FSCO-approved process for the treatment of uncomplicated musculoskeletal injuries resulting from a motor vehicle accident. The purpose of the MIG is to help expedite treatment by providing a pre-approved process, and as a result avoid delays due to lengthy approval requirements.

In terms of intent, the MIG is similar to FSCO’s Pre-approved Framework (PAF) guideline, released in 2003, but the MIG provides a more concrete definition of soft tissue injuries. In some ways, the MIG could be thought of as ‘tightening up’ soft tissue injury definition offered by the PAF guideline. However, there still appears to be confusion around ‘which injuries are in’ versus ‘which are out.’ To get a better handle on what injuries are included in the MIG versus excluded, here is an MIG refresher.

Putting the MIG in context

Before 1990, all benefits were resolved solely through law suits in the courts by way of what is known as a “tort action.” Then in 1990, the Ontario Motorist Protection Plan, Bill 68, became law introducing no-fault insurance and restricting the ability to sue—and establishing accident benefits. Fast forward to 1993 and Bill 164, the Insurance Statute Law Amendment Act, became law, expanding accessibility to accident benefits and introducing the Designated Assessment Centre (DAC) system. Then from 1994 to 2010, we saw the following developments:

• 1996: Automobile Insurance Rate Stability Act, Bill 59: allowed motor vehicle accident victims to be compensated for their losses through the courts by way of a tort action and/or from their insurer through no-fault coverage.

• 2003: Bill 198, Pre-Approved Framework (PAF) Guideline for Grade I and Grade II Whiplash Associated Disorders: outlined specific protocols for accessing treatment for whiplash associated disorders (WAD I and WAD II) without requiring prior insurer approval to start treatment, providing an overview of the expected course of treatment with a focus on maintaining normal daily activities.

• 2007: Revised Pre-Approved Framework (PAF) Guideline for Grade I and Grade II Whiplash Associated Disorders was introduced to improve the initial 2003 PAF guideline. At this time, the DAC system was eliminated because assessments were costing more than treatment.

• 2010: MIG: Superintendent’s Guideline No. 02/10 was introduced to tighten up the PAF definition of soft tissue injury and expedite treatment of soft tissue injuries

This brings us to where things now stand with the revised MIG, November 2011.

What is the MIG based on and how does the Functional Restoration Model fit in?

The MIG was developed in consultation with insurance industry stakeholders, healthcare professionals and legal representatives drawing extensively on findings identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. According to the task force, “for both WAD and other neck pain without radicular symptoms, interventions that focused on regaining function and returning to work as soon as possible were relatively more effective than interventions that did not have such a focus.” ¹

Accordingly, the MIG is based on the functional restoration model with a structured 12-week program broken into three phases. The focus of the functional restoration model is to not only provide your client with the knowledge to effectively self-manage their condition, but most importantly, to reduce the risk of developing chronic pain. Based on the functional restoration model, treatment should include active care—only using passive modalities with the intent of promoting active care—all supported by education including self-management and coping strategies. Essentially, the goal of the MIG is not necessarily to completely resolve the injury in 12 weeks but rather to provide your client with the knowledge, education, and strategies to help them return to full function within a reasonable amount of time.

What is considered a minor injury?

The MIG outlines two criteria that must be met for an injury to be considered a minor injury and included in the MIG: (1) The injury must fall within the MIG definition of minor injury and (2) there must be no “compelling evidence” of a pre-existing injury that could prevent recovery of minor injuries within the MIG cap of $3500.

MIG definition of minor injury: The MIG defines a minor injury as “a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelea. This term (minor injury) is to be interpreted to apply where a person sustains any one or more of these injuries.” Accordingly, the following injuries would not be considered a minor injury and would be excluded from the MIG:

Whiplash Associated Disorder Grade III: This refers to a neck complaint where there is objective evidence of neurological involvement within the physical findings and/or radiographic findings. These findings would result in the injury being excluded from the MIG.

Whiplash Associated Disorder Grade IV: This refers to a neck complaint with an associated fracture or dislocation. Radiographic evidence of a fracture/dislocation would result in this injury being excluded from the MIG.

Grade III Ligament or Musculotendonous Tear: This refers to a full tear of the ligament or muscle. Radiographic evidence of tear, with clinical correlation, would exclude this injury from the MIG. In addition, although Grade III ligament tears of the spine are rare, it is a very serious injury associated with spinal instability typically involving emergency surgery.

No pre-existing condition that could delay recovery: to be considered a minor injury, in addition to meeting the MIG’s definition of minor injury, there must be no “compelling evidence” of a pre-existing injury that could prevent recovery of minor injuries within the MIG cap of $3500. Put another way, a pre-existing injury/illness might exclude your client from the MIG if there is “compelling evidence” that the pre-existing illness or injury could delay healing of the minor injury beyond the expected recovery timeframes.

In terms of determining “compelling evidence,” according to the MIG, it is the responsibility of the healthcare provider who is submitting the OCF-18 to provide “compelling evidence” that a pre-existing illness/injury excludes your client from the MIG. For example, if your client had any of the following conditions an Insurer Examination would be necessary to determine whether these pre-existing conditions are compelling enough to prevent healing within normal timeframes—everything from medical conditions like diabetes, stroke, and heart disease to degenerative changes like disc disease, joint disease or prior musculoskeletal injury to psychological impairments or neurological conditions, as well as conditions like pregnancy and obesity.

Now what about the Revised MIG that came into effect November 2011?

As explained by FSCO, “The revised MIG provides direction for billing practices when a claimant changes health practitioners within the MIG, and direction on the integration of extended health care benefits with the MIG.” Apparently, FSCO had received numerous questions about this situation because, as they describe, “The first practitioner often bills for the entire Block amount for treatments leaving the claimant with no funds for additional treatment under that Block with their new practitioner. To address this issue the MIG has been amended to provide that where a claimant changes health practitioners, the first health practitione
r may only bill 25% of the amount otherwise payable for a Block for each week or part week in which that health practitioner provided treatment under the Block.”²

End Notes

1. Source: Spine: 15 February 2008 – Volume 33 – Issue 4S – pp S5-S7
2. Source: FSCO Bulletin: Revised Minor Injury Guideline,  October 19, 2011 http://www.fsco.gov.on.ca/en/auto/
autobulletins/2011/Pages/a-06-11.aspx