June 14, 2010 by Canadian Underwriter
Ontario’s insurance regulator, the Financial Services Commission of Ontario (FSCO), has posted its new Minor Injury Guideline (MIG), a key pillar of the province’s proposed new auto insurance reform package.
The MIG will apply to accidents that occur on or after Sept. 1, 2010, when the province’s new auto insurance reforms are introduced.
The MIG defines a “minor injury” as “a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation [a partial but not complete dislocation of the joint], and any clinically associated sequelae [symptoms following on these injuries].”
A whiplash-associated disorder is further described as a whiplash injury that “does not exhibit objective, demonstrable, definable and clinically relevant neurological signs and does not exhibit a fracture in or dislocation of the spine.”
The entire MIG, including more complete definitions, can be found at: http://www.fsco.gov.on.ca/english/pubs/bulletins/autobulletins/2010/a-10_10.asp
Benefits for minor injuries as defined in the new MIG are subject to a $3,500 limit.
The new MIG calls for health care providers to focus on “functional restoration,” which “refers to an approach in which the health practitioner is oriented toward function and to the delivery of interventions that help the insured person to reduce or manage his/her pain and associated psycho-social symptoms.”
The MIG says treatment should be “focused on what the insured person needs to do in order to function at his/her pre-accident level in his/her home and work environment.”
The MIG goes on to note impairments will not fall under the guideline “if the insured person’s impairment is predominantly a minor injury, but based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3,500 limit…”
The MIG says only in “extremely limited instances” would a pre-existing condition exclude a person’s impairment from the guideline. “The existence of any pre-existing condition will not automatically exclude a person’s impairment from this [guideline],” the MIG says. “It is intended and expected that the vast majority of pre-existing conditions will not do so.”
Treatments or monitoring are to be provided in three, four-week blocks of time. The health practitioner’s fees for each block of time are fixed.