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 how auto 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 a simplified, 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 MIG’s 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 MIG’s 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 yourinjuries 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 MIG’s 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:
- provide your auto insurer with medical documents supporting that your injuries do not fall within the “minor injury” definition, or
- 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 don’t have an experienced personal injury lawyer by your side. It is your lawyer’s job to assist you with this and to get you out of MIG where appropriate.
How is a Catastrophic Impairment determined?
The definition of Catastrophic Impairment includes:
- permanent loss of the use of a limb
- 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 you’ve 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-EarnerBenefit: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 CareBenefit: 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
- CaregiverBenefits: 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
- ExpensesBenefit: 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
Latest posts by Daria Kagan(see all)
- The Minor Injury Guideline (MIG) & Catastrophic Injury in Ontario Motor Vehicle Accidents - July 13, 2014
- Waivers & Releases of Liability in Sports & Recreational Activities - July 13, 2014
- What to Do Immediately After a Car Accident - July 13, 2014