Ontario drivers who are injured in car, bus or truck accidents in Kingston, Ottawa or Whitby will likely need medical treatment. An injured Ontario driver’s Ontario Health Insurance Plan (OHIP) is the first line of medical coverage. OHIP will pay for an injured driver’s acute care performed at a hospital. For example, if a driver is taken to an emergency room, OHIP will cover the acute care the injured driver receives.
For all medical expenses not covered by OHIP, they are covered by the injured driver’s medical and rehabilitation benefits coverage in his/her car insurance policy. The medical expenses incurred must be related to the injuries sustained in the auto accident and must be reasonable and necessary.
The amount of benefits the injured driver can access depends on his/her injuries. There are three classes of injury defined by the Statutory Accident Benefits Schedule (SABS):
- minor injury,
- non-minor injury, and
- catastrophic injury.
Minor Injury Guideline (MIG)
In order to help define minor injuries, the Financial Services Commission of Ontario (FSCO) released the Minor Injury Guideline (MIG) which also provides the approved treatments for uncomplicated minor injuries as a result of a motor vehicle accident in Ontario.
MIG defines minor injury as the following:
A sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae.
Associated sequelae means secondary consequences or results of an injury, such as a sprain, headaches, dizziness, difficulty sleeping, anxiety, depression and fatigue associated with a minor injury like whiplash.
If a driver’s injury is minor, his medical or rehabilitation benefits coverage is capped at $3,500. Therefore, it is assumed that an injured driver who has a minor injury will achieve maximum recovery within the $3,500 cap.
In some situations, certain injuries will be exempt from the minor injury group. A driver with a pre-existing condition that prevents him from achieving maximum recovery from the minor injury within the $3,500 cap will be exempt from the group. In this situation, the injured individual’s treating doctor would need to provide compelling evidence to support this claim.
For example, if an injured Ontario driver has diabetes or a heart disease that prevents him from achieving maximum recovery within normal timeframes and subject to the $3,500 limit, then he is no longer in the minor injury category.
Ontario drivers may be placed in the minor injury category after a car, bus or truck accident. They may disagree with their classification and should talk to an experienced car accident injury lawyer in Kingston or Ottawa. A comprehensive review of the driver’s medical history and related injuries may reveal that the driver should not be placed in the minor injury group.
If you were injured in a motor vehicle accident in Ontario and feel that you were improperly placed in the minor injury group, call the car accident lawyers at Bergeron Clifford. The lawyers at Bergeron Clifford will carefully review your case and help guide you through this complicated process. 1-866-384-5886.