Q: I was injured in a car-truck accident in Kingston. I filed an accident benefits claim with my car insurance company and was put in the minor injury group, what does that mean?
A: Pursuant to Ontario’s Insurance Act, a standard auto insurance policy provides an insured driver with benefits regardless of who is at fault. The Statutory Accident Benefits Schedule (SABS) defines the types of benefits you may receive.
Medical and rehabilitation benefits are just one of the types of benefits available. Based on your injuries, your insurance company will place you in one of three categories:
- minor injury;
- non-minor injury; or
- catastrophic injury.
The amount of medical and rehabilitation benefits you receive is dependent on which group you are placed in.
What is a Minor Injury?
A minor injury is defined by the Minor Injury Guideline, and examples of a minor injury are sprains, strains, whiplashes, contusions, abrasions, lacerations or any ailments associated with the minor injury.
Ailments associated with the minor injury can be headaches or dizziness related to the whiplash you suffered in the car accident.
How Much do you Receive for a Minor Injury?
For a minor injury, you can receive up to $3,500 in benefits and no more. What is confusing about this is if you bought optional or additional coverage for medical and rehabilitation benefits, you will not be able to use that optional coverage because you are placed in the minor injury group. Therefore, you will still only receive $3,500 in benefits despite the fact that you bought additional coverage.
If you were placed in the non-minor injury or catastrophic injury groups, then you would be able to access that optional coverage.
A Pre-Existing Condition May Exempt you from the Minor Injury Group
If you have a pre-existing condition that prevents you from maximum recovery within the $3,500 cap, you may be bumped out of the minor injury group.
For instance, if you have diabetes that delays your recovery and/or prevents you from reaching maximum medical recovery, you may be exempt from the minor injury group. In addition, if the diabetes exacerbates the new injury beyond the $3,500 limit, then you may be exempt as well.
However, the fact that you have a pre-existing condition does not automatically exempt you from the minor injury group. You must provide compelling evidence that the pre-existing injury interferes with how well you will recover from your injury. The compelling evidence would come from your treating doctor.
Injured individuals placed in the minor injury group may not belong in the group because they have a pre-existing condition or they simply do not have a minor injury. However, if they accept the insurance company’s classification, they will only receive $3,500 in benefits.
If you think you do not belong in the minor injury group, it is important to talk to a lawyer who can help you obtain compelling medical documentation and evidence that can pull you out of the minor injury group.
If you would like to discuss your accident, feel free to call my office and schedule a FREE consultation. 1-866-384-5886.