MIG Update – January 24, 2022
LAT Jurisdiction on Standalone MIG Issue
In the case reviewed this week the only issue in dispute on the LAT application was whether or not the Applicant’s injuries fall outside of the MIG. At issue was whether the Tribunal has the jurisdiction to hear the MIG as a standalone issue as the MIG in and of itself is not a benefit. Does the issue of the MIG have to be tied to a monetary benefit being claimed?
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Factor: MIG Standalone Issue
In Bobak v Travelers (21-004004), The issue in dispute before the Tribunal is whether Bobak’s injuries fall outside of the MIG. The Tribunal granted the Respondent’s motion and dismissed the Applicant’s application without a hearing on the basis that the Tribunal does not have jurisdiction to hear the issue of the MIG as a standalone issue unless it is tied to a benefit that requires its determination.
Travelers Position:
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- Three cases presented in which the MIG was not decided as it was not tied to any benefits in dispute
- Ontario Automobile Policy (OAP) sets out the benefits and the MIG is not there because it is a guideline and not a benefit
Bobabk’s Position:-
- Three cases presented wherein the MIG was decided by the Tribunal even though a medical or rehabilitation benefit was not tied to it
- Proceeding before the Tribunal without a denied Treatment Plan is supported by the Insurance Act and the Schedule. S.280(1) of the Insurance Act empowers the Tribunal to hear matters regarding the amount of benefits
- s. 18(2) of the Schedule refers to the MIG in the context of a limit, which, Bobak argued, can be heard by the Tribunal on its own
- Jurisdiction of the Tribunal is also supported by denial letters indicating that the Applicant had 2 years to dispute her classification in the MIG
The Tribunal held:-
- S.280(1) of the Insurance Act states that the Tribunal has jurisdiction to resolve “disputes in respect of an insured person’s entitlement of statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured is entitled.”
- The MIG is not a statutory accident benefit; it is a guide that defines what is a minor injury and the treatment framework for medical providers, and does not entitle a person to a benefit or grant them an amount of a benefit
- The decision to place someone in a specific classification based on their injuries is not statute-barred by s.56 of the Schedule. S.56 states that the insured person has two years from the insurer’s refusal to pay the amount claimed.
- There was no obligation on the adjudicator to decide the issue of the MIG in absence of a benefit that relies upon its determination
Related Issue:
MIG – A Guideline or Standalone Determination?
If you Have Read This Far…Our MIG Monday series discusses the multitude of factors to consider when evaluating a risk position on MIG cases. The Tribunal has ruled on the MIG in 24% of the decisions so far. Each case is nuanced, but with similar factors.
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