ON LAT reinforces Minor Injury Guideline treatment framework in insurance dispute

August 20, 2021

Gomes v. Economical Insurance, 2021 ONLAT 20-003216/AABS

On June 4, 2021, Adjudicator Brian Norris of the Ontario Licence Appeal Tribunal denied an application for certain medical benefits in a dispute involving an Applicant’s claim that her injuries, sustained in an automobile accident, fell beyond the characterization set out in the Minor Injury Guideline (the “MIG”) of the Statutory Accident Benefits Schedule.

The Applicant was injured in 2019 and sought benefits from the Respondent, an insurance company. The Respondent determined that the injuries were minor, per the definitions of the MIG, and refused to pay for certain medical benefits beyond its $3,500 funding limit. The Applicant disputed the denial, claiming that her injuries were mischaracterized and that MIG should not apply as her pre-existing intermittent back and neck pain precluded her from recovery.

In review of the Applicant’s medical records, the Adjudicator ultimately found that there was insufficient evidence to show that her pre-existing intermittent medical condition would preclude her recovery if subject to the MIG, and upheld the Respondent’s initial denial.

Emily Compton (Insurance Litigation) of Miller Thomson represented the Respondent in the proceedings.