MIG Update – December 19, 2022

No Jurisdiction to Hear MIG as Standalone Issue

This week, the Tribunal deals with a jurisdictional issue with respect to the MIG as a standalone issue. The analysis by the Tribunal here is instructive and clarifies this question – when a case is brought before this Tribunal where the applicability of the MIG is in dispute, it is to be heard in conjunction with a denied medical benefit.

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Factor: MIG Not a Standalone Issue for Tribunal

In McKay v. Travelers Insurance (20-008456), Patricia McKay, injured in an accident on March 22, 2013 sought a determination that her injuries were not predominantly minor and therefore not subject to the treatment within the MIG limit of $3500.

The Tribunal held:

• That it “does not have jurisdiction to deal with the issue of the MIG as a standalone issue unless a medical or rehabilitation benefit is tied to it pursuant to sections 15 or 16 of the Schedule”.
• The plain reading, context, and purpose of the Insurance Act. Section 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 in and of itself does not entitle one to a benefit or grant them an amount of a benefit.
  
• A MIG classification is not considered a refusal to pay the amount claimed nor does it entitle an insured person to any amount of benefits. Which tier of benefit can be argued at any time however there must be a substantive benefit that relies upon its determination.
  
• If there are treatment and assessment plans to bring before the Tribunal, the applicant can submit a new application which lists them as issues in dispute”. Then, the applicability of the MIG will be an issue for the hearing adjudicator to assess in conjunction with the treatment plans in dispute.

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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