MIG Update – February 22, 2021

Is Payment Beyond $3,500 an Automatic Escape?

In this edition of MIG Monday, we explore two cases where the Applicants received payment well in excess of the MIG $3,500 monetary limit. Does a payment of medical and rehab benefits in excess of $3,500 automatically remove the insured person from the MIG?

Factor: Merits or Monetary Limit

In Z.V. v Aviva (17-006874), Z.V. argued that the Respondent has conceded the MIG limits when it approved and paid over $6,700 in medical and rehabilitation benefits. The Respondent maintained that the overpayment was made as a result of an administrative error and repayment was not sought as a good faith gesture.

‘MIG hold’ – The Tribunal held:

  • Citing Stranges v Allstate, the Tribunal found, “Receiving payments above the Minor Injury Guideline limits due to an administrative error does not automatically take an insured person out of the Minor Injury Guideline or entitle her to benefits”
  • Z.V. still needs to meet the burden of proof that her injuries are not minor
  • Z.V.’s claim failed on its merits after the Tribunal’s consideration of a chronic pain report

In R.A. v Wawanesa (18-012358), the Respondent has approved over $5,000 in medical and rehabilitation benefits and $1,600 in IRBs. Despite these payments and an IE diagnosis of adjustment disorder, the Respondent maintained a MIG position.

‘MIG escape’ – The Tribunal held:

    • R.A. continues to suffer from pain nearly six years post-accident
    • Presence of psychological impairments as diagnosed by R.A.’s family physician and several other assessors, including the IE psychologist
    • R.A. has met their onus to prove that their impairments warrant treatment beyond the MIG based on the evidence of chronic pain and psychologist impairment

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