MIG Update – April 21, 2025
MIG Escape on Fractured Tooth 15 Months Later
This week’s case involves removal from the MIG on the basis of a dental fracture which was determined to be a non-minor injury not subject to the MIG. While the Applicant had not provided evidence of the dental fracture until 15 months after the accident, the Tribunal considered the OCF-18 treatment plans in dispute that were refused by the Respondent pursuant to s38 (5) while the Applicant was entitled to treatment under the MIG.
Section(5) An insurer may refuse to accept a treatment and assessment plan if the plan describes goods or services to be received or an assessment or examination to be conducted in respect of any period during which the insured person is entitled to receive goods or services under the Minor Injury Guideline in respect of the impairment.
What is the insurer’s obligation to revisit treatment plans denied during a period in which the Applicant can receive treatment under the MIG?
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Factor: Dental Fracture
In Muccilli v Aviva General Insurance (22-010975), Matthew Muccilli was injured while a passenger in a vehicle that struck a utility pole on the side of an urban roadway on October 27, 2019. He sought entitlement to four Treatment Plans for physiotherapy, chiropractic and psychological services and an OT assessment totalling $8,604.91.
He submitted that he should be removed from the MIG due to a right shoulder tear, chronic pain, psychological disorders and a fractured tooth as noted in the CNRs of dentist Dr. Kaplan, who recommended extraction, which was done in February 2021.
Aviva submitted that Muccilli did not extract the tooth until 15 months after the dentist’s recommendation, which suggested that it was not accident-related. It also refused to accept the physiotherapy and chiropractic services Treatment Plans pursuant to s.38(5) of the Schedule as its notice had advised Muccilli to submit a treatment confirmation form, pursuant to the MIG that the treatment was pre-approved under the MIG up to $2,200.00.
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The Tribunal found:
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- The dentist Dr. Kaplan’s CNRs, which were uncontradicted, indicated that the November 2019 visit was due to the accident two weeks earlier, diagnosed a fractured tooth based on X-rays and recommended extraction.
- The timing of the extraction, 15 months later, did not upset the fact that he sustained a non-minor injury, and that nothing in the Schedule required treating the fracture within a certain period of time.
- The December 2020 physiotherapy and November 2020 chiropractic services Treatment Plans that were refused by Aviva pursuant to s.38(5), while Muccilli was subject to the MIG, as he had not yet provided evidence demonstrating he suffered non- MIG injuries. As a result, the plans were not reviewable pursuant to s.38(6).
- While the November 2020 Treatment Plan listed psychological diagnoses, treatment plans on their own were not evidence and since Muccilli did not provide evidence of a non-minor injury until April 2021, when he provided Dr. Kaplan’s CNRs, he was subject to the MIG until that time.
- The psychological and OT assessment Treatment Plans were also submitted prior to the Muccilli providing evidence of a non-minor injury, however, s.38(7) removed them from the purview of s.38(5) because they were not services provided under the MIG, and therefore, they were subject to review.
- Muccilli provided no evidence of a psychological injury outside of the Treatment Plan itself as such the October 2023 IE report of psychologist Azzli was accepted noting that Muccilli was not interested in psychological treatment, finding as well that he scored below average on psychometric scales, and that he did not present with any significant psychological impairment causing functional limitations.
- Muccilli was not entitled to the OT assessment Treatment Plan as he made no submissions and provided no evidence regarding it.
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 33% of the decisions so far. Each case is nuanced, but with similar factors.
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