MIG Update – August 11, 2025
MIG Injury Splitting & Award
This week, a MIG case raised the underlying issue of whether the splitting of injuries under the MIG is settled law. In its analysis of whether the Respondent’s failure to mitigate and its unreasonable conduct rose to the level of award-worthy behaviour, the Tribunal considered the timing of the court’s finding in Bennett v. Co-operators regarding the issue of splitting injuries.
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In Amiri vs. Allstate (23-012246), Sepideh Amiri was involved in an accident on January 23, 2023 and suffered both psychological and physical injuries as a result. While Allstate took her out of the MIG due to her psychological injuries, it held to a position that Amiri suffered only minor physical injuries and that the disputed Treatment Plans were not payable. It was not until the case conference in April 2024, where it agreed to pay for all the previously denied Plans, as well as medication expenses.
Amiri submitted that Allstate’s position in splitting the determination on her injuries was arbitrary and warranted an award of 50% of the amounts withheld.
Allstate submitted that it was unsettled law at the time of the decisions and that it ultimately approved funding for all the treatment plans in dispute, which demonstrates that its actions were not excessive, imprudent, stubborn, unyielding, or immoderate.
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The Tribunal found:
- Allstate’s assertion that the issue of splitting injury determination was ‘unsettled law’ at the time of its denial decision was not supported by the case law.
- “The Applicant’s case is relatively analogous to the situation addressed in Co-Operators v. Bennett, 2024 ONSC 467 (CanLII) (“Bennett”). In Bennett, the insurer denied an insured person’s funding for an attendant care assessment on the basis that it concluded that she sustained a minor injury from a physical perspective but was not subject to the MIG for treatment of her psychological injuries. Bennett was released by the Divisional Court on February 7, 2024, which was after the Applicant submitted her application to the Tribunal, but before the parties submitted their case conference summaries and before the case conference occurred.”
- Crucially, the Tribunal had already addressed this issue in a decision released on January 9, 2023, two weeks before Amiri’s accident. The Tribunal had upheld its findings in Bennett on reconsideration with a decision released May 11, 2023, which was more than three months before Allstate received notice from its IE assessor that Amiri sustained psychological injuries due to the accident.
- Allstate failed to demonstrate any attempts to mitigate the issue. Despite the Divisional Court’s decision in Bennett being released two months prior to the April 5, 2024, case conference where Allstate finally agreed to approve the benefits, there was no indication that Allstate contacted the Applicant or her counsel to advise of an updated position.
- Allstate waited until the case conference to approve the benefits, which prolonged prejudice to Amiri and unnecessarily consumed the time of the parties and the Tribunal. Allstate had opportunities, such as in its February 12, 2024, response to the application or its March 26, 2024, case conference summary, to outline a change in position and potentially avoid a case conference altogether.
- By maintaining a split determination without supporting caselaw and waiting to approve benefits, Allstate’s actions to be excessive, imprudent, unyielding, and immoderate.
- Allstate’s actions of splitting the determination on Amiri’s injuries warranted an award. She was entitled to an award of $3,194.41, representing 50% of the amounts withheld by Allstate.
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