Minor Injury – Auto Insurance Reform Part 2

One of the most noticeable changes that comes with the Ontario Auto Insurance Reform Act on September 1, 2010 will be the introduction of a new Accident Benefit category called Minor Injury. Ontario drivers, riders, and passengers need to be very aware of this category and the new limitations it contains. Such a category naturally arouses suspicion since limitations are always one of those details that bedevil the insured when claim time comes. Close examination will, in our opinion, allay most concerns. Again, carefully reading and understanding the coverage is very important for all Ontario residents who will ride, drive, or be a passenger on a motorcycle, car, or truck.

The Financial Services Commission of Ontario (FSCO)has created a very clear document that outlines the definition of Minor Injuries and the new limits that go with injuries thus defined. The Minor Injury Guideline is very straightforward and readable, even with the medical terminology that defines specific injuries. This guideline has very simple goals. By setting specific rates for specific medical assessments, it allows insurance companies to have very well-defined costs for specific injuries. By defining minor injuries in very clear, narrow terms, the guideline also takes this large segment of auto-related injuries out of the bureaucratic maze of accident benefit adjusting and essentially fast tracks these treatments. This is definitely good news for claimants whose injuries are thus defined.

Here are some of the defined injury terms in the Guideline:

a) minor injury means a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. This term is to be interpreted to apply where a person sustains any one or more of these injuries.

b) sprain means an injury to one or more tendons or ligaments or to one or more of each, including a partial but not a complete tear.

c) strain means an injury to one or more muscles, including a partial but not a complete tear.

d) subluxation means a partial but not a complete dislocation of a joint.

e) whiplash injury means an injury that occurs to a person’s neck following a sudden acceleration-deceleration force.

f) whiplash associated disorder means a whiplash injury that:

(i) does not exhibit objective, demonstrable, definable and clinically relevant neurological signs, and

(ii) does not exhibit a fracture in or dislocation of the spine.

One of the most common issues that claimants have with Accident Benefits claims is the maze of paperwork and length of time that these claims can take, even in the best of scenarios. The Minor Injury Guideline should help to make such claims move more quickly and effectively, definitely a good thing for claimants.

But what about someone who has a medical condition prior to the accident that is, in combination with the “minor injury” that they sustain as a result of the accident, now a debilitating condition? This is a complication that the Minor Injury Guideline addresses. A doctor can certify that the pre-existing condition has rendered this Minor Injury more than minor in such an instance. In the words of the Guideline:

4. Impairments that do not come within this Guideline

An insured person’s impairment does not come within this Guideline if the insured person’s impairment is predominantly a minor injury but, based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3,500 limit referred to in section 18(1) of the SABS or is limited to the goods and services authorized under this Guideline.

So the above stipulation takes care of what would otherwise be a very grave concern of the claimant.

How does this affect Ontario motorcycle insurance claimants? It should help to streamline the claims of those who have minor injuries, which is a significant number of claimants. It should also help to stabilize the cost of motorcycle insurance claims by virtue of the increased efficiency and narrowly defined cost structure, and that’s very important to all of us.

Note: Attendant Care is no longer available in the instance of a Minor Injury claim. Even if you “buy back” the Attendant Care coverage, it will not respond to Minor Injury claims.

So all that remains is to see if this new guideline helps to make the minor injury segment of Accident Benefits claims move more quickly and more cost effectively. There is good reason to hope that it should based on the clarity of the guidelines.