Important Accident Benefit Decision

In September 2010 the Ontario government slashed the medical benefits you could get under your car insurance policy for injuries suffered in a motor vehicle accident.

The $100,000 limit for treatments (those not covered by OHIP) was reduced to $50,000. For accident victims with so-called “minor injuries”, such as strains, sprains and whiplash, the $100,000 limit was cut to $3,500.

Last month, the Financial Services Commission of Ontario (FSCO) ruled in favour of an accident victim who claimed expenses beyond the minor injury limit. Lenworth Scarlett argued that in addition his whiplash injuries he also had pre-existing injuries and subsequent psychological difficulties.  As a result, he wanted to claim medical and rehabilitation expenses beyond the $3,500 limit.

The position of Scarlett’s insurer, Belair, was that his injuries were “predominantly minor injuries” and that he was therefore limited to $3,500 in medical and rehabilitation costs. Belair relied on a single insurer examination in placing Mr. Scarlett in the MIG (the minor injury guideline).  The arbitrator concluded that was a mistake, writing that “this runs contrary to both the spirit of the accident benefit scheme and the stated purpose of the (minor injury) guideline itself.”

The $3,500 minor injury cap is really an exclusion from the $50,000 limit for accident benefits. This means the burden of proof is on the insurer to show that injuries and problems resulting from an accident are truly “minor”.

The case is an important one because it means that If you provide solid evidence that your injuries are more than minor strains, sprains and whiplash covered by the $3,500 limit, the insurance company has to prove you’re wrong.

Since 2010, thousands of accident victims have been denied benefits by insurers and were put into the MIG without proper medical support.  They then challenged the accident victims to prove they should not be in the MIG.

The Scarlett decision restores and affirms the rights of accident victims.

At McNally Gervan LLP we take the rights of accident victims seriously.  If you believe you are not being fairly treated by your insurer you can call us to scheudle a free consultation.