In September 2010 some significant changes were made to the SABS – the Statutory Accident Benefits Schedule. These changes impact what benefits are available to an injured person under their own automobile insurance policy.
One of the changes relates to the amount of medical and rehabilitation benefits that available to an injured person. If you are declared to have injuries which are “catastrophic” then you can access up to $1,000,000 in these benefits; if you are “non-catastrophic” then you can access up to a maximum of $50,000. However, if you are deemed to fall under the “Minor Injury Guideline”, known as the MIG, then the insurance company can limit your medical and rehabilitation benefits to $3,500.
Since this new change in the law, insurance companies have tried to place as many people as possible into the MIG category, so as to limit their exposure in paying benefits. This forces injured people to either pay for treatment out of pocket, or forego treatment all together which can lengthen the time it takes to recuperate from various injuries.
The good news is that a case went to arbitration in February 2013, which ruled in favor of the injured claimant. Although this case is current under appeal, we are able to use the arguments in this case to try to get our clients out of the MIG designation and into proper treatment under the $50,000 limit.
This Arbitration decision is called Scarlett v. Belair. Although the case looks at many surrounding factors relating to the MIG, the essential take-away is that the intention of the Accident Benefits scheme is, that once an injured person proves that he or she is covered by the automobile insurance policy, he or she should be entitled to receive the benefits, and that only then can an insurer look to prove that the insured person should fall under an exception that would justify non-payment. Insurance companies should not place an injured person automatically under the MIG where there are soft tissue injuries present, but rather that each case should be assessed on its merits.