Minor Injury Guideline: A Positive Decision for Ontario Accident Victims

Minor Injury Guideline: A Positive Decision for Ontario Accident Victims

In a recent decision of the Financial Services Commission of Ontario, Arruda and Western Assurance Company, Arbitrator Jeffrey Shapiro concluded that a diagnosis of chronic pain syndrome can remove an injured accident victim from the Minor Injury Guideline.

Jessica Arruda was injured in a motor vehicle collision. Her insurer placed her in the Minor Injury Guideline. The main issues on arbitration were whether Jessica’s injuries fell outside of the Minor Injury Guideline either due to a pre-existing medical condition and/or because of a subsequent diagnosis of chronic pain syndrome.

Throughout the first months of treatment, prior to exhaustion of the $3,500 Minor Injury Guideline limit, Jessica’s injuries were classified as soft tissue injuries. 20 months post-collision, Jessica had still not recovered and was seen by a specialist who diagnosed Jessica as suffering from chronic pain syndrome.

Arbitrator Shapiro determined that this new medical diagnosis established that Jessica’s injuries were no longer within the Minor Injury Guideline. Arbitrator Shapiro concluded that the insurer could not rely on an insurer’s exam from one year prior to the diagnosis of chronic pain syndrome as a basis for denying removal from the Minor Injury Guideline.

Arbitrator Shapiro did confirm that it is the injured person who must show evidence that their injury does not fall within the Minor Injury Guideline, which he concluded Jessica had, by presenting the insurer with the chronic pain diagnosis. He specifically quoted from Cowans and Motors Insurance Corporation that the insurer did not discharge its “…ongoing duty to assess and reassess a claim as new information is available…” by ignoring the new evidence in Jessica’s case when presented with it.

This is a great result for injured accident victims in Ontario, allowing them to access the treatment and services they are entitled to.

We had previously written about the devastating effect the Minor Injury Guideline can have on injured victims and their access to treatment. This case is one of only a few published decisions that endeavours to interpret the way in which the Minor Injury Guideline applies.

Joelle Briggs-Sears, Personal Injury Lawyer

Bonn Law Office, Trenton/Belleville, ON