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Posts Tagged ‘Ontario’

FSCO Revises Minor Injury Guidelines

The Financial Services Commission of Ontario (FSCO) has released a revised Minor Injury Guideline (MIG) that becomes effective on November 1, 2011.

The revised MIG provides direction for billing practices when a claimant changes health practitioners within the MIG, and direction on the integration of extended health care benefits with the MIG.
Included in the revisions is direction on payments to more than one health practitioner when a claimant changes practitioners within the MIG.  Now, where a claimant changes health practitioners, the first health practitioner may only bill 25% of the amount otherwise payable for a Block for each week or part week in which that health practitioner provided treatment under the Block.
FSCO has also clarified that the SABS rules regarding extended health care (collateral) benefit carriers as first payers have not changed.  Benefits covered by an extended health care plan must be exhausted first.  Amounts covered by other sources do not reduce the overall $3,500 cap for medical and rehabilitation benefits.

The actual revisions to the MIG can be accessed by clicking here.

Personal Insurance Hit With $28,000.00 Special Award

In a recent arbitration decision through the Financial Services Commission of Ontario (FSCO), The Personal Insurance Company of Canada was subjected to a $28,000.00 special award for unreasonably withholding accident benefits from their insured.

In Hoang and Personal, Arbitrator Denise Ashby found that The Personal unreasonably withheld payment for lost educational expenses and the costs of rehabilitation support worker services for Christopher Hoang, an 11 year-old boy who suffered a catastrophic brain injury from a motor vehicle accident.

Arbitrator Ashby noted that The Personal failed to reasonably assess the medical information available and acted unreasonably in denying his claim.  She noted that The Personal’s reliance on insurer’s examinations, “…in the face of the overwhelmingly consistent opinions and reasoning of the [treatment] Team and the other professionals who followed Christopher, amounts to an unreasonable disregard of the available information relating to the two rehabilitation benefits.”

Are you in the MIG? Maybe not.

Claims Canada Magazine is reporting that more than 50 percent of all claims in Ontario are currently falling under the Minor Injury Group (MIG). The article acknowledges that insurance companies are “holding their breath” to see how arbitration and judicial decisions will interpret the new regulations as to what is and is not considered a “minor injury”.

Interestingly, the question still remains open as to whether or not individuals who were injured after September 1, 2010 but prior to their policy renewal date can be placed within the MIG category and, more importantly, the $3,500.00 limit for medical and rehabilitation benefits, as this is based on a bulletin from the Financial Services Commission of Ontario (FSCO). A bulletin is not law.

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