More on Scarlett and Belair: Minor Injury Guideline Case Supports Injured Insureds
The recent case of Scarlett v. Belair Insurance Decision Date: 2013-03-26, Adjudicator: John Wilson, Regulation: 34/10, Decision: Arbitration, Preliminary Issue, FSCO 3965 is the first reported Minor Injury Guideline (MIG) case.
The gist of the decisions stand for the proposition that injured insureds should not be required to take extraordinary steps, or be forced to make leaps and bounds to prove that treatment they require for recovery does not fall within the MIG. In fact it is the opposite that is true. Once insureds, through their care providors, establish with convincing evidence that they will not meet maximum recovery within the MIG limit, the insurer must provide payment for the treatement unless they can prove that the insured is subject to the MIG. It can be said that the applicaiton of the MIG should be considered the exceptiopn rather than the rule.
To quote Arbitrator Wilson:
The insurer is in effect mandated to make an early determination of an insured’s entitlement to treatment beyond the MIG. In essence, because of the necessarily early stage of the claim when the MIG is applied, the determination must be an interim one, one that is open to review as more information becomes available.
What it is not is the “cookie-cutter” application of an expense limit in every case where there is a soft tissue injury present. Such does not respond either to the spirit of the accident benefits system or the policy enunciated in the Guideline of getting treatment to those in need early in the claims process.
While it is quite possible that the majority of claimants can be accommodated within the MIG, averages are misleading when applied to individual cases. Each case merits an open-minded assessment, and an acceptance that some injuries can be complex even when there are soft tissue injuries present amongst the constellation of injuries arising from an accident.