Motor Vehicle Accident Claims

There are 3 categories you may be classified under if you’ve been injured in a motor vehicle accident:

1. Minor injury guideline (MIG):

• Sprain or strain
• Whiplash injury
• Whiplash associated disorder
• Partial dislocation of a joint
• Laceration
• Contusion

2. Non-catastrophic (non-CAT):

• Fracture
• Bone break
• Full bone dislocation
• Psychological disorders associated to the accident
• Pre-existing medical condition that may delay recovery
• Was not able to recover within the MIG

3. Catastrophic Impairment (CAT):

• Amputation of a limb
• Severe paralysis
• Spinal cord injuries
• Severe head injuries
• Severe brain injuries
• Severe burns
• Blindness
• Deafness
• Other injuries that are so severe that you are permanently unable to work or perform activities of daily living

If you’ve exhausted your full $3,500 and require more treatment (unless you’ve already moved out of the minor injury guideline for any of the reasons listed under the non-catastrophic or catastrophic injuries described above), we’ll need to submit a treatment plan outlining the further treatment that’s required.

Your insurer will automatically decline the treatment plan and require you to attend an insurer examination by a physician of their choosing. If you’re being moved out of the MIG, we recommend you retain legal counsel.

During your first assessment and treatment, you will be assessed by one of our physiotherapists or chiropractors who will determine the injuries sustained from the accident. We then submit a treatment plan (OCF-23) to your insurer for automatic pre-approval. We then begin treating you under the pre-approved $2,200 MIG coverage in order not to delay treatment. If we form an opinion that you are required to be moved out of the MIG due to any of the listed reasons, we will begin the process while still treating you under the MIG to help you get on the road to recovery as soon as possible.

Your treatment plan may include a combination of physiotherapy, chiropractic, acupuncture, massage therapy, and manual osteopathy. We will determine what combination of treatment types are best for your injuries and allocate your coverage to the proper amount of sessions per modality.

Some cases are simpler than others to move clients out of the minor injury guideline (MIG) to non-catastrophic (non-CAT) or catastrophic impairment (CAT). A client who has sustained a break or fracture with supporting documentation (such as an x-ray) can be moved out of MIG fairly easily. Someone who is required to move out due to a brain injury, for example, requires a more exhaustive process and several insurer examinations.

If our medical professionals determine that you qualify to be moved out of MIG, we’ll refer you to one of our legal partners to seek advice and representation. We’ll work closely with your legal representative if you require a higher category of injury. Our legal partners are experienced with both minor and major cases. They’ll work to help you get the coverage and benefits you need to continue on your path to recovery, and potentially receive income replacement benefits if you cannot work due to your injuries.

We recommend seeking legal representation if your treatment plan or benefits are declined. Personal injury lawyers are experts in this field and would devise a strategy to appeal the decline of your treatment plan and advocate to get it approved.

*Please note: You are not always guaranteed approval for treatment coverage after the initial pre-approved $2,200 coverage. We do our best to help all our clients receive coverage, but ultimately if the insurance denies your claim, it is the responsibility of the client to settle any outstanding balances such as client-requested assessments.