Ontario's Minor Injury Guideline caps treatment funding at a much lower level than the standard non-catastrophic limit. Placement in that category is a determination made by the insurer, and it is regularly overturned with proper medical evidence.
What the category does
Injuries the insurer classifies as minor are funded at a sharply lower cap than other non-catastrophic injuries. Once that cap is exhausted, treatment is either paid privately or stops.
For a genuinely minor injury that resolves quickly, the category is appropriate. The problem is what happens when it is applied to an injury that is not.
How people end up in it wrongly
Early classification based on limited information is common. A person who walked away from a collision and was diagnosed with soft tissue injuries can be placed in the category before anything more serious has been identified.
Chronic pain, psychological injury and mild traumatic brain injury frequently emerge later, and they are frequently not reflected in the original classification.
Getting out of it
The way out is medical evidence: a properly documented diagnosis showing the injury falls outside the guideline, from practitioners who are treating you rather than reviewing paper.
Pre-existing conditions can also take a claim outside the category in some circumstances, which is one reason a full medical history matters.
Deadlines that apply to you
These are the dates that end claims. Check them first.
For an injury that is not catastrophic, medical, rehabilitation and attendant care benefits are capped at $65,000 combined, available for up to 260 weeks after the collision.
Statutory Accident Benefits Schedule, O. Reg. 34/10 · in force 2019-06-03
Injuries the insurer classifies under the Minor Injury Guideline are capped far lower. Being placed in that category wrongly is one of the most common and most costly things that happens to a claim.
Statutory Accident Benefits Schedule, O. Reg. 34/10, s. 18(1); FSRA Minor Injury Guideline (AU0026ORG)
Questions we get every week
Yes. It is a determination by the insurer, not a medical finding, and it is challenged successfully on a regular basis with supporting evidence.
Substantially lower than the standard non-catastrophic limit. The exact figure is set by regulation and guideline, and you should confirm the current amount rather than relying on an article.
Sometimes, depending on the circumstances. Keep every receipt and get advice before spending significant amounts.
Where this applies
Accident Benefits
Accident benefits are paid by your own auto insurer regardless of who caused the collision.
Read moreCar Accidents
After a car accident in Ontario you usually have two separate claims running at the same time: accident benefits from your own insurer regardless of who caused the crash, and a claim against the driver at fault.
Read moreInsurance Disputes
Ontario insurers owe policyholders a duty of good faith in how they handle a claim.
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