I have long suggested that insurers have not provided enough information with respect to Section 38(8).
Section 38(8) of the Statutory Accident Benefits Schedule (SABS) requires insurers, within 10 days after receiving a treatment and assessment plan, to provide claimants with a notice stating “the medical and any other reasons (emphasis added) why the insurer considers any goods, services, assessments or examinations or the proposed costs of them not to be reasonable or necessary.”
The importance of Section 38(8) cannot be understated.
The MIG does not apply if the insurer fails to give notice.
Section 38(11) If the insurer fails to give a notice in accordance with subsection (8) in connection with a treatment and assessment plan, the following rules apply:
1. The insurer is prohibited from taking the position that the insured person has an impairment to which the Minor Injury Guideline (MIG) applies.
Clearly I am not alone in my opinion. The Anti-Fraud task force recommended changes to Section 38(8)
ONTARIO AUTOMOBILE INSURANCE ANTI-FRAUD TASK FORCE recommendation #4
The government should reduce uncertainty and delay for those who have legitimate auto insurance claims by moving aggressively to:
a) address the current backlog of mediation cases before the Financial Services Commission of Ontario, and develop a more robust dispute resolution framework;
b) introduce treatment protocols for minor injuries that are based on scientific evidence; and
c) amend the Statutory Accident Benefits Schedule to make it clear that insurers are required to provide claimants with a full explanation when refusing to pay for treatment, assessment or other benefits.
How many of the current backlog of mediation cases revolve around the issue of the MIG?