September’s NewsWatch featured the MIG Takes Flight synopsis of the Minor Injury Guideline. That article considered the possibility that with the definition of serious injury so restricted, claims operations managers would set the bar for serious injury evidence higher than the MIG intended. After almost seven months since the MIG’s September 1 effective date, NewsWatch asked personal injury lawyer Drew Sinclair of the firm Oatley Vigmond to offer his perspective on how practice compares with MIG theory.
Read Sinclair’s entire article in the next issue of The Health Professional magazine in mid-April.
The Minor Injury Guideline is of concern to all stakeholders in the insurance system. For the injured, the ability to rehabilitate has been seriously compromised. For health care providers, without a financially backed client base, the ability to operate and provide medical and rehabilitation services has been put in jeopardy.
For insurers, the situation is slightly more complex. The broadly defined MIG will certainly capture more claims than its predecessor, the Pre-Approved Framework, and in the short term will provide financial savings. But in the long run insurers are going to feel the MIG’s ill effects as well. When incomplete rehabilitation eventually leads to more serious impairment, insurers are going to find themselves paying out their savings into other benefits. This situation is an opportunity for health care professionals and insurers to work together to make sure that claims with extensive rehabilitation needs are fully satisfied.
Adjusters are being advised to be strategic, and to watch for claims that could turn costly if rehabilitation is insufficient. Certainly many adjusters do their best to ensure claimants receive funding under the appropriate benefits stream (i.e. the MIG, non-catastrophic or catastrophic). But not all adjusters are advocates for their injured claimants and investigate claims to obtain the most comprehensive benefits. For some adjusters, there are too many files and not enough hours in a day. For others, the lure of immediate financial savings by putting a claim in the MIG may be too tempting to resist.
Health care professionals have been acting as advocates for their clients in the accident benefits system for many years. That duty is now heightened. When dealing with insurers, it’s going to be crucial for health care professionals to document as clearly as possible the cases where prolonged and intensive rehabilitation is needed.
Read full article at The Health Professional