Ontario minor injury threshold and deductible_.

What is the minor injury threshold?

The minor injury threshold is a broadly worded test set out in the Insurance Act that determines whether someone who has been injured in a car accident is entitled to sue for general damages for pain and suffering. The Act prohibits recovery of these damages unless the injured person has suffered a “serious disfigurement or serious impairment of an important physical, mental or psychological function.”

Since the wording of the threshold is broad, there is a regulation that provides further clarity. Essentially, in order to qualify for pain and suffering damages following a car accident, the impairment must:

1. Substantially interfere with the person’s ability to perform the necessary functions of their regular employment, career field, or activities of daily living; AND
2. Interfere with necessary responsibilities of their employment, career, activities of daily living, or their own self-care; AND
3. Have been continuous from the time of the accident and continue to be interfering.

In other words, the impairment must be serious, affecting important functions, and permanent.

Whether your injuries are subject to the minor injury threshold is an issue that must be decided by a judge at a pre-trial motion or at trial. Your lawyer will advocate on your behalf to seek a judgment that your injuries are an exception, and therefore do not fall within the minor injury threshold.

If your case settles outside of court, you do not need a judge to make a ruling on whether your injury falls under the minor injury threshold. Instead, your lawyer will negotiate on your behalf with the insurance adjuster or lawyer, to secure a favourable settlement. Insurance adjusters typically seek to settle out of court as a court case can be an expensive procedure for the insurance company.

What is the deductible for general damages?

Once you prove that your injuries exceed the minor injury threshold, your non-pecuniary damages, or general damages, will be lowered by the current year’s deductible amount. The deductible is prescribed in section 267.2 of the Act. Every year in December, the Ontario Gazette publishes what the deductible will be for the following year.

For example, if you were involved in a motor vehicle accident in 2018, you exceeded the threshold, and your non-pecuniary damages are assessed at $80,000, then they will be lowered by $37,983.33. The total damages awarded to you will be $42,016.67.

If your non-pecuniary damages are high enough, they will surpass another threshold where they will be exempt from the deductible (“the deductible threshold”). The threshold changes from year-to-year and is announced in the same issue of the Ontario Gazette, as the deductible is.

What is the Minor Injury Guideline (MIG)?

The Minor Injury Guideline (MIG) is part of the Statutory Accident Benefit Schedule (SABS) and provides a framework for treatments and other resources for those who have suffered a minor injury in a motor vehicle accident.

According to the Financial Services Regulatory Authority of Ontario, the MIG has three main purposes:

1. Access to speedy treatment
2. Improve utilization of resources
3. Certainty of costs for insurers and health care professionals

The MIG covers a maximum of $3,500 in medical and rehabilitation benefits, as set out in the Statutory Accident Benefits Schedule (SABS). However, this limitation does not apply where a health practitioner provides evidence that the injured person has a documented pre-existing medical condition that will prevent them from recovering fully if subjected to the treatment cost cap of $3,500.

How do we prove that your injury exceeds the minor injury threshold?

The lawyers and legal assistants at MacGillivray Law are aware of which types of evidence the court looks for when determining whether your injuries meet the minor injury threshold. We will gather evidence from physicians and health care providers who have treated you in the past. When necessary, we will co-ordinate assessments to ensure you are providing the most extensive evidence possible for your case.