Injuries from a Car Accident

If you have been involved in a car accident, call our clinic to book an appointment to be evaluated by one of our professional physiotherapists. You do not require a referral from a doctor to access physiotherapy services. Your insurance company has forms you will need to complete.

The Ontario government working with Healthcare providers and insurance companies has devised the Injury Guidelines for people injured in car accidents to speed access to rehabilitation. Once your assessment has been completed, your injuries will be designated as Minor or Major. Minor injuries have a maximum of $3,500 for treatment, Major injuries have $50,000. A minor injury would be a sprain, strain, bruise, superficial skin abrasions or cuts, partial joint dislocation, or whiplash without neurological problem or serious spine damage.

If you have a medical condition before the accident that was worsened by a minor injury you may not be limited to minor injury maximum benefit.

Physiotherapy and massage therapy visits are covered by your insurance. Treatment is expected to be complete in twelve weeks, starting from initial visit for assessment. If you require equipment to exercise at home and products to help with pain like hot/cold packs, braces, or back supports your health care provider can provide them for you without getting approval from your insurer or as long as the total cost is under $400. The cost for these products is in addition to your $3,500 for treatment.

Funding and Injury Guidelines

Insurance companies have separated the injuries caused by motor vehicle accidents (MVA) into two categories as of September 1, 2010. The Minor Injury Guideline (MIG) and The Major Injury Guideline came into effect at the same time as the new Statutory Accident Benefits Schedule (SABS) that prescribes it. The MIG replaces the previous PAF (Pre-Approved Framework) Guideline for Grade I and II WADís (Whiplash Associated Disorder) and thus supersedes it for such disorders arising on or after September 1, 2010. It also caps medical/rehabilitation and assessment/examination expenses for those and other minor injuries, as defined in the Guideline, to $3,500.

Following your accident, a health professional will examine you and determine if you have any clinically relevant neurological signs (weakness, changes in senses or sensation and changes in reflexes)

According to the guidelines, if you do not have any clinically relevant neurological signs then you are assigned to the Minor Injuries Guideline (MIG) category. This means that your medical/rehabilitation and assessment/examination expenses are capped, or cannot exceed, $3,500. This amount includes ALL your expenses i.e. physiotherapy, massage, chiropractic, acupuncture, gauze bandages, braces, splints etc.

Should you have clinically relevant neurological signs then your health professional will suggest you be included in the Major Injuries Category. Inclusion in this category means that your medical/rehabilitation and assessment/examination expenses are capped, or cannot exceed, $50,000.

There is an enormous disparity in accessible recompense when assigning an individual’s injuries as belonging to either the Minor Injuries ($3500) or Major Injuries ($50,000) Category. It is therefore in the best financial interest of any insurance company to ensure that all their clients fall within the Minor Injuries Category as this limits the insurerís financial exposure to $3500.

If your health professional has decided you fall into the Major Injuries Category they will then submit the appropriate paperwork. Most insurers will immediately flag the submission and require the insured to have either an independent physical examination or records examination meaning some other health professional will determine the validity of the original submission based on examining you or reading your health records. Donít take this scrutiny personally; this will simply be a policy of the insurer.

diagram of billing process
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