By Kiran Qureshi

The Government of Ontario is unveiling new changes to the Statutory Accident Benefits regime commencing February 1, 2014.  One notable change is that claimants who fall under the Minor Injury Guideline ("MIG"), may only seek treatment beyond the cap of $3,500.00 if they have a “pre-existing medical condition that was documented by a health practitioner before the accident.”[i]  The requirement that a pre-existing medical condition be documented is new.  Therefore, if a claimant did not receive medical attention for a pre-existing condition before the motor vehicle accident, then that condition will not be considered for the purposes of determining whether or not the client is in the MIG.   The practical result of the amendment is that the Government is casting a wider net for injured claimants to fall into the MIG and have their treatment limited to the $3,500.00 cap. 

Ironically, the new stipulation comes into effect at the same time that the Health Council of Canada has released a publication informing that long wait times are impeding Ontarians from receiving timely medical care. Their report states,

"fewer than half of Canadians surveyed, ranging from 31% to 46%, could get a same-day or next-day appointment when needed (not including ED visits), the worst of all the countries surveyed and with no improvement since 2004."[ii]

Thus, even where a patient has actively sought medical attention but never received it, they will have unintentionally disqualified themselves from the exclusions to the MIG should they be involved in a motor vehicle accident sometime in the future.

The pitfalls of the amendment are even more pronounced for people that are already marginalized.  For example, newcomers to Ontario who are subject to a three month waiting period for coverage from Ontario Health Insurance Plan (OHIP), because they may not seek medical attention during that time due to financial barriers.  Other “uninsured” groups on whom the effects of the change will be multiplied are those who have lost their identification, some refugees, temporary visa holders and undocumented residents.  Collectively, these people are less likely to have their pre-existing medical conditions “documented” and therefore the burden of the government’s changes will fall disproportionately on the shoulders of people that are already very vulnerable.

Finally, pre-existing conditions may not even be discovered until after an accident when a claimant is seeking medical attention for their accident-related injuries, yet those persons will also not be able to remove themselves from the MIG.

Unfortunately, for the government to rule that a pre-existing medical condition must be documented before the accident is akin to an badly aimed attack on persons that are already suffering and vulnerable.