Challenging a MIG Determination

Discover Limits to the Tribunal’s Jurisdiction or Ability to Hear This Issue

A recent case, Bobak v. Travelers Insurance[1], explored whether the License Appeal Tribunal (“Tribunal”) has jurisdiction over a matter in which the above issue is the only issue in dispute.

Mr. B was injured in a MVA on September 16, 2017. He sought statutory accident benefits from Travelers Insurance. Travelers denied his claims. He challenged this denial to the License Appeal Tribunal (Tribunal).

The issue in the proceeding is whether Mr. B’s injuries fall within the definition of the Minor Injury Guideline (MIG). However, the insurance company brought a motion before the case conference to dismiss the application without a hearing, on the grounds that the Tribunal lacks the jurisdiction to hear this matter.

Section 280(1) of the Insurance Act defines the jurisdiction of the Tribunal: to “resolve disputes in respect of an insured person’s entitlement of statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured is entitled”.[2] Travelers’ position was that the Tribunal does not have the jurisdiction over the proceeding because the MIG is a guideline, not a benefit or amount of a benefit. Mr. B’s position was that the Tribunal does have jurisdiction to decide the issue despite not being tied to a specific benefit. Both sides cited case law and argued statutory interpretations in their favors.

The Tribunal agreed with Travelers’ position.

The Tribunal supported its final decision with three main reasons.

First, if an insured person’s injury is classified as minor, nonminor or catastrophic, it merely allows that person to apply for benefits within that monetary tier. If an individual’s injury is classified as minor, it allows them to apply for medical and rehabilitation and attendant care benefits for a combined total of $3,500; but it doesn’t entitle them to that monetary limit. Rather, s. 18 of the Statutory Accident Benefits Schedule (SABS) allows them to apply for those benefits up to that limit. This statutory interpretation is most consistent with a plain reading and the context and purpose of the statutory scheme.

Second, the Tribunal rejected Mr. B’s argument that the two-year limitation period that applies to an insured’s right to challenge an insurer’s denial also applies to statute-bar an insurer’s ability to classify an injury as minor two years after the accident.

Third, the Tribunal stated that it is a waste of the Tribunal’s time to decide the MIG issue as a standalone issue without any particular benefits being tied to it.

In conclusion, the Tribunal determined that the MIG does not entitle an insured to benefits or an amount of benefits they are entitled to; consequently, it is not a dispute contemplated under s. 280 of the Insurance Act. For that reason, Travelers’ motion was granted and the application was dismissed without a hearing.

In conclusion, in answer to the question posed by the title of this blog post, this precedent clearly establishes that the Tribunal lacks jurisdiction over a proceeding where the only issue is whether the insured’s injuries are minor or not.

[1] 2022 ONLAT 21-004004/AABS.

[2] Insurance Act, R.S.O. 1990, CHAPTER I.8, s. 280(1).