Minor Injury Guideline Overview

The Minor Injury Guideline came into effect at the same time as the new Statutory Accident Benefits Schedule (SABS) that prescribes it. Effective September 1, 2010, the MIG replaces the previous PAF (Pre-Approved Framework) Guideline for Grade I and II WADs (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.

In addition, a new OCF-23 (Treatment Confirmation Form) was released, which according to the MIG, is now to be used for all goods and services for newly reported WAD I and II injuries pre-dating September 1, 2011 and for all minor injuries that occur on or after that date. The OCF-24 was also revised and is now called the Minor Injury Treatment Discharge Report. Unless the insurer waives the requirement for the OCF-23, it must be completed by a professional meeting the definition of “health practitioner” (the form lists the health professionals who meet the definition).

We remind our readers that these forms are all supported by Universal Office.

A full review of the MIG is beyond the scope of this Rehab Information Network release and readers are strongly advised to review it in detail at http://www.fsco.gov.on.ca/english/pubs/bulletins/autobulletins/2010/A-10_10-1.pdf. Given the MIG’s specific instructions about when and which forms to complete for different purposes, however, we as client partners are pleased to provide guidance about how to do so in Universal Office.

Now for the basics. The MIG describes a minor injury as “a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae”. As noted, under the MIG, goods and services that are provided for the assessment and treatment of minor injuries are subject to a $3,500 limit. According to the Guideline, however, under certain conditions, an impairment may fall outside the minor injury definition, and therefore be exempt from its funding limit. As the Guideline states, a claimant may be exempt if their injury or injuries are “predominantly a minor injury but, based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3,500 limit … or is limited to the goods and services authorized under this Guideline”. The MIG, though, goes on to stipulate that “the existence of any pre-existing condition will not automatically exclude a person’s impairment from this Guideline. It is intended and expected that the vast majority of pre-existing conditions will not do so”.

Within the $3,500 maximum, there is a pre-approved limit of $2,200 for assessments, treatments, supplementary goods and services (maximum $400) and discharge reporting, as prescribed by a service blocking and sequencing model, which is detailed in the MIG. We will provide you with a brief flavour for the model and its associated OCF use in this overview. For full details, click on the MIG GAP Codes and Fee Schedule.

The OCF-23 is not required if after the initial assessment, the practitioner determines that no further treatment is required. An OCF-21 C may be submitted for up to $215 for the session. If, on the other hand, the practitioner has compelling evidence that the patient’s injuries are so severe that they fall outside of the MIG and are therefore exempt from its limits, in addition to submitting the OCF-21C for the assessment, they should complete and submit an OCF-18 Treatment and Assessment Plan (also revised effective September 1, 2011). Further, an OCF-18 must be submitted in the normal manner if after the pre-approved limit of $2,200 has been reached, the practitioner determines that further interventions are required. In other words, the remaining $1,300 of the MIG cap of $3,500 requires an OCF-18.

A caveat is in order here. We are hearing anecdotally that submission of an OCF-23 without doing a thorough assessment and a review of a patient’s history for the identification of possible pre-existing conditions that might otherwise qualify the patient for goods and services covered under the serious injury limit of $50,000, increases the probability that an insurer will cite the submission of the OCF-23 itself as an indication that the patient is not exempt from the MIG.

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