Classification decisions sit at the centre of accident benefits practice. Whether an injury falls within the Minor Injury Guideline determines the treatment framework, the monetary limits that apply, and often the direction the file will take. At first glance, classification can appear straightforward. The regulation lists certain injuries, the MIG provides structure, and the adjuster applies the definition to the diagnosis presented. The recent decisions in Marcelo demonstrate that the process is more complex. Classification is not a dictionary exercise. As with adjusting, it is contextual.
Words in the Statutory Accident Benefits Schedule must be interpreted within the broader legislative scheme. Medical terminology must be understood in light of the body system involved and the clinical realities of diagnosis and recovery. From a practical standpoint, MIG classification must also be viewed as part of the evolving narrative of an accident benefits claim rather than as a single static decision.
Marcelo v The Personal: Context in MIG Classification
In Marcelo v The Personal Insurance Company[1], the claimant sustained a left frontal intracranial cerebral contusion (a brain contusion) in an August 2019 motor vehicle accident. The insurer placed her injuries within the MIG, limiting medical and rehabilitation benefits to $3,500. The Licence Appeal Tribunal upheld that placement, concluding that the definition of minor injury in section 3(1) of the Schedule includes a contusion and that the term was not limited. In the Tribunal’s view, a brain contusion fell within the MIG unless it resulted in a non minor impairment.
On reconsideration, the Tribunal affirmed that reasoning, maintaining that a contusion, including an intracranial contusion, remains a minor injury unless the resulting impairment rises beyond a minor level. The focus remained on the degree of impairment rather than on the nature of the injury.
The Divisional Court disagreed. On appeal, the Court held that the definition of minor injury is injury based, not impairment based. It concluded that an intracranial brain contusion does not fit within the type of injuries contemplated by the MIG framework and removed the claimant from the MIG. In essence, the Court confirmed language matters, but context matters more.
The importance of Marcelo extends beyond one diagnosis. It reinforces a broader principle. Classification under the MIG must be grounded in context.
Why MIG Classification Is Not a Word-Matching Exercise
The central lesson from Marcelo is about method. Proper classification requires attention to statutory context, medical context, and file context.
This approach aligns with a foundational principle in insurance law. In Smith v. Co operators General Insurance Co., 2002 SCC 30, the Supreme Court of Canada confirmed that insurance legislation must be interpreted through a consumer protection lens and in a manner consistent with its remedial purpose. Accident benefits legislation is designed to reduce economic hardship and provide structured compensation. That principle does not eliminate limits such as the MIG. It does require that those limits be applied in a manner consistent with the statutory scheme.
Statutory Context Under the SABS
Section 3(1) defines minor injury as including a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation. That definition operates within a structured regime. The MIG establishes a twelve-week functional restoration model, limited diagnostic access primarily X rays without prior approval, a $3,500 treatment cap, and an assumption of relatively predictable recovery patterns.
The Divisional Court concluded that this framework reflects a model designed primarily for musculoskeletal injuries. A neurological injury involving intracranial pathology identified on CT imaging does not align comfortably with that structure.
Medical Context: When a Contusion Is Not Just a Contusion
Medical terminology can create false uniformity. The word contusion may describe a bruise to muscle tissue or a contusion to the brain. The label is the same. The medical implications are not.
A brain contusion may involve intracranial pathology, require CT or MRI imaging, and raise concerns about delayed cognitive or neurological symptoms. It may necessitate neuropsychological assessment. These realities differ fundamentally from soft tissue bruising.
File Context and the Evolving Accident Benefits Claim
For adjusters, the most practical dimension of context is the trajectory of the file. Classification is rarely an isolated act. It influences what treatment is funded, what assessments are obtained, how evidence develops, and how the claim evolves.
The lesson from Marcelo is that adjusters should resist the temptation to treat classification as a word matching exercise. Context is important. An adjuster needs the ability to move beyond the micro aspects of the claim, such as specific report findings, and consider how each medical opinion fits within the context of the entire file. Micro analysis focuses on isolated phrases or diagnoses. Macro analysis examines how the injury, the medical evidence, and the statutory framework interact over the life of the claim. The presence of a listed term such as “contusion” does not end the analysis. Context completes it.
The MIG within its intended Scope
The MIG was designed to address the majority of uncomplicated soft tissue injuries that arise from motor vehicle accidents. It provides a structured and efficient treatment model for sprains, strains, and similar musculoskeletal conditions that typically follow predictable recovery patterns. In many cases, the MIG functions exactly as intended and should be applied confidently and consistently.
Reassessment Is Professional Discipline
Early classification decisions matter. They structure the file and influence its development. However, no classification decision is permanent. Medical evidence evolves. Imaging may be obtained later. Specialist opinions may clarify diagnosis. Symptoms may change. New information may arise from treating providers, insurer examinations, diagnostic testing, employer information, or claimant reporting.
Adjusters should never become so married to an early decision that reassessment becomes psychologically difficult. The appropriate question is: Given what we know today, is the current classification still appropriate?
Practical Takeaways for Accident Benefits Adjusters
- Do not treat classification as a word matching exercise. A listed term does not end the analysis.
- Distinguish between micro and macro analysis. Evaluate individual reports but also assess how the entire file aligns with the statutory framework.
- Confirm that the MIG structurally fits the injury. Consider body system, diagnostic pathway, and recovery trajectory.
- Apply the MIG confidently where appropriate. Most uncomplicated soft tissue injuries properly fall within its structure.
- Never become married to an early classification decision. Reassessment in light of new evidence reflects professional discipline.
- Regularly ask: Given what we know today, is the current classification still appropriate?
When classification decisions are grounded in context, adjusters protect the integrity of the statutory scheme, the fairness of the individual claim, and the defensibility of the file. Context does not complicate the analysis. It completes it.
Frequently Asked Questions About MIG Classification
Is a brain contusion automatically a minor injury under the MIG?
No. The Divisional Court in Marcelo v The Personal Insurance Company confirmed that MIG classification is injury-based, not impairment-based. An intracranial brain contusion does not automatically fall within the Minor Injury Guideline simply because the term “contusion” appears in section 3(1) of the SABS. The analysis requires consideration of statutory context and the nature of the injury.
Is MIG classification injury-based or impairment-based?
MIG classification is injury-based. The Divisional Court in Marcelo rejected the approach that focused solely on the degree of impairment. The proper question is whether the injury itself falls within the type of injuries contemplated by the Minor Injury Guideline framework.
Can an insurer reassess MIG placement later in the claim?
Yes. Classification under the Minor Injury Guideline is not fixed permanently at the outset of an accident benefits claim. As medical evidence evolves, imaging is obtained, or specialist opinions clarify diagnosis, the insurer may reassess whether MIG placement remains appropriate on the available information.
Does being removed from the MIG due to a brain contusion mean treatment is automatically payable?
No. Removal from the Minor Injury Guideline does not make treatment automatically payable. As with all accident benefits claims, proposed treatment must still be reasonable and necessary under the Statutory Accident Benefits Schedule and supported by the medical evidence.
[1] Marcelo v. The Personal Insurance Company, 2026 ONSC 974 (CanLII)
