By Viivi Riis and Brenda Barry

When the minor injury guideline (MIG) came into effect in September 2010, Insurance Bureau of Canada (IBC) began research – in the form of a survey – to monitor how the guideline was being used.

Early results of the research show that while more than half of claimants with minor injuries are being treated in the MIG, there is room for improvement.

Background
The government introduced the concept of “minor injury” within its auto insurance reform package last year. Minor injuries, including strains, sprains and whiplash-associated disorders, make up the vast majority of auto collision injuries.

The MIG is designed so that health professionals can immediately begin treatment on patients with injuries consistent with the definition of a minor injury without insurer prior approval. The cap on the total claim cost is set at $3,500. The intention is to ensure timely access to treatment for claimants to improve health outcomes, which may potentially reduce costs.

IBC Research Project

To monitor system behaviour, IBC estimated the number of claims expected to fall within the MIG.

Two experts – government actuary Oliver Wyman and IBC actuary Ron Miller – helped with the estimation. They concluded that 55% to 65% of all SABS claimants (including non-minor and catastrophic injuries) would fall within the MIG and the expenditure cap of $3,500.


We extrapolated from the work of Wyman and Miller, taking into consideration the health care literature, which suggests that approximately 80% of all injuries sustained in automobile collisions are soft tissue injuries. Since our sample would be made up entirely of minor injury claimants, we expected 75% to 85% of claimants with minor injuries should receive treatment within the MIG.

Participating insurers reported on claimants whose injuries were consistent with the SABS definition of minor injury based on the information provided by the claimant’s intake interview or initial statement of claim, OCF 1. When neither was available, the determination was based on the injury codes supplied on the first OCF 18 or OCF 23. (OCF 18s are intended to propose treatment for claimants not eligible for treatment in the MIG, while OCF 23s are intended for claimants whose injuries are suitable for treatment in the MIG.)

To assess how the MIG is being implemented, we looked at the rates of OCF 23 versus OCF 18 utilization in two groups. Cases in which insurers waived the OCF 23 were treated as if an OCF 23 had been submitted.

Group A is made up of claimants whose injuries occurred on or after September 15, 2010, two weeks after the MIG was implemented. Claimants in Group B sustained injuries on or after January 10, 2011, four months following the implementation of reforms. The two groups are comparable in terms of age, gender and employment status.

IBC Research Results

 
 The chart shows increased use of the MIG in the later group. Just after the guidelines were introduced, only 52% of claims were submitted on OCF 23s, while four months later, 63% were OCF 23s.

Use of the MIG also varied by region. In particular, fewer OCF 23s were submitted in the Greater Toronto Area in both groups. Further research is needed to understand the different rates of use based on geography.
As shown in the following chart, a number of claims were initially submitted on OCF 18s, but then treatment began within the MIG. Unfortunately, this process often requires the expense of an insurer examination, adding cost to the system. This also indicates that an OCF 18 submission is not always confirmation of non-minor injury or an injury unsuited for treatment in the MIG. 

Next Steps


 Data gathering for periods of 12 and 26 weeks after date of loss is underway for the last two phases of this research project. This will help determine rates of MIG use and associated costs, and offer insight into the minor injury cap of $3,500 and some of the medical and rehabilitation benefits provided within the MIG. We hope this research will assist to identify issues with the new claims environment, so that stakeholders can work together to find solutions.

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Viivi Riis, BScPT, MSc, is a health care researcher and senior health analyst at Insurance Bureau of Canada. Brenda Barry, BScPT, MHSc(HA), is a consultant focusing on health policy, planning and evaluation.