Personal injury law is a cornerstone of justice for those harmed by others’ negligence. At MG Law, we’re committed to challenging insurance companies that put profits before people. Recently, we secured two favourable decisions at the Licence Appeal Tribunal (LAT) for clients who suffered concussions in motor-vehicle accidents.
These decisions not only highlight our commitment to fighting for justice but also underscore the importance of holding insurers accountable when they ignore critical evidence—like concussions—that can drastically impact recovery.
Life-Altering Accidents and Denied Claims
Imagine being involved in a motor vehicle accident, sustaining injuries, and then facing years of denied benefits despite clear medical diagnoses. This was the reality for two individuals whose lives were turned upside down by accidents caused by negligent drivers. Both men sought fair treatment under Ontario’s statutory accident benefits system but found themselves trapped within the Minor Injury Guidelines (MIG), with Economical Insurance refusing to acknowledge their concussion diagnoses.
For these clients the struggle wasn’t just about financial compensation. It was about accessing the treatments they desperately needed to recover. Being stuck in the MIG meant limited access to essential therapies, leaving them to navigate physical, emotional, and financial hardships on their own. These cases shine a light on how insurers like Economical often delay or deny claims, forcing victims into prolonged legal battles while their health deteriorates.
Case 1: Mohammed v. Economical Insurance
The Applicant was involved in a motor vehicle accident on July 8, 2020. Despite consistent reporting of post-concussion symptoms to his family physician, Economical refused to remove him from the MIG. The insurer claimed there was insufficient evidence of a concussion despite a formal diagnosis and ongoing documentation of Applicant’s symptoms, including headaches, sensitivity to light, and dizziness.
The Licence Appeal Tribunal (LAT) reviewed the medical evidence and concluded that the Applicant’s concussion diagnosis warranted removal from the MIG. While the Tribunal denied some disputed treatment plans due to lack of clarity, the ruling reinforced the principle that concussions are not minor injuries—a major win for personal injury law.
Case 2: Zeineddine v. Economical Mutual Insurance Company
The Applicant faced a similar battle after a January 20, 2020 accident. Diagnosed with a concussion at Ottawa General Hospital by Dr. Sebastian Dewhirst, he ought approval for various treatments, including occupational therapy, psychological assessments, massage therapy, and social rehabilitation counseling. Economical, however, maintained that the Applicant’s injuries fell within the MIG and denied all requested treatments.
In its decision, the LAT ruled in favour of the Applicant, affirming his removal from the MIG and awarding funding for multiple treatments. The Tribunal placed no weight on Economical’s assessor, Dr. Michael Aiello, whose report ignored the documented concussion diagnosis. This victory ensured Ahmed received the care he needed to address both physical and psychological impairments stemming from the accident.
Why These Cases Matter
These rulings go beyond individual victories—they address broader issues affecting personal injury law in Ontario:
1. Can insurers block access to treatments by ignoring medical evidence?
Economical argued that concussions didn’t justify removing Applicants from the MIG, even though concussions are explicitly excluded from the definition of “minor injuries” under the Schedule. The Tribunal decisively rejected this argument, reaffirming that insurers cannot dismiss valid diagnoses without compelling evidence.
2. What happens when concussion diagnoses are dismissed under the MIG?
For both applicants, the denial of benefits meant years without proper care. Their stories illustrate why it’s crucial for insurers to respect medical evidence rather than relying on flawed assessments.
3. How far should insurers go before accountability kicks in?
Economical’s tactics—including dragging out disputes for years—highlight the need for stronger safeguards to protect accident victims from such practices.
This case became more than a fight for benefits. It was a defining moment for justice, dignity, and ensuring no one is sidelined in their recovery journey.
The Presumption of Evidence Over Assumptions
Both cases underscored the importance of relying on credible medical evidence rather than subjective opinions. These decisions reaffirmed that insurers cannot dismiss valid claims without substantial proof. They also reinforce a key principle in personal injury law: the presumption of capability and the burden of proof lies with the insurer.
What This Means for You
If you’re dealing with a denied insurance claim, these cases offer valuable lessons:
– Document everything: Seek immediate medical attention and ensure your injuries are thoroughly documented.
– Recognize unfair treatment: Insurers may downplay serious conditions like concussions to avoid paying benefits.
– Seek legal help: An experienced personal injury lawyer can make all the difference in challenging denials and securing the compensation you deserve.
At MG Law, we understand the complexities of personal injury law and are here to guide you through every step of the process.
A Legacy of Resilience and Justice
By affirming that concussions fall outside the MIG, the LAT sent a clear message: insurers cannot avoid legitimate claims. These victories reinforce protections for all accident victims, ensuring they receive the care and support they need to rebuild their lives. Click here to explore both cases.
How MG Law Can Help
At MG Law, we believe that personal injury law is about more than financial recovery. It’s about preserving dignity and autonomy. Our team fought tirelessly for our clients, proving that insurers cannot act with impunity. If you’re facing challenges with your claim, don’t face them alone. Contact us today for a free consultation, and let us help you secure the justice you deserve.
