December 4, 2015

Draft Common Traffic Impairment (CTI) Guidelines – Are These the New MIG?

Daniel MacDonald

Daniel Macdonald

This year has already seen a number of amendments made to the Statutory Accident Benefits Schedule. It now appears that even more changes are on the horizon. This summer the Financial Services Commission distributed for consultation new draft guidelines called the Common Traffic Impairment (CTI) Guidelines[1]. The CTI Guidelines are directed toward “minor injuries” and how treatment is provided for those injuries. The CTI Guidelines would be a replacement for the current Minor Injury Guidelines.
The basis for these future changes comes from a report commissioned by the Financial Services Commission (FSCO). That report, completed earlier this year and titled “Enabling Recovery from Common Traffic Injuries: A Focus on the Injured Person”, was prepared by the Ontario Protocol For Traffic Injury Management (Optima) Collaboration, chaired by Dr. Pierre Côté.[2] The findings also inform new clinical treatment guidelines or “care pathways” which direct how specific injuries are to be treated.

Many stakeholders whose members provide treatment to those injured in motor vehicle collisions or who advocate for injured persons have reviewed the draft CTI guidelines have expressed concerns with the draft. Feedback and concerns of the some stakeholders, more comprehensive than the scope of this update, can be found online.[3]

One of the major concerns with the guidelines stems from the report that the guidelines are based on. The report finds that for the general population who have “minor” injuries caused by traffic collisions, at least 50% of people recover within six months. Based on this, the CTI Guidelines provide treatment pathways or care plans for up to six months. But what about the 50% of the people who don’t recover within six months? The CTI guidelines don’t help those people. What good are guidelines that right off the bat are insufficient to help half of the people that get injured in a motor vehicle collision? Those individuals will require a physician or nurse practitioner to provide compelling evidence as to why their injuries should exclude them from the CTI. This is going to exclude a great deal of people from the medical rehabilitation treatment they require.

The table below sets out some of the other changes in the CTI Guidelines as compared to the current Minor Injury Guidelines.



  Reason for Concern
The definition of a “Common Traffic Impairment” is more expansive than a “Minor Injury” and would include radiculopathies, TMJ disorder, mild traumatic brain injury, and psychological impairments. More injuries will now receive the minimal level of medical rehabilitation benefit.

To get out of the CTI, there must be “compelling” evidence provided by a physician or nurse practitioner.  Other treatment providers cannot give that evidence.



Physicians and nurse practitioners are going to end up playing a critical gate-keeping role.  This places a huge burden on these health care providers to act as advocates for their patients.   Individuals who do not have a family physician or access to a nurse practitioner will be disadvantaged.



Excluded from the list of health professionals permitted to initiate and coordinate goods and services for insured persons under the CTI Guidelines are occupational therapists, speech language pathologists and psychologists.


It is mystifying why these professionals, whose scopes of practice allows them to provide treatment proscribed in the care pathways set out in the Guideline, are excluded from co-ordinating care.

There is a maximum 6 month timeframe for treatment from the date of the crash.  Care pathways set out available treatment for 2 phases: recent onset phase (0-3 months) and persistent phase (4-6 months).



Those injured in a motor vehicle collision will have to get treatment early and hope you better quick.  If not, they may be out of luck.Those who take a wait and see approach may be limited in their options for treatment.  Indeed, the Guidelines specifically provide that a person who begins treatment between 4 and 6 months post-accident may only access treatment set out in the persistent phase.



There is a maximum benefit per month and per treatment phase.

Although the fees payable per month and per-treatment phase are not yet identified in the draft Guidelines this seems very controlling and restrictive.


It remains to be seen what the final version of the CTI Guidelines will look like. However, the current draft should be very concerning. This regime imposes a great number of restrictions on when, what, and how much treatment a person injured in motor vehicle collision can receive. Most concerning, is that the entire regime is directed at providing treatment over a period of time where only 50% of the general population recovers. This seems to follow the recent trend in accident benefits of getting fewer benefits for injured people.

It is also worth noting that a policy like this is penny wise and pound foolish. People who don’t have access to rehab dollars but need the rehab don’t go back to work like they would have. That means an income loss claim in tort. This strategy is reminiscent of the limitation on the ability to sue for health care costs: that made no sense, because it sent plaintiffs to trial with the possibility of retraining to mitigate their income losses, but no funds could be awarded to put that into place. So the income claim goes up.

Someday, governments and accountants at insurance companies will realize this is not an exercise in bean counting. Someday…






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