Pre-Existing Conditions and the Minor Injury Guideline > Accident Benefits – Part 6
One exception to the Minor Injury Guideline are pre-existing medical conditions which “will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject” to the Minor Injury Guideline (i.e. the $3,500 hard cap).
This exception is only expected rarely, as explicitly set out in Paragraph 4 of the Minor Injury Guideline:
Only in extremely limited instances where compelling evidence provided by a health practitioner satisfactorily demonstrates that a pre-existing condition will prevent a person from achieving maximal recovery from the minor injury for the reasons described above is the person’s impairment to be determined not to come within this Guideline. Exclusion of a person from this Guideline based on reasons or evidence falling short of this requirement is inconsistent with the intent of the SABS and this Guideline.
It is noted that “compelling evidence” is required from the health practitioner who is submitting the OCF-18 Treatment Plan.
It is noted that the legislation regarding tort claims have not been modified in conjunction with the introduction of the Minor Injury Guideline, leaving open to claimants a claim in tort for health expenses not paid for by the Accident Benefits carrier.