Documents mental health treatment outcomes and recommended next steps at the end of treatment.
- Completed by
- Health care practitioner (mental health)
- Issued by
- Alberta Treasury Board and Finance (Care-First)
- Language
- English
Alberta MI-3: Certified Examiner Minor Injury Opinion
A Certified Examiner uses this prescribed form to give an opinion on whether a claimant's motor vehicle injury is or is not a minor injury under Alberta's Minor Injury Regulation and the Insurance Act. It follows a request for a Certified Examiner assessment, and the examiner gives a copy of the opinion to both the claimant and the defendant.
Who completes it
A health professional on the Superintendent of Insurance's Certified Examiner Register completes the whole form, from claimant and insurer details to the examination findings and conclusions. The examiner signs Part 13.
Submitting and payment
- How to submit it
- The form states that the Certified Examiner provides a copy of the opinion to both the claimant and the defendant, including all the information the form lists.
- Who pays
- Certified examiner assessment and reporting fees are published in a Superintendent of Insurance bulletin.
Good to know
- The form ends with two questions: whether the injury is a minor injury as defined in the Minor Injury Regulation, and whether there is a serious impairment as defined there.
- It is prescribed under Section 11(1) of the Minor Injury Regulation and Section 803 of the Insurance Act, and applies to accidents on or after October 1, 2004.
- The form recommends reviewing the College of Physicians and Surgeons' guideline on Medical Examinations by Non-Treating Physicians (NTMEs) and its Advice to the Profession before completing the report.
- The MI-3 is a general format that the examiner may fill out or alter as required for an individual claimant.
Get the official form
Download the current version from the source each time; forms change without notice.
Certified Examiner Prescribed Form for Providing an Opinion
Fill it with Vero
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
What sections are in the MI-3?
After claimant and insurer details and a statement of why the examination was requested, the MI-3 covers consent, information reviewed, history of injury, medical history, occupational history, normal activities of daily living, examination details, and conclusions with diagnosis and prognosis. Part 12 lists any attached documents.
How is a Certified Examiner chosen in Alberta?
The MI-1 notice requests an assessment by a Certified Examiner and is completed by the applicant, either the claimant or the insurer. The MI-2 asks the Superintendent of Insurance to select a Certified Examiner, with one version for IRIS users and a public version, both dated July 28, 2026.
Does the MI-3 ask whether the claimant was treated under the DTPR?
Yes. Part 6, History of Injury, asks whether the claimant was treated through the Diagnostic and Treatment Protocols Regulation, with options of yes, no or unknown, alongside the working diagnosis, mechanism of injury, treatment to date, response to treatment and current symptoms.