MIG Update – June 30, 2025
Success Factors in Chronic Pain MIG Escape
This week’s MIG escape case highlights several key factors acknowledged by the Tribunal in their analysis of a chronic pain diagnosis. The Applicant was successful as a result of providing corroborating evidence from treating physicians and treatment providers which was ultimately what the Tribunal preferred and repeatedly referenced in their ruling.
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In El-Sayegh v. Allstate (23-006982), Georgette El-Sayegh was injured in an accident on December 25, 2019 and sought entitlement to five Treatment Plans for physiotherapy services and for psychological and FAE assessments totalling $9,551.44. She sought to be removed from the MIG based on chronic pain.
El-Sayegh relied on the CNRs of family physician Dr. Mikhail, who documented her ongoing physical and psychological complaints. She also relied on pain consultant physician Dr. Ta’s April 2024 pain medicine assessment report, diagnosing her with chronic pain and noting objective findings of functional limitations.
El-Sayegh worked as a full-time cashier before the accident, was off for a year, returned for two weeks on modified duties, but then stopped due to severe physical and psychological impairments, and relied on her family Dr. Mikhail’s October 2021 Attending Physician Report.
She submitted that the physiotherapy Treatment Plans were reasonable and necessary due to ongoing physical impairments, relying on Dr. Mikhail’s continuous recommendations for physiotherapy, and asserting that his records should be preferred over those of IE assessor Dr. Khan.
Allstate relied on physiatry IE assessment reports of Dr. Khan from March 2022 and February 2023, which confirmed minor injuries, and found that El-Sayegh had reached maximal medical recovery. It argued that Dr. Ta’s report did not establish that her chronic pain was not a sequelae of her minor injuries, and that her inaccurate work history undermined Dr. Ta’s conclusions about her withdrawal from work.
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The Tribunal found:
- El-Sayegh had chronic pain with functional impairment, placing significant weight on the CNRs of family physician Dr. Mikhail, who El-Sayegh saw regularly with ongoing physical complaints and reports of functional limitations.
- These CNRs supported the conclusions in pain consultant physician Dr. Ta’s April 2024 pain medicine assessment report, which reviewed the CNRs, provided a detailed description of her functional impairments and opined she met five out of six AMA Guides chronic pain criteria.
- El-Sayegh had a chronic condition based on her reliance on prescription medication (as evidenced by the prescription summary), excessive dependence on healthcare providers/family, secondary physical deconditioning, withdrawal from social milieu, failure to return to pre-accident employment despite a trial, and psychological symptoms evidenced in Dr. Mikhail’s records.
- El-Sayegh was entitled to $2,951.44 for the two physiotherapy Treatment Plans as the CNRs of Dr. Mikhail supported the need for it based on multiple recommendations. More weight was afforded to El-Sayegh treating practitioner, who regularly assessed her over the IE reports of physiatrist Dr. Khan, who only saw her for the purpose of assessment. Dr. Khan’s conclusion of maximum medical recovery conflicted with Dr. Mikhail’s record of ongoing pain complaints.
- El-Sayegh was also entitled to $2,200.00 for the psychological assessment Treatment Plan. The initial complaints were after an October 2021 left wrist fracture. However, Dr. Mikhail’s CNRs linked the psychological impairments to the accident, and that he diagnosed her with several psychological disorders and referred her for psychotherapy. Her psychological complaints were also documented in physiatrist Dr. Khan’s February 2023 report and pain consultant physician Dr. Ta’s April 2024 report.
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