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  MIG Update – August 25, 2025

Chronic Pre-Existing Low Back Pain Exacerbated by MVA

This week, a MIG escape case where the Tribunal considered the critical issue of a pre-existing significant chronic back pain condition and any exacerbation and or worsening of the condition. The findings of the Tribunal outline the key evidence that was examined and why the Applicant was successful.

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In Ouzzine v Intact Insurance Company (23-010080), Abbes Ouzzine was involved in an accident on May 17, 2021 and sought removal from the MIG due to a pre-existing chronic back condition. This condition, including severe degenerative disc disease and previous spinal decompression surgeries in 2001 and 2006, reportedly caused significant chronic pain and would prevent maximal medical recovery if subject to the MIG limit. He also sought entitlement to NEB and two specific treatment plans for physiotherapy and chiropractic services dated August 10, 2021 and January 30, 2024 and an award for Intact’s unreasonably withholding or delaying payments.

Ouzzine contended that his pre-existing condition affected his ability to recover from the accident injuries, noting an increased level of pain since the accident. He relied on the records from his family doctors, Abrishami (May 20, 2021) and Dr. Enas Abuelalaa (September 29, 2021, and October 28, 2021), which documented “aggravation of pain in his back,” “acute lower back sprain,” “severely decreased range of motion,” and pain “flaring up” and “shooting to both legs” post-accident. Of note, his last visit prior to the accident to Dr. Katayoon was on April 20 2021 where a referral to a pain management centre was made to explore alternatives to pain management. He also relied on records from his treatment provider that documented his pre -existing low back pain that continued to be a barrier to recovery documented in the August 2021 treatment.

Intact argued there is no expert medical evidence proving Ouzzine has pre-existing conditions that justify treatment outside of the MIG. It noted that Ouzzine’s medication and symptoms remain unchanged from before the accident, the accident is barely mentioned in medical records, there was no follow-up with a chronic pain specialist, physiotherapy ended in June 2021 showing only minor injuries, and no diagnostic tests show any worsening of this condition. It relied on the October 2021 IE report of general practitioner Dr. Bansal concluded that Quzzine’s injuries were minor. Further stating Ouzzine did not provide medical records prior to the IE assessment despite multiple requests, and Dr. Bansal’s October 2023 addendum maintained his opinion after reviewing the records.

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The Tribunal found:

• Ouzzine provided sufficient medical evidence documenting his pre-existing back condition and that this condition would prevent maximal medical recovery within the MIG funding limit.
• His consistent post-accident reports of pain exacerbation to multiple medical practitioners supported this finding.
• The initial assessment report of his treatment provider from May 2021 reported his previous lower back pain would present as a barrier to recovery. Similarly, the August 2021 Treatment Plan advised he faced barriers to recovery due to his “previous lumbar spine injuries…multiple severe areas of injury including low back, shoulders, neck and elbow.”
• The IE and Addendum reports of Dr. Bansal were unpersuasive and given little weight. Specifically, the October 2021 conclusion that Quzzine did not have a pre-existing medical condition contributing to his current medical status as it was not supported by the medical evidence, noting that even without pre-accident records, Quzzine had advised Dr. Bansal of his previous back surgeries and complaints, and multiple Treatment Plans were provided for his review.
• Following the review of the complete record, Dr. Bansal’s October 2023 addendum report provided no analysis of how the pre-existing medical evidence affected Quzzine’s post-accident recovery, only concluding that soft tissue injuries would have long since healed, despite Quzzine’s ongoing complaints and functional limitations.
• The treatment plan for physiotherapy and chiropractic services, dated August 10, 2021, was found to be reasonable and necessary. However, the January 30, 2024 was not as Ouzzine did not specifically address it in submissions, and there were no contemporaneous medical records provided to support its reasonableness.
• No award would be levied as Intact’s conduct was reasonable and that were entitled to rely on their experts’ opinions, especially considering they were not provided the requested medical records for the IE assessor prior to the initial assessment.

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