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  MIG Update – May 18, 2026

LAT Rejects Second In-Person IE as Duplicative

This week’s MIG review focuses on a chronic pain dispute where the Respondent attempted to compel a subsequent in-person IE upon receiving the Applicant’s s. 25 chronic pain assessment report. Ultimately, the Tribunal considered whether this additional assessment met the ‘reasonable and necessary’ test in light of the Applicant’s refusal to attend.

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Factor:

In Small v. Northbridge General Insurance Company (24-008713) , the Applicant, Neil Small, was involved in an accident on July 31, 2023. He sought entitlement to four Treatment Plans for physiotherapy, chronic pain, physiatry, and neurological assessments totaling $7,440, arguing his injuries warranted removal from the MIG.

Preliminary Issue and Parties’ Positions

Northbridge argued that Small breached Section 44 by failing to attend a properly scheduled in-person IE with Dr. Dharamshi. Northbridge contended a new in-person assessment was necessary to respond to a fresh January 2025 Chronic Pain Assessment Report from Dr. Siva, arguing that IE assessors generally prefer in-person exams when prior assessments are more than six months old.

Small argued the second in-person IE was not “reasonable and necessary,” was overly intrusive, and was entirely duplicative. Northbridge already possessed two in-person IE reports (including one from Dr. Dharamshi) addressing the MIG and chronic pain. Because no new treatment plans were submitted, the insurer could have easily proceeded via a less intrusive paper review.

MIG

Small submitted that he developed accident-related chronic pain diagnosed by Dr. Siva with myofascial pain syndrome and chronic pain syndrome and suffered functional impairment at his construction job. He also relied on a pre-existing February 2023 MRI showing an L4–L5 disc bulge and L5–S1 herniation, alongside atypical, unresolved headaches. He relied on GP Dr. Chung’s CNRs from August 2023 to December 2024, which documented persistent back, neck, and shoulder pain and headaches.

Northbridge contended that Small did not meet the AMA Guides diagnostic criteria for chronic pain, relying on May 2024 IE reports from Dr. Dharamshi, a physiatrist (Dr. Khan), and a neurologist (Dr. Spevick) which concluded that further assessments would not provide diagnostic clarity or alter treatment.

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The Tribunal found:

• • Citing 17-005291 v. Travelers specifically, the Tribunal applied the six established criteria for determining if an IE is reasonably necessary and found that the Respondent did not establish that the Applicant was non-compliant with s. 44.
    
  • There was a reasonable nexus between the impairment and the requested IE, and the timing of the request was due to the receipt of the January 2025 s. 25 report. However, Northbridge had already obtained two IE reports in May 2024 from physiatrist Dr. Khan and GP Dr. Dharamshi, who had already addressed whether the chronic pain assessment was reasonable and necessary and whether the Applicant remained within the MIG.
    
  • An additional in-person IE to address the same issues was duplicative. Northbridge did not provide evidence that assessors prefer in-person examinations for assessments over six months old, nor did it explain why an addendum could not be obtained by a paper review.
    
  • The family doctor noted persistent pain between September 2023 and December 2024, and Dr. Siva diagnosed Small with chronic pain syndrome and myofascial pain syndrome.
  • Functional impairment was established, as the Applicant was limited to light duties at his construction job and his sleep was impacted.
    
  • The unresolved, atypical headaches and a pre-existing 2023 MRI-documented disc herniation which Northbridge’s own IE doctor conceded may have been aggravated justified the chronic pain, physiatry, and neurological assessments. These assessments were reasonable and necessary to determine whether specific underlying pathology exists beyond conservative care.
    

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