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  MIG Update – June 1, 2026

OHIP-Funded Specialists Determinative Over IEs

This week we review a MIG escape case where the Tribunal weighed a two-year timeline of treating OHIP-funded specialist evidence against conflicting IE reports. We analyze how consistent treating records overcame allegations of psychological malingering, and how the insurer’s own physical IE findings ultimately supported the Applicant’s chronic pain claim.

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Factor:

In Sadriwala v. Primmum Insurance Company (24-014791) , Hussain Aliasgar Sadriwala sought entitlement to five treatment plans for chiropractic and psychological services, as well as psychological, physiatry, and orthopedic assessments, totaling $12,876.36. He submitted that he suffered from accident-related chronic pain, functional limitations in his shoulders and lower back, and psychological impairments following an October 14, 2022, accident.

The medical evidence he relied upon spanned two years:

• • October 2022 – March 2024: His family doctor, Dr. Warraich documented continuous, repeated complaints of physical and psychological concerns in the CNRs.
  • May 2024: Dr. Warraich formally diagnosed Sadriwala with chronic pain; in July 2024, he added a diagnosis of severe anxiety.
  • May 2024: Treating psychiatrist Dr. Shahmalek diagnosed persistent pain, panic disorder, major depressive disorder (MDD), PTSD, and somatic symptom disorder.
  • July 2024: Treating chronic pain specialist Dr. Gonzalez diagnosed myofascial shoulder pain.
  • September 2024: Psychologist Dr. Steiner diagnosed severe depression and somatic symptom disorder.

  Primmum argued the injuries were minor, resolving sequelae. They relied on:
  

  • • • November 2023: IE by physiatrist Dr. Ko, who diagnosed simple sprain and strain injuries. Notably, however, during this examination, Dr. Ko was unable to move Sadriwala’s shoulders due to severe pain.
      • April 2024: IE by psychologist Dr. Seon, who noted that Sadriwala required assistance with personal care and feeding, but suggested potential malingering based on psychometric test scores indicating symptom exaggeration.

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  The Tribunal found:
  

  • • The medical evidence from three separate, OHIP-funded specialists all supported diagnoses of persistent, long-term chronic pain. Notably, none of these specialists submitted the Treatment Plans in dispute, which inherently enhanced the objectivity and credibility of their clinical findings.
      
    • Primmum’s own physiatry IE from Dr. Ko recorded a total restriction of shoulder movement due to severe pain more than a year after the accident. Because simple sprain and strain injuries should have been resolved by that point, these findings objectively validated Sadriwala’s chronic pain claim.
      
    • Despite the April 2024 IE psych validity scores suggesting malingering, the overwhelming consistent records from multiple OHIP-funded specialists sufficiently proved an accident-caused psychological disorder.
      
    • Sadriwala was entitled to the treatment plan for chiropractic services, as the CNRs from early 2023 and the self-reports given to both IE assessors (Drs. Ko and Seon) consistently proved he received material pain relief from past therapy.
    • The psychological assessment and the 16 sessions of psychological treatment were reasonable, necessary, and commensurate with the scope of the injuries, supported by the collective recommendations of Drs. Steiner, Shahmalek, and Warraich.
      
    • Sadriwala failed to show why both the physiatry and orthopedic assessments were required and why they would not constitute a duplication of services, given the chronic pain diagnoses already established by the OHIP-funded specialists.
      

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