MIG Update – April 1, 2024

Ortho Opinion Prevails on Origins of a Fracture

The Tribunal considers the cause of a T7 vertebral fracture in this week’s MIG case. The diagnostic evidence alone was not sufficient to establish a MIG escape. The expert’s medical opinion outweighs that of the family physician.

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Factor: Expert’s Opinion

In Stewart v. BelairDirect Insurance Company (20-015375), Melanie Stewart was involved in a motor vehicle accident on August 25, 2019 and sought removal from the MIG due to a T7 vertebral fracture. She was seeking entitlement to three Treatment Plans for chiropractic services, physiatry assessment, and massage services.

Steward relied on various records to establish her T7 vertebral fracture was as a result of the subject accident. A lumbar and thoracic spine x-ray from Milton General Hospital following the accident revealed a minor wedging of the superior endplate of T7. The CNRs of Dr. Shariff documented an upper back strain, low back strain and a T7 vertebrae fracture, all of which Dr. Shariff attributes to the accident. The treatment plan by Manju Ramesh, physiotherapist, at Health Plus Physiotherapy echoed Dr. Shariff’s diagnosis.

Belair disagreed, submitting that the fracture was degenerative and/or undiagnosed prior to the accident. They relied on the IE report of orthopedic surgeon Dr. Jaroszynski dated September 2020 which opined that the T7 fracture was not accident related.

The Tribunal found:

      • “At the hospital following the accident, the applicant complained of neck, lower back, coccyx and leg pain. A lumbar and thoracic spine x-ray was completed, revealing a minor wedging of the superior endplate of T7 as could be seen with a minor superior endplate compression fracture. The remainder of the x-ray was unremarkable. The applicant was discharged and advised to consult with her family physician. The applicant did not visit Dr. Shiraz Shariff until October 1, 2019.”
      • “While I acknowledge that the medical evidence reveals that the applicant sustained a fracture to her T7 vertebrae, I put more weight on the medical opinion and assessment of orthopedic surgeon Dr. Jaroszynski than that of the applicant’s family physician or her physiotherapist, as an orthopedic surgeon is better suited to assess the origin of a fracture.”
      • Dr. Jaroszynski indicated that Stewart’s “T7 abnormality was not compatible with an acute fracture, which under normal circumstances would be acutely painful in that area” yet Stewart did not report any specific pain or tenderness to the T7 area.
      • Delays in seeking treatment were related to a cancer diagnosis and extended travel and did not interfere with treatment for her mva related injuries.
      • Based on the opinion of Dr. Jaroszynski the T7 fracture was not accident related and the injuries Stewart sustained were uncomplicated soft tissues injuries as a result of the accident. Thus, Steward has not provided evidence that ‘but for’ the accident the fracture would have occurred.

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