MIG Update – April 18, 2022

Persistent Pain Warrants Further Investigation

The MIG escape case in review this week deals with a series of injuries where the Tribunal affirms which injuries consistently fall under the minor injury definition and those that do not.

Included is a review of medical evidence, largely that of the insurer, that supported the exploration of treatment options for the applicant’s persistent pain complaints.


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Factor: Persistent Pain

In Semih v. Aviva (20-000954), Nejdet Semih was injured in an accident on January 25, 2018, seeking removal from the MIG on four grounds:

  1. A diagnosis of bursitis in the left shoulder,
  2. Pre-existing chronic pain condition for which he was on ODSP since 1998
  3. Current chronic pain as result of subject accident
  4. Psychological impairment

Aviva, relying on various IE’s in particular, Dr. Dessouki, physiatrist, Dr. Kopto, general practitioner and Dr. Syed, neuropsychologist submitted, Semih was not diagnosed with chronic pain as a result of the accident. That bursitis and a partial tear are minor injuries. Dr. Syed opined that Simeh was suffering from ongoing maladaptive beliefs about his condition and that a psych assessment was not reasonable and necessary.

To advance his case, Semih relies on his affidavit, OCF-3 Disability Certificate, an ultrasound, the report of Dr. Dessouki and the findings of a psychological screening interview from Psychology Health Solutions.

The Tribunal prefaced its considerations and conclusions in this matter with the affirmation that the Tribunal has:

  1. Determined that chronic pain with functional impairment warrants removal from the MIG, as same is not captured by s. 3 of the Schedule.
  2. Further, the Tribunal has consistently found that a partial thickness tear does not warrant removal from the MIG because a full tear is required.
  3. Inflammation conditions such as bursitis and tendinosis fall within the MIG as accident-related sequelae.

In Semih’s case the Tribunal held:

  • Dr. Dessouki does not diagnose chronic pain syndrome, however, he does indicate Semih impairments fall outside of the MIG and provides a diagnosis of myofascial pain syndrome and features of a chronic pain syndrome with the opinion that further investigation from a psychological perspective would be needed.
  • Semih’s complaints of pain at 2-years post accident, where the pain continues to affect activities of daily living, long-standing pain from his previous accident and with the consumer-protection nature of the Schedule in mind warrant further exploration for treatment to see if his pain can be reduced with further intervention.
  • Semih’s reports of lingering pain post-accident, is enough to warrant removal from the MIG on a balance of probabilities.
  • Dr. Dessouki’s recommendation for a psychological assessment to investigate the Semih’s chronic pain condition, the results of the psychological pre-screen interview and Semih’s affidavit where he reports ongoing emotional difficulties, including stress, anxiety and panic attacks, justify further investigation as to whether his pain condition has a psychological component to it.

If you Have Read This Far…

Our MIG Monday series discusses the multitude of factors to consider when evaluating a risk position on MIG cases. The Tribunal has ruled on the MIG in 24% of the decisions so far. Each case is nuanced, but with similar factors.

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