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:
- A diagnosis of bursitis in the left shoulder,
- Pre-existing chronic pain condition for which he was on ODSP since 1998
- Current chronic pain as result of subject accident
- 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:
- Determined that chronic pain with functional impairment warrants removal from the MIG, as same is not captured by s. 3 of the Schedule.
- Further, the Tribunal has consistently found that a partial thickness tear does not warrant removal from the MIG because a full tear is required.
- 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…
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