MIG Update – April 19, 2021

‘Chronic’ Misapplication of AMA Guides

Quite often MIG cases turn on whether the “minor injuries” as defined by the Schedule would be found “chronic” in nature, such that recovery would not be possible within the MIG limits.

In the case explored this week, the Tribunal adopted the 6th Edition of the AMA Guides, published in 2008 in considering a chronic pain case, stating “it better reflects the development of defining and understanding chronic pain syndrome than the 4th Edition published 15 years earlier.” While not binding, the Tribunal noted such a definition may be persuasive as an “authoritative source”.

Factor: AMA Guide 6th Edition – ‘A Guide to Chronic Pain Cases’

In Nguyen v Allstate (19-006606), Nguyen sought removal from the MIG based on a report from his orthopaedic surgeon finding that he satisfies two or more diagnostic criterion (duration and dysfunction) under the 4th edition of the AMA Guides to “establish a presumptive diagnosis of chronic pain syndrome.”

The Respondent took issue with said diagnosis as the assessor had applied an older definition of chronic pain syndrome set out in the American Medical Association’s (AMA) Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, which has been superseded by the definition set out in the 6th edition, 2008. In particular, the 6th edition specifies that at least three of the following criteria must be met for a diagnosis of chronic pain:

1. Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances
   
2. Excessive dependence on health care providers, spouse, or family
   
3. Secondary physical deconditioning due to disuse and or fear-avoidance of physical activity due to pain
   
4. Withdrawal from social milieu, including work, recreation, or other social contracts
5. Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs
6. Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or nonorganic illness behaviors
   

‘MIG hold’ – The Tribunal’s finding:

• Neither party provided a copy of the section of the 4th or 6th Editions they rely on. Thus, the Tribunal could not determine if Nguyen’s assessor is correct that presence of two diagnostic criteria are sufficient to support “a presumptive diagnosis”
  
• A “presumptive diagnosis” suggests there may need to be more criteria to confirm the diagnosis
  
• Nguyen’s assessor’s diagnosis of chronic pain syndrome was “not convincing because he has misapplied the factors to be taken into consideration”
  
• The use of the word ‘chronic’ does nothing to change the underlying nature of the injuries, that is, strains of the upper and lower spine and his diagnosis falls squarely within the definition of ‘minor injury’”
• “The 6th Edition published in 2008 better reflects the development of defining and understanding chronic pain syndrome than the 4th Edition published 15 years earlier”
  
• Ultimately, Nguyen was found to have not met any of the 6 criteria outlined in the 6th edition

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