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  MIG Update – April 6, 2026

Psych Treatment Plan Not Guaranteed After MIG Escape

This week, we review a case featuring a successful MIG escape where the Applicant established a psychological impairment. However, despite the finding on the MIG, the Treatment Plan for psychological services was not granted. The Tribunal considered the lack of evidence showing how the proposed counselling goals would actually be met, the failure to justify an extensive 24-session plan amidst recovery uncertainty, and the absence of proof regarding the treating therapist’s registration with the College of Registered Psychotherapists of Ontario.

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In Alaarag v. Intact Insurance Company (24-010107), Moath Alaarag was involved in an accident on December 9, 2022, and sought entitlement to three Treatment Plans for physiotherapy services and psychological assessment and counselling, totalling $12,417.29. He sought to be removed from the MIG based on a psychological impairment.

Alaarag relied on the CNRs of GP Dr. Kler, which documented difficulty sleeping and a recommendation for cognitive behavioural therapy (CBT) for insomnia. He also relied on the CNRs of GP Dr. Sandro, reporting significant sleep disturbances, including an incident where he reported waking up screaming with involuntary urination during a severe nightmare. In March 2024, he was prescribed Lorazepam, and in October 2024, he reported continued daytime fatigue and impaired concentration. He relied on psychologist Mr. Eriksen’s August 2023 report, which diagnosed major depressive disorder, severe, with anxious distress. He submitted that physiotherapy was reasonable and necessary to mitigate pain symptoms and that the goals of pain reduction and increased strength were legitimate and achievable.

Intact relied on psychologist Dr. Saunders’ reports, which concluded that there was no credible evidence of significant accident-related psychological symptoms and that Alaarag likely exaggerated symptoms leading to unreliable test results. It submitted that the physiotherapy Treatment Plan was not reasonable and necessary based on GP Dr. Naiman’s IE report findings of uncomplicated soft tissue injuries and that further facility-based therapy was not warranted.

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The Tribunal found:

• • Alaarag suffered from a psychological impairment characterized by significant sleep disturbances, nightmares, daytime fatigue, and impaired concentration. The Tribunal accepted that the treatment recommended by his GPs, Dr. Kler and Dr. Sandro namely cognitive behavioral therapy and Lorazepam was consistent with the August 2023 psychological assessment by Mr. Eriksen, whose standardized test results directly correlated with the GPs’ CNRs.
  • Dr. Saunders’ IE report and observations were internally inconsistent as his initial statement that Allarag’s behaviour and demeanour were consistent with his reported symptoms contradicted his conclusion that Alaarag likely exaggerated symptoms to the point that the test results were unreliable.
  • Despite Alaarag being removed from the MIG and entitled to a psychological assessment, he was not entitled to $6,447.13 for the psychological counselling Treatment Plan. While the goals of the plan were adequately identified, Alaarag failed to establish how those goals would be met or that the associated costs were reasonable.
  • While the Treatment Plan was completed by psychologist Mr. Eriksen however was reviewed with Alaarag by a therapist with no indication that this therapist was registered with the College of Registered Psychotherapists of Ontario (CRPO), nor was there any provided information regarding her training.
  • That the Treatment Plan merely referenced the assessment report, which itself concluded that it was unclear when or if symptom management would occur. Consequently, the recommendation for 24 sessions lacked justification, failing to explain how that specific number was determined or why such an extensive course was warranted given the uncertainty of recovery.
    
  • That the proposed physiotherapy treatment plan lacked evidence of therapeutic effectiveness. The family doctors’ CNRs from September 2023 and October 2024 indicated that Alaarag’s back pain remained unchanged despite ongoing treatment. As such continuing this plan was unlikely to yield any meaningful benefit.

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