MIG Update – August 21, 2023

Absence of Applicant’s Medicals A Difference Maker

This week’s case, concussion and chronic pain diagnoses rendered by the Applicant’s experts in the absence of a review of the Applicant’s medical records were considered by the Tribunal in this MIG hold decision.

With over 1100 MIG decisions since the inception of the LAT a recurring fatal flaw is a failure to review Applicant’s records and the alignment of the evidence with those records. inHEALTH’s data shows that when the Applicant’s medical records/CNR’s are factored into the determination, the Applicant’s success is improved from an overall average of 21% to 33%.

LAT Update – What Difference Did A Year Make?

The LAT released Performance Stats up to mid-year 7 which is current through to the end of September 2022. Together with the LAT’s last update we can now provide a comparison of year over year, with projections through to the end of year 7 in this annual update. What difference did a year make?

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Factor: Applicant’s Medical Records

In Ratnarajah v. BelairDirect, 2023 (20-010209), Ahalyah Ratnarajah was injured in an accident on September 17, 2018. She sought removal from the MIG on the basis of chronic pain and concussion diagnoses, relying on the reports of chronic pain specialist Dr. Jacobs dated May 9, 2019 and neurologist Dr. Basile dated October 2020 along with the hospital family doctor records. Ratnarajah was seeking entitlement to treatment and the cost of assessments in excess of $35,000.

Dr. Basile diagnosed post-concussive syndrome, post-traumatic headaches, likely radiculopathy, vertigo, soft tissue injuries to her neck and back, and likely converted to chronic pain syndrome.

Dr. Jacobs concluded that the Applicant had developed chronic pain and made various recommendations for further investigations and treatment. There is very little analysis regarding her ability to function despite this largely normal evaluation.

The Tribunal found:

• Following the accident, Ratnarajah underwent a comprehensive assessment at hospital, including a CT scan with no diagnosis of concussion made by doctors at the hospital.
• The family doctor assessed Ratnarajah three days after the accident, and although she reported a headache, he also did not diagnose a concussion, nor was there any further reference to headache, medication or referrals.
• Dr. Basile’s conclusions contradict what was otherwise a largely normal examination. While he reviewed the x-ray and CT scan from the date of loss, he did not review the hospital records or the clinical notes and records of the family doctor—neither of which diagnosed a concussion. He also conducted the assessment without the aid of an interpreter.
• With respect Dr. Jacobs conclusions, there was very little analysis regarding Ratnarajah’s ability to function, Dr. Jacobs also reviewed only the two imaging reports from the date of loss, but no hospital records or notes from the family doctor. Ratnarajah also did not describe any headaches or cognitive issues to this assessor.
• Ratnarajah does not meet the criteria in the AMA Guides often used as a tool to determine chronic pain conditions. “there was no indication she abused prescription drugs, she was not excessively dependent on family or healthcare providers, and no evidence that she failed to restore to pre-injury function or that she was physically deconditioned due to disuse and/or fear avoidance of activity due to pain, she returned to work on a full-time basis, and there was no psychological impairment.”

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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