MIG Update – August 22, 2022

Consequences of Inconsistent Reporting

This week a MIG hold case highlighting the pitfalls of the Applicant’s inconsistent reporting to his own assessors as compared to what he was reporting to his family doctor. To that end, the Applicant failed to make their case regarding chronic pain and the impact of pre-existing conditions as set out in a report by Dr. Karmy. Further the conclusions of the Insurer’s Examinations corroborated the records of the family doctor.

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Factor: Inconsistent Reporting by Applicant

In Lobo v. Intact Insurance Company, (20-009565), Fabian Lobo was involved in a motor vehicle accident on November 27, 2018. He claimed that he suffers from a pre-existing injury, chronic pain, and a psychological impairment, and should not be subject to the MIG. Lobo sought entitlement to physiotherapy totaling nearly $19,000, as well as a psychological assessment, a chronic pain assessment and an FAE.

Lobo relied on the records and reports of Dr. Karmy August 7, 2019, family physician, Dr. Chacko, psychologist, Dr. Brunshaw; and psychotherapist, Ms. Ilios May 8, 2021 in support of his claim.

The Tribunal found:

• The records of the family physician Dr. Chacko contemporaneous with the report of Dr. Karmy August 7, 2019 findings along with Lobo’s reporting were inconsistent.
• Dr. Karmy reports that Lobo “had a previous MVA in 2012, at which time he developed neck, bilateral shoulder, upper, mid and lower back pain. The applicant stated that the pain was tolerable and did not result in significant functional limitations until the subject accident occurred.” This led Dr. Karmy to opine that Lobo’s pre-existing condition worsened after the subject accident.
• Yet, in the Brunshaw/Ilios report Lobo confirms he had recovered from the 2012 accident.
• Dr. Karmy reviewed limited documents, a letter dated June 2018 prior to the loss from Lobo’s family doctor, the OCF 3 and some Treatment Plans and ultimately listed 11 diagnoses as a result of the accident, amongst them being mild traumatic brain injury, post-traumatic fibromyalgia, and mood disorder with vehicular anxiety.
  
• The conclusions of the IE assessors were supported by contemporaneous records of Lobo’s family doctor Dr. Chacko.
• The diagnoses by Dr. Brunshaw of an Adjustment Disorder with Mixed Anxiety and Depressed Mood, and Specific Phobia (Vehicular) and recommendation of 12 counseling sessions and psychotherapy was not reliable. Lobo reported pain in every single part of his body (40 locations) which simply were not corroborated by any of records and IE’s.

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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