MIG Update – August 29, 2022

AMA Guides Persuasive Guiding Factors for Chronic Pain

This week, a MIG escape where the Tribunal applies the AMA Guides in determining a chronic pain case. This, despite the fact that the Schedule does not define what constitutes a chronic pain condition, nor does it incorporate the AMA Guides’ criteria. The Tribunal once again confirmed that it is not bound by the AMA Guide criteria however, found them to be persuasive guiding factors in determining whether pain is chronic or not.

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Factor: Application of AMA Guides

In Ishaq v. Wawanesa Mutual Insurance Company (20-009146), Tania Ishaq involved in an accident October 26, 2018, sought treatment outside of the MIG due to suffering from chronic pain. She also sought IRB, despite having returned to work for approximately 11 months post accident, until allegedly having had to quit due to her injuries.

Ishaq complained of widespread body pain, including both shoulders, low back, neck and legs, headaches and fatigue. In addition to her family doctor records, disability certificates and treatment plans, she relied on a November 1, 2019 report from the Vaughan Pain Clinic that her injuries had evolved into fibromyalgia/chronic pain syndrome.

In response Wawanesa argued that Ishaq’s medical consultations were primarily based on symptoms unrelated to the accident; and that her claims are misleading. Wawanesa did not submit any independent medical evidence for consideration, rather contending that Ishaq’s evidence should be discounted, Further, that following the accident she saw her family doctor for unrelated matters and she was not referred to the Vaughan Pain clinic until one year following the accident. Finally, the consultations with Dr You and Dr. Merablan from the Vaughn Pain Clinic were solely based upon subjective factors.

The Tribunal found:

Ishaq sustained physical, accident-related injuries, specifically, ongoing, pain that meets the definition of chronic pain, requiring treatment beyond the treatment limit for minor injuries.

Ishaq’s “subjective evidence must be considered”. She was referred to the pain clinic by her family physician because of reportedly worsening pain throughout her body including her shoulders and neck. “More to the point, I disagree with the respondent’s characterization of the reports. These reports were not solely based on the applicant’s self-reporting but also on the doctors’ own examinations, including physical examinations”.

Ishaq met five of the six criteria set out in the AMA Guides:

  1. Her neck and low back pain began shortly after the accident and she requested x-rays of her shoulder within one month of the accident.
  2. The existence of pain is well recorded, 15 times having consulted with her family doctor/pain clinic practitioners post accident due to pain complaints and worsening of same, sought further investigation and refill of prescribed pain meds.
  3. The medical documentation evidenced persistent, ongoing pain symptoms lasting well beyond the approximate 12-week recovery for” minor injuries”, now over two years.
  4. “It is unlikely that the applicant would have been able to secure a third disability certificate on March 23, 2021, more than two years post-accident, if her subsequent pain complaints were not credible and her medical examinations did not corroborate her self-reports”.
  5. The most prominent evidence of the adverse effect is the fact that she was unable to meet the demands of her work activities (standing, bending, reaching, etc.), in the same way she did before the accident.

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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