MIG Update – December 5, 2022

Knee Complaints 3.5 years later Connected to MVA

This week, the Tribunal relied upon an insurer’s IE that diagnosed Meralgia paresthetica, (also known as lateral femoral cutaneous nerve entrapment) to explain how knee pain and ‘locking’ in the morning some 3.5 years later was caused by the accident.

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Factor: Nerve Entrapment Diagnosis Non Minor

In Goralwalla v. Allstate (20-007243), Ebrahim Goralwalla was involved in a motor vehicle accident on June 5, 2018. He claimed that he suffered whiplash type injuries to his back, neck and shoulders and pain in his knee that became chronic.

With respect to his left knee, Goralwalla did not have any significant symptoms until one week after the accident when his left knee “gave out” playing soccer. He received physio treatment for over a year mostly for his back injuries, with the last on November 27, 2019. Thereafter, a gap in treatment until January 2021 when family physician Dr. Vaid ordered diagnostic tests of Goralwalla’s knee and a referral to an orthopaedic surgeon.

Allstate advanced that the knee injury was as a result of the soccer injury not the subject accident. Furthermore, Allstate relied on 3 reports from its IE assessor Dr. Khan, in- person assessments in May 2019 and August 2021, and a review of various records including an MRI.

Goralwalla produced only the note of the single visit with the doctor at GTA Doctors on July 1, 2019 and then notes of Dr. Vaid in 2021 in support of his case, however there was no report or letter opining the injuries were non minor.

The Tribunal held:

  • The Insurer’s Examination reports and opinion of Dr. Khan established Gorlwalla’s knee impairment was non-minor in nature.
  • Dr. Khan opined that Gorlwalla’s “accident-related diagnosis are (1) SI Joint dysfunction, left-sided, (2) Meralgia paresthetica, left-sided; and (3) Left-knee contusion.
  • The Tribunal previously found that Meralgia paresthetica (also known as lateral femoral cutaneous nerve entrapment), citing C.D. vs. Aviva Insurance Company (19-002213) was not defined as minor. ‘Perhaps the nerve entrapment explains why E.G. is still experiencing knee pain and that his knee “locks” in the morning’.
  • Dr. Khan’s medical opinion assisted the Tribunal in understanding the medical diagnosis but disagreed with how he applied this medical diagnosis of Gorlwalla’s knee injury to the legal definition under the Schedule. Specifically, as determined in the reconsideration of L.P-C. v. Aviva Insurance Canada (19-001009) “While medical experts may directly opine on how their medical findings apply to the applicable [legal standard or] test as an assistance to the Tribunal, ultimately the application of the legal test to the medical and other evidence is for the Tribunal.”
  • Dr. Vaid’s CNRs were consistent with Dr. Khan’s findings and provide some support for Dr. Khan’s diagnosis in that they show the visits three years post accident were motivated by the knee pain. Further that Dr. Khan’s records included a full assessment and detailed report not provided by Golwalla’s doctors.
  • Dr. Khan, while fully aware of the soccer incident did not make the same inference as Allstate as Golwalla was at the time suffering from some accident related issues when his knee ‘gave way’ playing soccer.

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