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  MIG Update – February 10, 2025

GP Evidence Preferred over IE Regarding Concussion

This week a MIG escape case where the Tribunal considered the Respondent’s neurological opinion sought 3 years after the accident in determining whether the accident related injuries fell within the definition of the MIG or whether the Applicant sustained a concussion.

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In Tabone v. Economical Insurance Company (22-012036), Peter Tabone was involved in an accident on September 7, 2020, and sought entitlement to three Treatment Plans for physiotherapy and chiropractic services totalling $6,116.49 and removal from the MIG on the basis of sustaining a concussion and chronic pain as a result of the accident.

Tabone was a passenger in an Uber and the driver had to apply the brakes suddenly to avoid hitting another vehicle. Tabone reported that he hit his head on the head rest after the sudden stop. Economical had taken the position that this was a ‘non-accident’ as there was no collision. However, the Tribunal agreed with Tabone that a collision is not required and that the impairment was a result of ‘an incident in which the use or operation of the vehicle directly causes an impairment’ pursuant to the definition of “accident” as set out in section 3(1) of the Schedule.

Tabone relied on the CNRs of his family doctor, Dr. Ng who consistently noted post concussive symptoms, cervicogenic headaches and whiplash recommending ongoing physiotherapy and chiropractic treatment and referral to a pain clinic. As well, the records of Dr. Shandu at the Centre for Chronic Headache and Pain Management who diagnosed post-traumatic pain syndrome.

Economical argued that Tabone’s family doctor, Dr. Ng had diagnosed a “possible” mild concussion but never confirmed it. It relied on the August 2023 report by neurologist Dr. Nikneshan, who concluded that Tabone had whiplash-associated headaches which fell in the MIG, and that there was no need for chiropractic or physiotherapy for headaches. It also relied on the February 2023 report of GP Dr. Stewart, who concluded that Tabone’s injuries fell in the MIG and that no further chiropractic, massage or physiotherapy was reasonable and necessary.

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The Tribunal found:

• • At the September 9, 2020 assessment Dr. Ng noted Tabone reported pain in the head, neck, shoulders, upper back, some tightness around the brows, a bit of photosensitivity, and some fatigue. Dr. Ng assessed Tabone with post accident cervicogenic headache, a possible mild concussion, and whiplash and made a referral for physiotherapy and chiropractic.
  • The subsequent visit October 5, 2020 Dr. Ng noted ‘post concussion’ and whiplash type injuries and to continue with chiropractic and physiotherapy as Tabone reported it was helping. Likewise, entries December 3, 2020 December 17, 2020 confirm complaints of ongoing post concussive symptoms, fatigue, headaches and insomnia.
  • In January 2021 Dr. Ng noted ongoing concussion and sleeping issues and diagnosed chronic post concussive symptoms, prescribed Gabapentin, ongoing therapy and made a referral to Dr. Shandu at the Centre for Chronic Headache and Pain Management.
    
  • The August 2021 consultation with Dr. Sandhu was over the phone due to the pandemic where a diagnosis of post-traumatic pain syndrome was made with recommendation for nerve block injections and the need for ongoing regular physical therapy.
  • “I have also considered that the respondent relies on the Insurer’s Examination that was conducted by Dr. Davar Nikneshan, Neurologist, on August 21, 2023. Dr. Nikneshan reviewed the applicant’s medical history and conducted a physical examination of the applicant. He concluded that, from a neurological perspective, the applicant has a whiplash associated headache which falls within the MIG. I place little weight on this opinion as I note that the examination was conducted almost three years after the accident. Further, in his review of medical records, Dr. Nikneshan only cited two of Dr. Ng’s clinical notes and records that referred to concussion or concussive symptoms, namely, September 8, 2020, and January 26, 2021. I find that the applicant’s family doctor, who had regular contact with the applicant in the months following the accident, is in a better position to make a proper diagnosis. I find that Dr. Ng consistently diagnosed the applicant with a concussion.”

If you Have Read This Far…

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