MIG Update – February 14, 2022

Totality of Medical Evidence

In the case reviewed this week, a MIG escape, the Applicant’s success was based on the consistency and continuity of medical evidence supporting ongoing physical injuries. The opinions of the insurer’s IE assessors, conducted much earlier in the claim process, were found not to align with associated findings.


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Factor: Totality of Medical Evidence

In Ibrahim v Economical (20-007384), Ibrahim sustained neck, back injuries and headaches as a result of a February 23, 2017 accident. He sought ongoing chiropractic treatment beyond the MIG limits.

Ibrahim relied on the clinical notes and records of both his family doctor and treating chiropractic that showed he continued to seek medication care and ongoing physical treatment for his ongoing pain symptoms, physical impairments and functional limitations. The records from the family doctor demonstrated continuity of complaints through January 2020.

Economical relied on IE findings conducted by both an orthopedic surgeon and neurologist in July 2017 and a general practitioner in July of 2018. In addition referencing a 14 month gap in visits to the family doctor and the unreliable evidence of the chiropractor.

The Tribunal disagreed with Economical and held that Ibrahim sustained a physical impairment that is not predominantly a minor injury.

The Tribunal found:

  • Economical’s argument of a 14-month gap in reporting complaints to his family doctor was trumped by the totality of the medical evidence presented
  • The totality of medical evidence was sufficient in establishing that Ibrahim was consistently seeking medication care from his family doctor and/or chiropractor for his back pain and headache symptoms and functional limitations/impairments
  • The clinical notes and records of Dr. Mistry, chiropractor persuasive and reliable documenting that Ibrahim continued to seek ongoing physical treatment for pain symptoms. Further Dr. Mistry’s reassessment report dated April 2019 noted Ibrahim’s continuing complaints of neck and back pain, and diagnosis of chronic pain
  • The orthopedic IE July 2017 recommended multimodality therapy for Ibrahim’s neck and back pain
  • The neurological IE July 2017 diagnosed Ibrahim with persistent headaches associated with a whiplash type injury to the neck region, and if not improving, recommended a course of amitriptyline/nortriptyline/topiramate
  • The IE by Dr. Taylor, general practitioner July 2018, opined that Ibrahim’s injuries were minor yet the prognosis was “guarded given that more than a year has passed since the injuries occurred” which is inconsistent with his opinion that Ibrahim’s “injuries are fully healed.” Further the clinical examination found deficits in movements and significant discomforts in the c-spine. Likewise in the lumbar spine

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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