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  MIG Update – January 12, 2026

Early IE Only a Snapshot

This week a MIG escape involving an Applicant with pre-existing lupus and anxiety, raising the question of whether those conditions created barriers to recovery. The Tribunal considered the competing medical evidence, with the Respondent relying on early IE”s suggesting resolution of soft-tissue injuries, and the Applicant pointing to ongoing symptoms documented over time. At issue was how the Tribunal should assess medical evidence that captured only an early snapshot versus evidence reflecting the progression of symptoms.

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Asieduaa v. TD General Insurance Company, 2025 ONLAT 24-002324, Princess Asieduaa was involved in an accident on February 6, 2022, and sought entitlement to six Treatment Plans for chiropractic services, a chronic pain program, prescriptions, and chronic pain and psychological assessments totalling $23,783.60. She sought to be removed from the MIG based on pre-existing conditions.

Asieduaa submitted that she suffered from pre-existing lupus and fibromyalgia, which were significantly exacerbated by the accident, with a significant increase in her medical attendance and complaints of neck, shoulder and back post accident as documented by Dr. Mok, her family doctor. She relied on rheumatologist Dr. Lipson, who had treated her active lupus since 2017 and rheumatologist Dr. Zhang, who diagnosed her with fibromyalgia in March 2024. She further relied on physician Dr. Karmy’s August 2023 chronic pain report, which confirmed a diagnosis of chronic pain syndrome in August 2023, noting functional impairment and widespread tenderness. She contended that her treating providers recommended a multidisciplinary chronic pain program and assessments after conservative treatments failed.

Asieduaa also relied on Dr. Gabidulina’s June 2024 report, which diagnosed her with adjustment disorder, mixed anxiety, and depressed mood, to support the psychological and chronic pain program Treatment Plans. She maintained that she incurred out-of-pocket costs for pain medications and that TD’s rigid reliance on the MIG despite medical evidence warranted an award.

TD maintained that Asieduaa’s symptoms were consistent with her longstanding pre-existing conditions rather than the accident. It relied on GP Dr. Bansal’s July 2022 IE report, which concluded her soft-tissue injuries had resolved and she could resume pre-accident activities. It further relied on psychologist Dr. McCutcheon’s July 2022 IE report, which found only mild symptoms not warranting treatment. It argued that the chiropractic Treatment Plans were duplicative and excessive, and that the chronic pain and psychological assessments were unnecessary because prior IEs deemed her impairments minor. It contended that the chronic pain program was costly and unlikely to yield functional improvement.

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The Tribunal found:

• • Asieduaa had pre-existing conditions sufficient to satisfy the first prong of the test. She suffered from well-documented lupus and chronic pain and prior to the accident she managed her symptoms without active treatment.
    
  • “Dr. Mok documented a significant increase in attendance following the accident, with consistent complaints of neck, shoulder, and back pain. Dr. Zhang diagnosed fibromyalgia on March 8, 2024, and Dr. Grigory Karmy, a physician specialized in pain management, on August 22, 2023, confirmed chronic pain syndrome, noting widespread tenderness, poor sleep, and functional impairment.”
  • Dr. Karmy’s opinion, which was made after prolonged pain and decline, provided a comprehensive report with signs of chronic pain syndrome. His later timing allowed him to see the full progression of Asieduaa’s condition, making his diagnosis more persuasive and reflective of her current state.
    
  • In contrast, the July 2022 IE report of GP Dr. Bansal, while closer to the accident, failed to account for the subsequent clinical progression and formal diagnoses of fibromyalgia and chronic pain syndrome.
  • The medical records show that passive rehabilitation and routine therapy failed to resolve her symptoms, leading her treating physicians to escalate care to a chronic pain assessment as such the assessment was found reasonable and necessary.
  • Asieduaa was entitled to $11,821.05 for the chronic pain program Treatment Plan as the evidence showed that conventional modalities, such as physiotherapy and chiropractic, offered limited benefits. The recommendations of physician Dr. Karmy and psychologist Dr. Gabidulina, both supported multidisciplinary management for chronic pain and adjustment disorder, and they explained how the goals would be addressed through a structured, multidisciplinary approach supported by medical literature.
    

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