MIG Update – January 9, 2023
Persistent Pain Complaints Require $10k Chronic Pain Program
Welcome back to the first edition of MIG Monday of 2023! This week, a MIG escape wherein the Tribunal ruled on a chronic pain diagnosis and the $10,000 cost of a chronic pain treatment program following over 2 years of persistent and documented pain complaints.
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Factor: Chronic Pain Treatment Program
In Rodrigues v. Wawanesa Mutual Insurance Company (20-007165), Natalia Rodriques sustained head, neck, left shoulder and back injuries in an accident on July 20, 2017. She sought removal from the MIG due to both pre- and post-accident, psychological and physical injuries sustained. Amongst other benefits she sought a chronic pain assessment in June 2019 ($2200) and chronic pain treatment program in September 2019 ($10,610.60).
Rodriques had started physical rehabilitation treatments a week after the accident, which ended on May 7, 2018, she was taking prescribed pain medication and although therapy helped to decrease pain in her neck and increase range of motion, she still had ongoing pain in the neck, left shoulder and lower back as well as right thigh and knee.
Rodriques relies on the records of her family physician Dr. Leung and the report of Dr. David Brooks, a physician of Finch Health, on July 23, 2019 to establish her ongoing physical injuries, chronic pain diagnosis and need for an 18 week chronic pain treatment program.
Wawanesa conceded that the records show that Rodrigues had persistent pain complaints however, didn’t agree that those complaints met the test for chronic pain.
The Tribunal held:
- The evidence shows that immediately after the accident Rodrigues complained of and was diagnosed with physical injuries. Thereafter, the continuity of the complaints were consistently documented throughout the family doctor and assessors records.
- The physiatry IE’s of June 12, July 24 and July 30, 2018 conducted by Dr. Devin noted “with respect to her pain complaints, I cannot offer an opinion given her pain complaints have now been ongoing without any significant improvement for almost one year. It is likely her pain complaints will continue.”
- In Dr. Devin’s July 30, 2018 IE, document review assessment, he affirms his previous conclusions and re-confirms the primary area of physical pain complaints, concluding “I believe the initial diagnosis is that of cervical strain and her current diagnosis is that of chronic pain…’
- In a January 19, 2019 letter, Dr. Leung, implored the insurer to consider further physical treatment as Rodrigues was experiencing persistent problems to her neck, back, right knee and shoulders; and numbness of her left arm/hand. Further that the anti-inflammatory and muscle relaxation did not improve Rodrigues pain complaints.
- Dr. Brooks validates Rodriguez’s complaints as being credible, on the basis of his examination and observations. His recommendation of chronic pain treatment regimen, was based on his findings of chronic, residual, unresolved pain, restricted range of motion and decreased functional endurance.
- Rodriguez met most of the criteria found in the AMA Guidelines because she used prescription drugs/injections for pain extensively; she has frequently sought the services of health care providers; she avoided physical activities that cause pain, such as household activities; she was not been physically restored to pre-accident condition over a period of years; and, there was evidence that she developed sleep issues.
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