MIG Update – July 17, 2023

“Elements of Concussion” Not A Formal Diagnosis

This week’s case is a MIG hold where the applicant’s concussion and resulting post concussion symptoms were at the center of this dispute. The Tribunal considered the medical evidence with emphasis on the family doctors records to determine if there was a diagnosis of concussion.

LAT Update – What Difference Did A Year Make?

The LAT released Performance Stats up to mid-year 7 which is current through to the end of September 2022. Together with the LAT’s last update we can now provide a comparison of year over year, with projections through to the end of year 7 in this annual update. What difference did a year make?

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Factor: ‘Concussion Elements’

In Nelson v. Coseco Insurance (20-015014), Jennifer Nelson was involved in an accident on June 10, 2020 and submitted that she should be removed from the MIG as she suffered from a concussion and post concussive symptoms, psychological injuries, and an exacerbation of a pre-existing condition.

Nelson relies on the clinical notes and records (“CNRs”) of Dr. David Ryan, family physician, The doctor’s notes confirmed Nelson was suffering from concussion symptoms as a result of the accident, including neck pain, headache, jaw pain, sleep difficulties, fogginess, poor concentration, mood changes, nausea, and fatigue. Included with her submissions were the ambulance call report and the emergency records; the CNRs of Dr. Bryan Brodeur, chiropractor; the CNRs of Lisa Vetsch, occupational therapist.

Coseco relies on two IE reports, both conducted via videoconference, with the assessors in Ontario and Nelson in Alberta. First, Dr. Raymond J. Zabieliauskas, physiatrist dated September 27, 2021. Second, A report by Dr. Garry Moddel, neurologist dated January 25, 2022, who found no sign of any neurological impairment as a result of the accident. The report of ongoing and frequent migraines were most likely the result of increased stress and anxiety, not the result of neurological sequelae connected to the accident.

The Tribunal found:

• Nelson claims that Dr. Ryan diagnosed her with a concussion on July 13, 2020, which did not agree with his notes from that appointment that indicate ‘whiplash injuries’ followed by ‘elements of concussion. Dr. Ryan’s records however consistently lead with ‘whiplash injuries’ first. There was nothing in the records that Nelson was formally diagnosed with a concussion as a result of the accident.
• According to the ambulance call report Nelson told the paramedics that she did not hit her head nor did she lose consciousness. The subsequent hospital report noted “neck stiffness (described as “chronic” due to the applicant’s comment to paramedics and physicians about this issue having been caused by a previous accident)”.
• Dr. Ryan did not perform concussion testing, order diagnostic imaging or refer Nelson to a neurologist to further investigate head trauma. If Dr. Ryan suspected that Nelson had experienced any sort of traumatic brain injury in the accident he had many opportunities to investigate. He was still recording the same general symptoms until at least January 27, 2021.
• Although the IE assessments took place via cell phone while Nelson was sitting in her car, which was not the ideal location for any sort of physical examination, the opinion of Dr. Moddel was of value regarding the concussion claims as he was the only neurologist to assess Nelson.
• Nelson’s references to psychological impairments and issues related to a previous car accident about 10-20 years earlier were not persuasive. There was little mention of mental and emotional symptoms in the CNRs of her family physicians and no record of her seeking or receiving any psychological treatment following the accident.

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.

Inform your position & present persuasive arguments. Include an Outcome Analysis Report (OAR) in your case evaluation complete with For/Against cases. Need an OAR?