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  MIG Update – July 27, 2026

Pre-Existing Baseline vs. Post-MVA Aggravation

This week’s case review is centered on a MIG removal for chronic pain. The primary issue before the Tribunal was determining whether post-accident complaints reflected an MVA-induced aggravation of a pre-existing baseline or merely a continuation of prior impairments. The Tribunal considered a section 25 assessment alongside neutral, contemporaneous CNRs, and how the absence of opposing medical evidence shaped its analysis and determination.

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Factor – Failure to Submit Controverting Medical Evidence

In Oudeh v. Co-operators General Insurance Company (25-002667) Yusra Oudeh was involved in an automobile accident on November 2, 2023, and sought entitlement to three Treatment Plans, physiotherapy, a psychological assessment, and a chronic pain assessment. She sought to be removed from the MIG based on chronic pain and a pre-existing condition.

The Applicant’s Position

Oudeh acknowledged having pre-existing pain prior to the subject accident, but asserted this accident significantly aggravated her baseline condition to the point where it evolved into chronic pain with functional impairment. She relied on an October 2024 chronic pain assessment, by pain specialist Dr. Nadir Al-Jazrawi who diagnosed her with chronic pain in her neck, and her upper, mid, and lower back. The report identified functional limitations in her ability to sit or stand for long periods of time, along with difficulties in squatting, climbing, lifting, carrying, driving, and cognitive impairment. She also relied on the CNRs of her GP, Dr. Alshami, which documented that her neck and back pain worsened after the accident. The records noted specific complaints on December 11, 2023, a recent exacerbation on December 27, 2023, and reports that her pain was radiating to her lower legs in February 2024.

The Respondent’s Position

Co-operators argued that Oudeh failed to meet her burden of proof, maintaining that while she may suffer from chronic pain, the condition pre-dated the motor vehicle accident. It did not file medical evidence or an independent assessor report to counter the findings of Oudeh’s pain specialist or family doctor.

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The Tribunal found:

• • Dr. Al-Jazrawi is a recognized pain specialist who explicitly reviewed Oudeh’s pre-accident/post-accident family physician records before forming his opinion, ensuring his diagnosis accounted for her baseline history.
  • The CNRs of family doctor, Dr. Alshami, as an OHIP-funded doctor in an ongoing, pre-existing treating relationship with Oudeh is regarded as an independent, neutral observer.
  • The CNRs established ongoing pain documenting “recent exacerbation” and “pain is getting worse” radiating into legs across multiple visits from Dec 2023 to March 2024.
  • “In summary, the applicant has provided a pain specialist’s report which clearly identifies accident-caused chronic pain with a functional limitation. This diagnosis is confirmed by the independent observations of the applicant’s family physician, Dr. Alshami. Furthermore, the respondent has chosen not to include medical evidence in its submissions, meaning I can not consider medical evidence from the respondent.

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