MIG Update – July 8, 2024

MIG Escape Despite Unrelated Psych Issues

In review this week, a MIG escape case wherein the Tribunal considered the Applicant’s long standing history and unrelated psychological concerns in its determination. At the center of the conflict was the causal link of the complaints to the subject accident.

Factor: Pysch

In Kinslikh v. Aviva Insurance Company, 2024 (22-006435), Alla Kinslikh was involved in a motor vehicle accident on July 23, 2021, in addition to NEB she sought entitlement to six Treatment Plans for physiotherapy, physical rehabilitation, assistive devices, neuropsychological assessment, cognitive assessment, neurological assessment, and orthopedic assessment totaling $13,903.15.

Kinslikh claimed that she should not be held within the MIG due to a psychological impairment. She led medical evidence from her family doctor, Dr. Trinchuk where it was noted she started to report psychological symptoms in August 2021; an October 2021 assessment report from psychologist Dr. Papazoglou, that diagnosed her with Adjustment Disorder with mixed anxiety and depressed mood and; the records from psychiatrist Dr. Chekina, from August to November 2022, who had diagnosed her with PTSD and depression, provided supportive therapy and prescribed Cipralex.

Aviva claimed that the Kinslikh suffered soft tissue injuries that fell within the MIG and that her psychological concerns (anxiety) pre-dated the accident. Kinslikh was on ODSP pre-accident for her myasthenia gravis condition. Aviva relied on the IE report of Dr. Koepfler, who found no indication of significant impaired function from a psychological perspective. Similarly, IE neurologist Dr. Desai, found that Kinslikh suffered from intermittent headaches secondary to whiplash associated disorder, which fell within the MIG.

With respect to the disputed OCF-18s, IE assessor, Dr. Silver found that physical treatment was not reasonable and necessary and that further facility-based treatment was not required. In addition, IE physiatrist Dr. Hosseini determined that an orthopedic assessment was not reasonable and necessary for Kinslikh’s soft tissue strains and sprains.

Of note, none of the dates of the Aviva’s IE”s were reported in the decision.

The Tribunal found:

  • Although, they agreed with Aviva that the s25 report of Dr. Papzoglou did not reference a review of the Kinslikh pre-accident medical records or an awareness of Kinslikh’s pre-accident anxiety, her treating psychiatrist Dr. Chekina expressly referenced Kinslikh’s pre-accident treatment and concerns. Dr. Chekina still linked Kinslikh’s psychological impairments to the subject accident.
  • The OHIP records noted the last recorded date of treatment with psychiatrist Dr. Matensko was February 2019. Aviva did not direct any evidence to conclude that the psychological complaints continued up to the date of the accident.
  • “Although I agree with the respondent that Dr. Chekina referenced other stressors including health concerns such as the applicant’s 30 year history of myasthenia graves and emotional neglect during childhood, in my view, the accident was identified as a primary factor in her impairments. In the September 1, 2022 CNR entry, Dr. Chekina noted that one of the main themes of the session was the exploration and discussion of recent “traumatic” experiences as a result of the accident. In the November 28, 2022 entry, Dr. Chekina assessed the applicant as having difficulty dealing with post MVA sequelae and again diagnosed the applicant with PTSD and depression. Dr. Chekina noted the applicant’s complaints of depressed mood, insomnia, lack of interest and energy since the subject accident. As the applicant’s treating psychiatrist, I place significant weight on Dr. Chekina’s findings.”
  • The treatment plan for physiotherapy dated July 30, 2021 in the amount of 2764.36 was reasonable and necessary as the timeframe linked with the ongoing complaints of physical pain found in the family doctors records August 2021.
  • As for the balance of the OCF 18’s for assessments and devices Kinslikh did not lead any evidence to overcome the opinions of Aviva’s assessors.

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