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  MIG Update – June 17, 2024

Cause of ‘Remote’ Finger Fracture Questioned

This week, a MIG hold case wherein the Applicant relied on a X-Ray finding 3 days post accident that revealed a ‘likely remote’ fracture of the finger. The Tribunal considered the clinical and orthopedic evidence to determine if this ‘remote’ fracture was related to the accident.

Factor: Orthopedic Evidence

In Muhumed v. Economical Insurance Company (22-006383), Abdiaziz Muhumed was involved in a motor vehicle accident on February 9, 2021, and sought entitlement to five OCF-18s for physiotherapy , totalling almost $6,000.00; as well as psychological and orthopedic assessments.

Muhumed relied on a number of diagnostic opinions that included:

• Diagnostic imaging from February 12, 2021, three days post-accident, which reported a “likely remote fracture involving the head of the middle phalanx” in the 4th finger of his right hand;
• Family physician Dr. Wilcox October 2021 note referencing the said diagnostic and pain secondary to the accident for the past 6 months;
  
• Further diagnostic imaging on November 15, 2021 reviewed by Dr. Edwin Wu, physician who confirmed a “post-traumatic deformity of the mid phalanx” in the 4th finger of the right hand with a step deformity similar to the images taken in February 2021 noting moderate osteoarthritic changes;
• The orthopedic report of Dr. West from November 2021 which stated that the fifth finger on the right hand revealed a lack of full extension by 45 degrees and the 4th finger “demonstrated similar but less severe findings.”

Dr. West also found that he sustained multiple deep soft tissue injuries involving several areas of his body including both the cervical and lumbar spine.

With respect to the claimed psychological impairment, Muhumed relied on the March 2022 report of psychologist, Dr. Langis and psychotherapist, Mr. Srinivasan, which diagnosed him with Other Specified Trauma and Stressor-Related Disorder, Specific Phobia (situational, vehicle related), and Somatic Disorder with Predominant Pain Persistent.

Economical submitted that the alleged fracture of the 4th right finger did not fall outside the MIG because the deformity could be considered minor; and there was no evidence that it rose to the level of a fracture, or any evidence that it was caused by the accident. They relied on a June 2022 IE by physician, Dr. Naiman, who diagnosed Muhumed with only minor injuries arising from the accident, and did not mention the possible fracture or deformity of the 4th finger. On the psychological injury, they relied on the IE report of psychologist, Dr. Mandel, who found a lack of consistent, objective information that would support a poor psychological prognosis, a DSM 5 diagnosis, or that Muhumed suffered clinically significant symptoms of a psychological impairment from the accident. Dr. Mandel also stated that the accuracy of the Applicant’s reported dysfunction was questionable given his score on validity tests.

The Tribunal found:

• “The question of whether the applicant sustained a physical injury beyond minor, turns on whether the 4th finger was fractured, and if so, whether the fracture was caused by accident. The medical evidence persuades me that the applicant indeed suffered a fracture to his 4th finger at some point, but there is insufficient evidence for me to conclude that the injury was caused by the accident.”
• The only reference to the 4th finger being fractured is from the February 12, 2021 X-ray where the radiologist, Dr. Zeev Maizlin, reported Muhumed had previously and likely sustained a remote fracture involving the head of the middle phalanx of the 4th finger
  “The applicant has not provided any clarity as to whether a “remote fracture” is from three days ago or many months or years ago. This lack of certainty around what “remote” means, makes the report of the fracture less convincing”.
• Following the November 2021 X-Ray Dr. Wu, only references the 4th finger injury as a post-traumatic deformity with no reference to subject accident nor whether the deformity is accident related.
• Neither the IE of Dr. Naiman nor Dr. West mention the 4th finger as an accident injury despite each of them having reviewed the diagnostic imaging results and assessed the applicant in-person.
• With respect to the other physical injuries referenced by Dr. West his conclusions were inconsistent with the family doctor’s records, the latter aligned with Dr. Naiman’s IE diagnosis and conclusion of sprain and strain injuries from the accident.
• “I find a significant gulf between the psychological profiles of the applicant in these two reports. For example, the Srinivasan/Langis report concluded the applicant suffers from severe driver anxiety, but Dr. Mandel reported the applicant is confident in driving five days per week as an Uber driver.”
• Dr. Mandel’s assessment included validity testing, a document review, and he is qualified to determine a psychological diagnosis whereas the Srinivasan/Langis report relied on Muhumed’s self-report and it was unclear to what extent Dr. Langis conducted the assessment.

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