MIG Update – June 24, 2024



Chronic Pain Diagnosis 4 Years Later Uncontroverted

The Tribunal considered the cumulative medical evidence that documented the chronicity of low back pain complaints over a 4 year period in the MIG escape case reviewed this week. The lack of competing medical evidence was determinative on the issue of causation.




Factor: Orthopedic Evidence

In Sharma v. CUMIS General Insurance Company (21-008290), Kamakshi Sharma suffered soft tissue injuries of the neck and back from the motor vehicle accident November 15, 2015. She sought entitlement to a treatment plan for physiotherapy some 4 years later in November 2019.

Sharma submitted that in the approximately 4 years leading up to the disputed treatment plan all her family doctors, of which there were 3, had documented her ongoing complaints and made referrals for further investigations. She relied on an MRI from November 2019 which concluded she had lumbar scoliosis, “L4-L5 right paramedian extruded disc herniation with significant thecal sac and mild L4 nerve root compression. L5-S1 diffuse mild disc bulge.” ; a consultation report of Dr. Arthur Lau, rheumatologist dated December 2019 which noted the MRI results and: a report by Dr. Mark Friedlander, chronic pain specialist, dated December 2, 2020 which concluded a causal relationship between the chronic pain and the subject accident.

Cumis on the other hand, relied solely on the records that Sharma produced making reference to the various records which documented ongoing complaints due to lack of exercise and life stressors. Amongst the notes in 2018 Sharma advised her family doctor that she was doing well academically and that her back pain had fully resolved. Moreover, the back issues from 2019 to current had to do with her being diagnosed with scoliosis, as stated by Doctor Lau. Further Dr. Friedlander assessment was conducted virtually and his opinion was at odds with the other medical evidence.




The Tribunal found:

  • Sharma had recanted her statement to her GP in 2018 that her back pain had resolved, that it was an error, she only said that as she was tired of going to doctors and clinics. This was found plausible for her age and circumstances.
  • The consultation report of Dr. Arthur Lau rheumatologist December 2019 noted the MRI results and report of numbness radiating down with referral to a spine surgeon however, nothing further was provided for consideration to reach a conclusion on causation.
  • Dr. Friedlander was preferred as he had reviewed all the records to conclude; “ But for the accident in question, the clinical course of Ms. Sharma’s injuries and resultant physical and possible psychological impairments would not have been as described. I do not believe there was anything in Ms. Sharma’s pre-accident history that contributed to making her vulnerable to the injuries sustained in this accident. There were no preexisting conditions that contributed to Ms. Sharma’s chronic pain condition.”
  • The fact that Dr. Friedlander’s assessment was conducted virtually was found appropriate due to COVID restrictions.
  • Cumis did not provide any competing medical opinion in support of its allegation that Sharma’s ongoing complaints were due to her scoliosis or that Dr. Friedlander’s conclusion of chronic pain syndrome caused by the subject accident was incorrect. As such Dr. Friedlander’s opinion was accepted.


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