MIG Update – March 14, 2022

Fibromyalgia Diagnosis 3 Years Later – No Causal Connection

This week, a fibromyalgia diagnosis almost 3 years after the accident was considered by the Tribunal. The Applicant could not overcome the gaps in the medical record to establish a causal connection to her ongoing complaints. Why was the Applicant’s expert’s opinion not accepted?


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Factor: Fibromyalgia and Causal Connection to Accident

In Shih v. Economical Insurance (20-005669), an April 20, 2017 accident, Shih sought removal from the MIG on the basis that her injuries were not predominantly minor.

Economical relied on the February 14, 2018 opinion of their assessor, Dr. Dilkas, physiatrist who opined Shih sustained sprain/strain injuries and no ongoing impairment.

To support that the injuries were not predominantly minor, Shih led the following evidence:

  1. Her family doctor, Dr. Lai CNR’s at 6 months post accident noted ongoing pain in the shoulder, arms and back.
  2. An OCF 3, 9 months post-accident, from physiotherapist Ms. Peneda indicated Shih would benefit from referral to a chronic pain specialist.
  3. In March 2020 her family doctor referred her to Dr. Wong, a physiatrist noting Shih continued to experience pain in the shoulder, arms and low back. Dr. Wong diagnosed Shih with fibromyalgia.

The Tribunal found:

  • The next visit to the family doctor was on November 6, 2017 with no mention of MSK, back and left arm pain. Shid did not see her family doctor again until November 14, 2018.
  • In the 19 visits to Dr. Yuen between November 14, 2018 until July 15, 2020 Shih did not mention any accident related injuries.
  • The treatment plan for physiotherapy February 2018 by Ms Peneda following the completion of the OCF 3 s does not suggest chronic pain specialist referral.
  • Dr. Yuen’s referral to Dr. Wong in March 2020 noted “puffy forearms because moved house and doing household chores” nothing related to injuries arising from the accident.
  • Dr. Wong’s diagnosed “Fibromyalgia” , however a progress note April 2020 indicated there are no more symptoms, no tender areas, upper extremity right normal and she was ‘recovered’
  • Neither of Dr. Wong’s notes dated March 17, 2020 and April 6, 2020 mention any accident related injuries. Dr. Wong, relied on Shih’s self-reporting, failed to review any medical records and therefore failed to establish a causal connection between the diagnosis and accident.
  • Ultimately, the opinion of Dr. Dilkas, February 2018 was preferred over the diagnosis of “fibromyalgia” by Dr. Wong.

If you Have Read This Far…

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