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  MIG Update – March 16, 2026

Why a Diagnosis Doesn’t Guarantee an IE

This week’s MIG review examines a dispute over whether the Applicant’s claims of psychological impairment and chronic pain constituted non-minor injuries. The Applicant argued his claims should be accepted on the basis that the insurer lacked a foundation for denial without first conducting an IE. Conversely, the insurer maintained it had no duty to investigate claims that lacked foundational medical evidence.

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In Limson v. Wawanesa Mutual Insurance Company (24-001349), Paul Limson was involved in an accident on May 24, 2022, and sought entitlement to a Treatment Plan for a psychological assessment and removal from the MIG based on chronic pain, physical injuries, and a psychological impairment.

Limson relied on the December 2022 psychological assessment report by social worker Viktoria Tolmatshov, supervised by psychologist Dr. Fariba Touyeh who diagnosed him with adjustment disorder, mixed anxiety and depressed mood, and automobile fear. Ms. Tolmatshov noted that Limson scored 57 out of 80 on the PCL-5 checklist, which she found was consistent with PTSD directly related to the accident. Furthermore, since there was no IE undertaken by Wawanesa to rebut the report there is no basis for the denial.

Regarding his physical injuries, Limson pointed to the OCF-3 of chiropractor Dr. Nailli, which listed nightmares and anxiety. He cited Elbahja v Wawanesa to argue that the absence of complaints to treating practitioners does not undermine the validity of a diagnosis. Regarding chronic pain, he referenced functionally disabling pain.

Wawanesa argued there was a lack of contemporaneous medical evidence or documentary submissions regarding psychological issues. It argued that it had no basis to order an IE because these issues were never in question.

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The Tribunal found:

• • Little weight was given to the OCF-3 of Dr. Nailli because the chiropractor provided no explanation for the mentions of nightmares and anxiety, and he was not directed to any other records where Limson complained of psychological sequela.
  • Less weight was given to the December 2022 psychological report by Dr. Touyeh and Ms. Tolmatshov due to internal inconsistencies:
  • While the report stated that Limson experienced elevated stress, it also indicated he reported being bothered by anxious feelings hardly at all in the preceding weeks.
    
  • It was contradictory that the report described Limson struggling with personal tasks while the assessors simultaneously recorded that he continued to perform all activities of daily living.
  • The assessors failed to identify any impacted employment tasks and did not include the CNRs of Dr. Alegado for consideration.
    
  • Dr. Touyeh recorded that Limson experienced financial stress, but this was not attributed to the accident and was not in the formal report, suggesting his challenges were not solely accident-related.

  • “There is no contemporaneous or corroborating evidence before me that supports the conclusions of Viktoria Tolmatshov, a registered social worker, under the supervision of Fariba Touyeh, a psychologist. Based on the self-reported ability to continue to perform all activities of daily living I find the Applicant’s symptoms do not interfere with his functional ability and therefore do not rise to a level of impairment.”
  • Limson did not explain how chronic pain limited his functional abilities or refer to the AMA Guides or a specific diagnosis. The December 2022 psychological report was given little weight regarding pain because there was no evidence of changes to Limson’s participation in social, employment, or physical health activities.

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  Need a briefing on recent MIG trends or a case law training session for your team? We can help.

  Contact us today or reach out on live chat to set up a tailored session or request a stat report and summary of recent MIG rulings.

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