MIG Update – March 18, 2024

No Weight Afforded to Handwritten Illegible CNR’s

The pitfalls of not providing a complete evidentiary record was exemplified in this week’s MIG hold case. The Applicant was ordered to have their family doctor’s largely illegible notes transcribed, however failed to comply. The Respondent having agreed to pay for the cost of same, asked the Tribunal to afford no weight to the records.

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Factor: CNRs

In Washington v. The Personal (21-015360), Homahan Washington was involved in a motor vehicle accident on April 2, 2019 and sought removal from the MIG on the basis of a psychological injury and chronic pain.

Washington’s intention was to rely on the records of his family physician Dr. Lamotharan, who diagnosed him with PTSD; an OCF 3 by Dr. Lamotharan dated October 2021; the pre-screen report of psychologist Dr, Akram-Pall; the January 2023 report of chiropractor Dr. Nolan, and treating clinic Pro Life Wellness CNRs.

The Personal took the position that Washington failed to provide compelling information to conclude that he sustained a psychological injury or chronic pain as a result of the subject accident. Further he breached Tribunal’s order to have the illegible hand written notes of his GP transcribed, even after they agreed to pay for the cost of same.

The Tribunal found:

• • “I agree with the Respondent and afford Dr. Lamotharan’s CNRs no weight. There is a clear disagreement between the Applicant and the Respondent regarding the contents of Dr. Lamotharan’s CNRs and I am unable to settle the dispute over their contents without the transcription. Further compounding the severity of the breach is the fact that the Tribunal Order stipulates that the Respondent agreed to pay for the transcription, thus there is no financial barrier for the Applicant to produce the records. I will not consider the hand-written CNRs under these circumstances.”
    
  • The pre-screen report by Dr. S. Akram-Pall, psychologist, unpersuasive and was given little weight as the report fails to outline why the pre-screen was commissioned. “It is as if the psychologist called up the Applicant without any reason or prior relationship and administered an 80-item screening tool and interview without any prior evidence of possible psychological injury.”
  • The treatment facilities records did not provide any information that indicated psych symptoms that would warrant a psych pre-screen further diminishing the contents of the pre-screen report.
    
  • The OCF 3 by Dr. Lamotharan dated October 11, 2021 clearly refers to PTSD symptoms arising after a subsequent accident in December 2020 as such cannot conclude the diagnosis was related to the subject accident.
    
  • The Personal is not required to commission an IE with each benefit. “The burden of proving an accident-related psychological injury rests with the applicant, not for the respondent to disprove it. To me, the minor psychological complaints in the Applicant’s medical record are sequelae of his minor injury.”
    
  • Likewise Washington failed to provide evidence that he meets the criteria for a chronic pain condition as outlined in the AMA Guides.
    
  • The MIG discharge report completed by Pro Life Wellness, dated August 20, 2019 that recommended further treatment failed to note that Washington had functional impairments, despite prompts on the form for that information.
    
  • Overall there were no references to functional impairments in the records.
    

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