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  MIG Update – March 23, 2026

Why Chronic Pain Specialists Overrule IEs

This week, we review a MIG escape case where the Tribunal prioritized the specialized evidence of chronic pain experts over the IE reviews conducted by the Respondent’s general practitioners. The central takeaway from this decision is the Tribunal’s finding that being “functional”such as the Applicant’s return to work and driving does not negate a chronic pain diagnosis. Ultimately, the decision confirms that a consistent clinical history and the specialized expertise of the right assessor are the deciding factors in moving beyond the MIG.

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In McDonald v. Belair (23-012496), Byron McDonald was involved in an accident on July 7, 2022, and sought entitlement to IRBs from December 9, 2022, to July 7, 2024, and five Treatment Plans for physiotherapy services and a chronic pain assessment, totalling $13,388.01. He sought to be removed from the MIG based on chronic pain.

McDonald submitted clinical records from family doctor Dr. Drakhshan who documented chronic functional impairments, alongside expert reports April and May 2024 from specialists Drs. Frempong-Manso and Wilderman. These specialists diagnosed radiculopathy, chronic pain syndrome, and fibromyalgia noting that conservative treatments like injections provided little relief. Crucially, McDonald argued that the specialized chronic pain expertise of Drs. Wilderman and Frempong-Manso merits greater evidentiary weight than the findings of Belair’s assessors.

McDonald maintained that his ongoing impairments clinically justified the five treatment plans in dispute, specifically those proposed by chiropractor Dr. Zanjani in 2022 and 2023 to improve strength and facilitate a return to work. He further argued that physiotherapist Rohani’s September 2023 request for a chronic pain assessment was a “reasonable and necessary” measure to address persistent symptoms and reduced range of motion. This need for comprehensive evaluation is reinforced by his family doctor’s repeated referrals to a specialized pain clinic.

Belair argued that McDonald’s independence in driving, personal care, and return to work demonstrated a lack of functional limitation. It relied on the December 2022 and May 2024 IE reports of emergency medicine physician Dr. Krievins and GP Dr. Klein, who diagnosed soft tissue injuries. Consequently, it maintained that additional physiotherapy and a chronic pain assessment were unnecessary, supported by a functional abilities evaluation by kinesiologist Ms. Becker which suggested McDonald’s physical capacity met his pre-accident job demands.

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The Tribunal found:

• • McDonald suffered from documented ongoing pain and functional impairments, specifically noting a worsening of back pain and an inability to sit upright or stand for extended periods.
  • Greater weight was assigned to the assessments of the pain specialists Dr. Wilderman and Dr. Frempong-Manso) over Belair’s IE doctors noting their specialized focus on pain management and their use of the AMA Guides (6th Edition) to confirm chronic pain syndrome.
  • The chronic pain specialists’ findings were well-supported by the long-term CNRs from the McDonald’s family doctor, Dr. Drakhshan, which documented a consistent history of pain since 2022.
  • The failure of conservative treatments including injections and Tylenol with codeine, provided only limited or temporary relief, further supporting the chronic nature of the injuries.
  • The IE reports of Dr. Krievins and Dr. Klein failed to adequately review the family doctor’s CNRs or perform relevant testing and their diagnosis of minor soft tissue sprains/strains were inconsistent with McDonald’s documented clinical history and functional limitations.
    
  • Belair failed to sufficiently address McDonald’s limitations in standing, bending, walking, and driving.
  • Given the consistent complaints documented across multiple medical sources the chronic pain assessment was deemed a reasonable and necessary step to determine the severity of his condition.
    
  • A chronic pain diagnosis on its own did not establish that the specific services proposed in the four Treatment Plans were reasonable and necessary at the time they were submitted. There was no evidence from any treating practitioner recommending physiotherapy contemporaneously with the disputed plans.

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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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