MIG Update – March 4, 2024

Concussion and Chronic Pain Diagnoses Require Expertise

This week, a MIG hold case where the Applicant’s medical evidence and experts rendering the diagnoses were put to the test. The Tribunal considered their relevant expertise and supporting findings in coming to its conclusions.

Factor: Medical Evidence

In Vigliotti v. Echelon Insurance Company (22-000150), Roman Vigliotti was involved in a motor vehicle accident on January 16, 2021 and sought entitlement to two Treatment Plans for psychological and physiotherapy services. He claimed that he should be removed from the MIG due to a concussion, chronic pain, pre existing psychological condition and driver’s anxiety.

Vigliotti relied on the OCF-3 by chiropractor Dr. Matheson dated February 3, 2021, which indicated a diagnosis of concussion; the CNRs of family physician Dr. Lo, to support his claim that he was diagnosed with chronic pain. Further, he meets at least three of the six AMA Guides criteria for chronic pain, including excessive reliance on support from family and friends for housekeeping responsibilities, withdrawal and lack of engagement in pre-accident hobbies, and an inability to drive due to fear. He advanced evidence of entering an opioid rehabilitation program in October 2021 to address his drug dependency.

Echelon submitted that Vigliotti did not sustain a concussion as a result of the accident as there was no report of hitting his head or any body part as recorded in the adjuster’s log notes dated January 21, 2021. There was also no compelling evidence of a chronic pain diagnosis. It further relied on the IE report of psychologist, Dr. Direnfeld, in support of its position Vigliotti did not have a psychological diagnosis relating to the subject accident.

The Tribunal found:

    • Insufficient evidence to support Vigliotti’s claim that he suffered a concussion as a result of the subject accident.
    • As only three types of practitioners are regulated in Ontario to make a diagnosis of concussion: a physician, nurse practitioner, or neuropsychologist little weight was given to the chiropractor, Dr. Matheson’s diagnosis of concussion as he is not qualified to make such diagnosis.
    • Dr. Matheson’s notes did not offer any rationale for the diagnosis, nor need for additional tests or examination. Further there is no record of Vigliotti being advised to follow a post-concussion protocol, and no referrals are noted.
    • Vigliotti first reported the mva to his family doctor 5 days post-accident with complaints of pain in his neck, headache, and tenderness in his upper back the day following the accident. The records reflect he was diagnosed as suffering a sprained neck. The GP’s records do not mention nor support a diagnosis of concussion.
    • On the issue of chronic pain, there was only one reference in the GP’s notes 10 months after the accident where Vigliotti complained of ongoing neck, back and right shoulder pain. The GP’s records were insufficient to support a finding of chronic pain. There was no referral to a chronic pain specialist and Vigliotti did not lead evidence that the GP had the credentials to make such a diagnosis.
    • There wasn’t a causal link between his drug addiction and the mva. The intake records of Recovery Care’s dated October 21, 2021, indicate an eight-year history of cocaine with no reference to the subject accident and any dependency on drugs Virgillio may have acquired.
    • Dr. Direnfeld’s IE opinion is persuasive in that there was insufficient evidence of any accident-related functional impairment from a psychological perspective.

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