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  MIG Update – March 9, 2026

50% Award – Price of Ignoring Concussion Diagnosis

This week’s MIG review involves a concussion case where the Tribunal weighed the objective evidence of a concussion diagnosis including a CT scan and ER records versus a one-time IE report conducted months later. The consequences of the Respondent’s decision to maintain its position regarding the MIG limits were detailed in the ruling on the special award, which levied the maximum amount of 50% of the withheld treatment.

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In Desangher v. Intact (24-010632) Paiton Desangher, was involved in an accident on January 8, 2024, and sought entitlement to two Treatment Plans for physiotherapy services and a physiotherapy assessment, totalling $5,027.12. He sought to be removed from the MIG based on a concussion. He also sought a special award, arguing that Intact denied access to physiotherapy on the inappropriate statement that a concussion is a minor injury. It ignored objective medical evidence and demonstrated an excessive, stubborn, and unyielding attitude.

Desangher relied on physician Dr. Kelly’s January 2024 emergency room report, which indicated that he underwent CT scans of the head and spine, and it provided a final diagnosis of a concussion injury of the brain and a final impression of a neck strain. GP Dr. Lanz-O’Brien’s January 2024 CNRs indicated a potential brain bleed or concussion and included a recommendation for immediate emergency treatment. Physiotherapist Ms. Souliere’s January 2024 assessment provided for vestibular physiotherapy.

Intact submitted that Desangher had not met the burden of proof to establish a concussion. It relied on GP Dr. Bansal’s July 2024 IE report, which indicated that Desangher suffered only sprain and strain type injuries and concluded that it was unnecessary to remove him from the MIG. It argued that a physiotherapist is not qualified to diagnose a concussion. Regarding the Treatment Plans, it submitted that the denials were based on the report of Dr. Bansal. It submitted that Desangher did not demonstrate how it acted in bad faith or unreasonably withheld the benefits.

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The Tribunal found:

• • A physiotherapist is not qualified to make a diagnosis regarding a concussion, and therefore gave no weight to the diagnosis of physiotherapist Ms. Souliere, despite her concussion management certification.
    
  • Desangher provided more than sufficient evidence of a concussion, as diagnosed by two independent medical doctors. The January 2024 emergency room report by physician Dr. Kelly included CT scans of the head and spine, with the diagnosis section stating “Concussion injury of brain.” This evidence aligned with the initial diagnosis of GP Dr. Lanz-O’Brien, whose January 2024 notes indicated a potential brain bleed or concussion.
    
  • The July 2024 IE report of GP Dr. Bansal did not comment on whether or not Desnagher suffered a concussion.
    
  • The Physiotherapy Treatment Plan and assessment plans in the amounts of $3,227.12 and $1,800.00 were supported by the medical evidence in the form of physiotherapist Ms. Souliere’s assessment and the CNRs of GP Dr. Lanz-O’Brien supported the claim for physiotherapy treatment.
    
  • Desangher was entitled to an award of 50% of the physiotherapy Treatment Plans, finding that Intact’s conduct was stubborn and unyielding noting that it had long been established that a concussion removes an insured party from the MIG, yet Intact refused to accept this conclusion despite the diagnoses of two independent doctors.
    
  • The Treatment plans were clearly tied to post-concussion recovery and were supported by medical evidence and recommendations.
    
  • Intact either made a mistake in assuming a concussion is a minor injury or chose to disregard clear and objective evidence, such as the CT scan and relied on a July 2024 IE report that did not speak to whether Desangher had been concussed. This conduct justified the maximum award.
    

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