MIG Update – May 27, 2024

Differing Opinions on Right Knee Injury Causation

This week differing opinions on the cause of a knee injury are at the center of the MIG dispute. The Tribunal considered the evidence of the Applicant’s pre-existing arthritic knee as well as the new symptoms following the accident in its ruling. What medical evidence was key in the Tribunal’s determination?

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Factor: CNRS

In Ferrier v. Economical Insurance Company (21-014606), Michael Ferrier was involved in a motor vehicle accident on August 25, 2019 and sought entitlement to four Treatment Plans for chiropractic services,and orthopedic, psychological and chronic pain assessments totaling $8,003.73.

Ferrier submitted that he suffered a right knee injury in the accident that resulted in a meniscal tear requiring surgical repair. He relied on the CNRs of the hospital, his family physician Dr. Gin, the January 9, 2020 examination by orthopedic surgeon, Dr. Sayedi and a February 2020 MRI. Additionally, the surgical intervention by Dr. Bhargava in October 2020 to debride and repair the meniscus. Ferrier also argued that he suffers from chronic pain, psychological symptoms including anxiety, depression, and sleep disorder, and that the accident exacerbated pre-existing arthritis.

Economical on the other hand contended Ferrier did not complain of right knee issues immediately post-accident and that he did not provide sufficient medical evidence to link the right knee injury to the accident. Rather, the medical evidence indicates that Ferrier suffered from pre-existing right knee degeneration and arthritis which led to the meniscus tears and surgery. It relied on two IE reports by orthopedic surgeon, Dr. Weisleder dated February 23, and November 16, 2022, who opined Ferrier sustained right knee strain injuries as a result of the accident and that he had reached maximum recovery from these injuries.

The Tribunal found:

• • • In support of Ferrier’s contention he complained of right knee pain following the accident, the hospital records and his family doctor, Dr. Gin’s family records observe and note pain and small laceration on right knee and shin.
    • The family doctor’s referral to Dr. Sayedi, orthopedic surgeon due to ongoing right knee pain examination on January 9, 2020 found Ferrier could not fully extend his right knee and there was severe tenderness on the medial side. Ferrier displayed a severe limp and walked with a cane.
      
    • The pre-existing arthritis of the right knee was supported by findings from a series of x-rays from November 2019. Dr. Sayedi concluded the “new onset pain after [the] accident may be related to internal derangement of the knee.”
    • Although Economical argued the opinion of Dr. Sayedi did not have a definitive diagnosis that the accident was the cause of the injury, Dr. Sayedi’s report indicates the accident played a significant role in Ferrier’s right knee issues and that the knee pain was newly developed following the accident.
    • It could not accept Economical suggestion that Ferrier would have required the same treatment because of the progressing arthritis.
    • Ferrier was fully functional prior to the subject accident with no indication of mobility problems related to his right need. Furthermore immediately post-accident his right knee worsened, causing him to walk with a limp, the aid of a cane and to seek extensive medical care.
    • The investigation led to an MRI February 2020 which revealed a “horizontal tear [of the medial meniscus] both centrally and peripherally along the posterior horn, and On October 1, 2020, Dr. Bhargava performed a partial medial meniscectomy, debridement of traumatic flap lateral femoral condyle, and right knee arthroscopy.
    • “Although the respondent asserts that neither the reports of Dr. Sayedi and Dr. Bhargava, nor any others, fully make a connection between the meniscus tears and the accident, I reiterate that the applicant’s burden is to demonstrate that his injuries fall outside of the MIG on a balance of probabilities. Absolute certainty is not required. In my opinion, the hospital report from the day of the accident; family doctor CNRs; diagnostic imaging reports; results of the MRI investigation; reports of two orthopedic surgeons; and the resulting surgery combine to more than meet this burden of proof with regard to the applicant’s knee injury being the result of the subject accident.”
    • Dr. Weisleder’s IE report of February 23, 2022 acknowledged that arthroscopic surgery had been performed yet concluded the diagnosis as a right knee strain and did not give an opinion on the cause of the meniscus tear.

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