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  MIG Update – November 24, 2025

No Family Doctor, No Problem?

In this week’s MIG case, the Tribunal addresses the evidentiary difficulties presented when an applicant with chronic pain does not have a family physician and receives treatment primarily through walk-in clinics. Central to the analysis is whether specialist opinions can offset deficiencies in the family doctor record.

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In Capalbo v. Economical Insurance Company (23-014852), Luccio Capalbo was involved in an accident on February 27, 2019 and sought entitlement to three Treatment Plans for psychological services, and psychological and chronic pain assessments, totalling $8,446.25. He sought to be removed from the MIG based on chronic pain.

Capalbo submitted that the evidence demonstrated persistent pain that significantly impaired his ability to work, perform household tasks, and engage in social activities. He relied on specialist in anesthesiology and interventional pain medicine Dr. Rozen’s September 2022 report, which diagnosed chronic cervical, thoracic, and lumbar myofascial pain, a possible T9 compression fracture, worsening pre-existing spinal degeneration, right knee osteoarthritis, and chronic right elbow pain.

Capalbo also relied on the walk-in clinic CNRs, which confirmed ongoing lower back pain and a diagnosis of chronic pain in May 2021. Additionally the OT Ms. Mehata’s July 2019 IE report, which concluded that he needed assistance with the physical aspects of daily activities.

Economical submitted that there was limited documentation of impairment in the family physician’s CNRs. It relied on GP Dr. Belfon’s July 2019 report diagnosing sprain/strain injuries to the cervical and lumbar spine and noting tenderness on palpation of the right lumbar paraspinal musculature.

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The Tribunal found:

• Capalbo’s explanation of the limited references in the family doctor’s CNRs, as he did not have a regular family doctor and relied on walk-in clinics, was consistent with his report to Dr. Rozen.
  
• The hospital CNRs supported that Capalbo began experiencing pain immediately following the accident. An April 2019 OCF-3 listed lower back pain, and May 2021 walk-in clinic CNRs confirmed ongoing lower back pain and included a diagnosis of chronic pain.
  
• Dr. Rozen’s September 2022 report was detailed, applied the AMA Guides, and provided a thorough evaluation of Capalbo’s chronic pain condition. Further, while GP Dr. Belfon’s July 2019 IE report identified soft-tissue injuries, it also noted ongoing neck and lower back symptoms.
• Dr. Rozen concluded that Capalbo suffered from chronic pain syndrome, which affected his mood and sleep, noting that he met at least three of AMA Guides six chronic pain criteria. Dr. Rozen also recommended a psychological assessment.
  
• “ Having considered the totality of the evidence, I find that the applicant suffers from ongoing and functionally limiting chronic pain. Unlike the limited documentation criticized by the respondent, the applicant has submitted detailed assessments from qualified specialists, supported by clinical records”.

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