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  MIG Update – October 20, 2025

Key Evidentiary Gaps in Concussion and TMJ Claim

This week, a MIG hold where the Tribunal examined whether there was sufficient evidence to support diagnoses of concussion, seizures, and TMJ as being caused by the subject accident. The decision also included an analysis of the Applicant’s evidence regarding psychological injuries. What was the key evidentiary failure that led to the outcome?

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In DaCosta v. Belair Insurance Company Inc (23-007920), Raquel DaCosta was involved in an accident on February 14, 2022 and sought entitlement to two Treatment Plans for physiotherapy services and psychological assessment totaling $7,413.61. She submitted that she should be removed from the MIG, as she suffered concussion, TMJ pain and seizures as a result of the accident.

DaCosta relied on the emergency triage note, which stated that she had post-concussive symptoms including headache, chest pain, neck pain with associated loss of consciousness. The CNRs of family doctor Dr. Pantakis dated March 2022, showed that she reported having various post-accident symptoms including headache and neck and back pain and that she fainted once in the shower, for which CT of her head was ordered.

She also submitted the April 2022 clinical note of orthodontist Dr. Rondeau, which found TMJ pain and clicking for which she was with a splint to be worn.

DaCosta relied on the June 2022 note from neurologist Dr. Burneo, which indicated that she had a first-time seizure in June 2022 and described the accident and associated loss of consciousness and post-concussive symptoms.

She was taking medication for anxiety and depression, and after the accident, she was given many more medications related to her mental health.

Belair submitted that DaCosta’s injuries were within the MIG, as the IE report by GP Dr. Bansal dated September 2022 concluded that DaCosta sustained soft tissue injuries of the back and neck in the accident. It also relied on the IE report of psychologist Dr. Mor dated August 2022, who concluded that, although DaCosta had anxiety, she did not meet the criteria for a diagnosis as related to the accident, and her prognosis for any accident-related psychological injuries was excellent. Belair further submitted that DaCosta’s psychological impairments pre-date the accident and were not caused by the accident.

On the claim for the diagnosis of TMJ Belair submitted that the CNRs of Dr. Rondeau did not support removal from the MIG because there was no description of the mechanism of injury causing the TMJ pain or any diagnosis or recommendation suggesting the pain was anything other than soft tissue in nature.

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The Tribunal found:

• The head CT was unremarkable and that family doctor Dr. Pantakis did not diagnose DaCosta with a concussion.
  
• The evidence that TMJ pain was caused by or made worse by the accident was in the form of self-reports by DaCosta to orthodontist Dr. Rondeau in April 2022. There was no other evidence that connected the TMJ pain / clicking to the accident.
• No evidence that DaCosta’s seizure was related to the subject accident. According to neurologist Dr. Borneo’s CNRs, his impression was that the tonic-clonic seizure was likely provoked in the context of using certain medications. This was further corroborated by Dr. Pantakiz reported to the Ontario Ministry of Transportation, where he stated that DaCosta’s seizure / loss of consciousness was provoked by prescription medication and had been resolved. The seizure did not recur according to the CNRs in evidence.
  
• While DaCosta saw Dr. Pantakiz in May 2022 about “questionable behaviour”, for which he prescribed medication to treat potential bi-polar disorder and referred her to a psychiatrist, there was no indication in the medical evidence that the mental health and focus / concentration challenges that she was subsequently treated for by psychiatrist Dr. Pillai were related to the accident.
  
• “I accept the opinion of Dr. Mor, psychologist, who assessed the applicant on August 16, 2022 by way of psychometric testing and clinical interview. Dr. Mor concluded that, although the applicant has anxiety, she does not meet the criteria for a diagnosis as related to the accident, and her prognosis for any accident-related psychological injuries is excellent. Dr. Mor concluded that the applicant should be treated within the MIG”.

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