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  MIG Update – October 27, 2025

Credibility of Conflicting Concussion Assessments

This week’s MIG review involves a concussion case where the Tribunal considered whether the early skepticism of the Applicant’s family doctor and the insurer’s neurologist outweighed the consistent and cumulative evidence of concussion documented by the Applicant’s treating medical team which included a sports medicine physician and an optometrist who provided a neuro-optometric assessment report.

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In Eisner v Cooperators General Insurance Company (23-009845), Christina Eisner was involved in an accident on July 21, 2021 and sought entitlement to a Treatment Plan for neuro-ophthalmology assessment in the amount of $915 and removal from the MIG as she sustained a concussion as a result of the accident.

Eisner submitted that the force of the impact of the accident jolted her head forward and back with enough force to cause her hat to fly off her head. She relied on the Brain Injury Canada’s definition of a concussion to assert that she suffered a brain injury. She relied on the CNRs of family doctor Dr. Rabie dated from July 2021, which indicated that she complained of confusion, nausea, dizziness, poor memory, and decreased focus, for which she was prescribed pain and anti-depressant medications. This was further corroborated by sports medicine physician Dr. Mai’s report dated November 2022, who diagnosed Eisner as suffering from persistent concussion symptoms. He recommended physiotherapy, OT, registered massage therapy, and medication.

Eisner also relied on the neuro-optometrist assessment with Dr. Wareham, optometrist whose neuro-optometric report and opinion (January 2023) diagnosed her as presenting with visual diagnoses commonly found in post-traumatic brain injury patients.

Cooperators argued Eisner did not sustain a head injury that would have her sustain a concussion and she did not hit her head. More specifically, that the question mark next to the word “concussion” in Dr. Rabie’s clinical note dated July 2021, was an indicator that the doctor was not convinced that Eisner suffered from a concussion. It asserted that Dr. Rabie did not perform any concussion testing or order diagnostic imaging of Eisner’s head or engage in other concussion related investigations.

Further, Cooperators submitted that Dr. Mai was not qualified to make the assessment and referral because he is not a neurologist and therefore, he cannot make a diagnosis that Eisner had a concussion. It relied on the July 2022 and May 3, 2023 IE neurologist Dr. Robinson’s reports concluded that Eisner’s injuries were predominantly minor and could be treated within the MIG.

On the procedural issue of admitting Dr. Mai’s May 30, 2023 report, Cooperator argued that it was submitted outside of the75 day production deadline. While Eisner failed to comply with disclosure rules the Tribunal allowed the report to be admitted because its probative value outweighed the prejudicial effect, as the Cooperator had time to review and respond.

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The Tribunal found:

• The family doctor, Dr. Rabie, having Eisner’s medical history, repeatedly reported that she experienced a concussion and concussion symptoms. Although she might not not have been convinced that Eisner had a concussion in July 2021, in the following months, ranging from July 2021 to October 2022, she consistently referred to Eisner as having concussion symptoms and concussion.
  
• That sports medicine physician Dr. Mai saw Eisner on two occasions, dated November 1, 2022 and May 30, 2023 where he recommended that she continue with therapy and start psychology appointments as soon as possible and medication for her ongoing headaches.
• Dr. Robinson evidence carries more weight given his expertise as a neurologist, however, Cooperators did not cite any authority establishing that a sports medicine physician cannot diagnose concussions. “I have accepted Dr. Mai’s report into evidence, though I have given it reduced weight.”
• “Further, Dr. Mai attended to the applicant on two occasions, dated November 1, 2022, and May 30, 2023. His opinion is based upon the applicant’s self reporting, her family doctors’ clinical notes and report and the opinion of Dr. Wareham. He reviewed the IE report and he disagreed with Dr. Robinson’s opinion stating that the applicant was inadequately treated. He recommended that the applicant continue with therapy and start psychology appointments as soon as possible and medication for the applicant’s ongoing headaches.”
  
• Dr. Robinson did not get to review Dr. Mai’s May 30, 2023 report as he provided his addendum opinion May 3, 2023.
• “Furthermore, Dr. Wareham opined that many of the visual signs and symptoms associated with concussion are linked to a dysfunction of the oculo vergence system. And the applicant presented with visual diagnoses commonly found in post traumatic brain injury (TBI) patients”

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