MIG Update – October 31, 2022

Psych Diagnosis ‘Out of Scope’ For Pain Specialists

This week we discuss two MIG hold cases where the Applicant’s chronic pain specialists included psychological diagnoses in their conclusions, found by the Tribunal to be out of the scope of their respective practices. In neither case were the chronic pain specialists found to have certification, designation, or expertise in diagnosing and treating psychological impairments.

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Factor: Psych Diagnosis out of Scope for Pain Specialist

In Rowe v. Economical Mutual Insurance Company (20-010448), Patsy Rowe was involved in an accident on December 5, 2018 who sought removal from the MIG on the basis of chronic pain.

Rowe relied primarily on the report of Dr. Igor Wilderman, Pain Specialist, dated July 15, 2020, who utilized the American Medical Association Guides, 4th Edition and highlighted eight criteria in assessing whether a person suffers from chronic pain syndrome. Dr. Wilderman also undertook psychometric testing as part of his assessment noting Rowe met 6 out of the 8 criteria and rendered a diagnosis of chronic pain syndrome, chronic whiplash disorder (WAD) type II, bilateral impingement syndrome of the shoulder, bilateral rotator cuff syndrome, post-traumatic osteoarthritis of the acromioclavicular joint on the right, bilateral myofascial pain syndrome of the rhomboid region, depression, anxiety, and PTSD.

Economical relied on the IE report of Dr. Mohamed Khaled, General Practitioner, dated November 29, 2019 who diagnosed Rowe with grade 2 whiplash of the neck with associated shoulder sprain/strain, noting these were uncomplicated soft-tissue injuries.

The Tribunal found:

• With respect to the psychometric testing undertaken by Dr. Wilderman that identified symptoms of moderate anxiety, mild depression and PTSD, these conclusions were beyond the scope of Dr. Wilderman’s practice despite being a Pain Specialist.
• “Aside from Dr. Wilderman’s conclusions, I have no evidence of psychosocial sequelae including anxiety, fear, depression or non-organic illness behaviours”.
  
• Reports of pain to the family doctor, Dr. Krulewitz were sporadic and inconsistent between December 2018 and May 2021. Of the eight reports of pain, the last visits made no reference to the motor vehicle accident.
  
• Rowe sustained minor injuries and not chronic pain syndrome. Rowe failed to demonstrate a functional impairment with regard to the AMA Guides as while there had been a diagnosis of chronic pain, there was no evidence of a functional impairment.
  

In Kandola v. Economical Insurance Company (20-011592)), on May 11, 2019, Baljinder Kandola was the seatbelted driver when struck from behind while stopped at a traffic light, suffering soft tissue injuries to his neck and low back.

Kandola relied on the April 19, 2021 report by pain specialist Dr. G. Karmy, who conducted a virtual assessment and concluded that the Kandola suffered substantial psychological distress resulting from the accident, and diagnosed Kandola with Chronic Pain Syndrome.

Economical relied on the opinion of Dr. Marino, a psychologist who conducted an in person examination of Kandola in February 2020. Dr Marino administered a series of psychometric tests and found Kandola to be “honest and forthright” and concluded Kandola did not present with any significant psychological impairment.

The Tribunal found:

• Kandola made three visits to his family physician, after the motor vehicle accident and the CNRs did not contain any complaints or observations by Dr. Dhillon, of any psychological impairment.
• Kandola did not suffer a psychological impairment placing greater weight on the February 13, 2020 IE examination by psychologist Dr. A. Marino, who administered psychometric testing concluding Kandola experienced some pain but did not present with any significant psychological impairment or diagnosis.
  
• Dr. Karmy relied on the self-reporting of Rowe and did not conduct any psychometric testing. Dr. Karmy had a limited scope of observation of Rowe due to the virtual examination format.
  
• “I assign little weight to the diagnosing of psychological impairments as this is outside his area of expertise. In his report Dr Karmy states his credentials as a chronic pain specialist but makes no indication of any training, certification, designation, or expertise in diagnosing and treating psychological impairments”.
  

If you Have Read This Far…

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