MIG Update – October 4, 2021
Can You Be Both In and Out of the MIG?
In this week’s edition something a little different on a topic that comes up quite a bit and is tricky to navigate. We share a case both for and against the Applicant from an Outcome Analysis Report (OAR) request of the past week on the topic. The fact situation:
“A psychological diagnosis removes the Applicant from the MIG, but the physical injuries are soft tissue in nature and fall squarely within the definition of the MIG. Are there cases that limit access to physical treatment to the MIG?”
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Can’t Be In and Out of the MIG – In GP v Aviva (18-012548), the Tribunal held ‘the decision to remove the applicant due to psychological impairment is not segmental – that is, it does not limit the applicant to only psychological treatment, but instead is the reason to breach the threshold and access further reasonable and necessary treatment’.
In this case, a February 2017 loss, GP’s chiropractic and massage treatment in April 2017 was denied based on the November 2017 IEs. Subsequently, the Applicant was removed from the MIG on psych and the previously denied chiropractic treatment was found to have met the ‘reasonable and necessary’ test.
The Tribunal’s finding turned on:
- The removal from the MIG due to psychological impairment is not “segmental” but is the reason to breach the $3,500 threshold and access to further reasonable and necessary treatment
- Prior to the MIG removal, the Applicant had access to only one treatment plan for physical injuries, as her psychological assessment and treatment consumed the remainder of the MIG funds available
- The subject chiropractic treatment was found reasonable and necessary, as ongoing pain complaints and its relevance to her psychological impairment were documented by the psych IE
Can Be In and Out of the MIG – In JB v Aviva (18-005595), a December 8, 2016 accident, the Tribunal determined JB met the burden of proof in establishing pre-existing depression and anxiety were exacerbated by the subject accident and therefore JB was out of the MIG on psych. The Tribunal at the same time ruled that JB did not submit medical evidence to establish that her physical injuries are anything but predominantly “minor”.
“Because I conclude that J.B. has not met the onus of showing that she suffered physical injuries that are not considered to be minor as a result of the accident, I find the claimed treatment plans are not reasonable and necessary”
The Tribunal’s finding turned on:
- The December 2017 report of Dr. Chaudhry who opined that J.B. suffered injuries that were predominantly minor. J.B.’s complaints of cervical and bilateral lumbar pain upon testing showed normal range of motion and strength across all joints.
- “J.B.’s delay in seeking medical treatment for her physical injuries supports my finding that her physical injuries fall within the MIG”.
- J.B. attended Winston Churchill Medical on three different occasions after the initial post-accident visit on December 9, 2016. The first visit occurred on April 4, 2017, more than four months post-accident; the last visit occurred on June 19, 2017. J.B. attended the clinic for issues completely unrelated to the subject accident.
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