MIG Update – April 22, 2024

Records Alone Do Not Warrant MIG Removal on Pre -Existing

This week, a MIG hold case, the Tribunal considers a matter wherein the Applicant had a documented history of a knee condition. As well as, an opinion that the Applicant ‘likely’ has chronic pain as a result of the accident.

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Factor: CNRs

In Sehgal v. Aviva (21-007940), Neelam Sehgal was involved in a motor vehicle accident on July 29, 2020. In addition to IRB she sought entitlement to three treatment plans for chiropractic services and prescription medications. She claimed that she should not be subject to the MIG as her pre-existing knee injury was exacerbated by the accident, as well as a diagnosis of chronic pain in her neck, back and shoulder as a result of the accident.

Sehgal relied on the clinical notes and records of Dr. Saini, her family doctor, pre-accident reports of orthopaedic surgeons Dr. Karabatsos and Dr. Harrington, a pain assessment report of Dr. Wasswa-Kintu, general practitioner, dated May 3, 2021, and neurodiagnostic report of Dr. Rasquinha, general practitioner, dated November 30, 2021. She also relies on the CNRs of her treating clinics.

Aviva relied on the IE reports of physiatrist, Dr. Soric dated February 19, 2021, addendum August 24, 2021, who diagnosed Seghal with soft tissue injuries as a result of the accident which fall under the MIG. Further the surveillance report of Intrepid Investigation dated November 18, 2021.

The Tribunal found:

• • • Although Seghal’s records and reports establish that prior to the accident she had a five-year history of problems with her left knee, arthroscopic surgery and knee pain complaints to her family doctor in the year prior the accident, the records alone do not warrant removal from the MIG.
    • “What I find lacking in this case is evidence from a treating practitioner supporting that the applicant’s pre-existing left knee impairment was exacerbated by the accident or would prevent her from achieving maximum medical recovery in the MIG, as is required for removal by s. 18(2).”
    • The post accident report of Dr. Wasswa-Kintu and Dr. Rasquinha, relied upon by Seghal, did not mention the left knee at all or note any exacerbation. Seghal also did not report any symptoms involving the left knee to Aviva’s assessor Dr. Soric.
    • Dr. Soric’s physical examination in February 2021 was unremarkable, finding full range of motion of the cervical spine and normal strength in all four extremities. After reviewing the records in August 2021 Dr. Soric’s opinion remained unchanged.
    • Dr. Wasswa-Kintu diagnosis of chronic pain, was given little weight because the assessment took place by telephone and the doctor did not carry out a physical examination. The report interchangeably refers to Seghal as male and female throughout and did not review any pre- or post-accident CNRs. All of which challenge the reliability of the opinion.
    • Dr. Rasquinha’s report has similar limitations in that the doctor did not review any pre- or post-accident CNRs. The physical examination of Seghal was normal, yet rendered the opinion that Seghal likely suffers from chronic pain syndrome.
    • Dr. Soric opinions were preferred because the assessment was more thorough, records were reviewed and consistent with Seghal’s self-reports about her post-accident function.
    • The surveillance report from November 2021 showed Seghal participating in grocery shopping and running other errands confirming her self-reports and Dr. Soric findings.

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    If you Have Read This Far…

    Our MIG Monday series discusses the multitude of factors to consider when evaluating a risk position on MIG cases. The Tribunal has ruled on the MIG in 24% of the decisions so far. Each case is nuanced, but with similar factors.

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