MIG Update – February 5, 2024

CT Scan of Wrist Fracture Contradicts Medical Opinion

This week a MIG escape wherein the crux of the dispute was whether or not the Applicant sustained a fractured wrist. The Tribunal considered a number of diagnostic scans and associated reports in reaching their conclusion.

Winter Virtual Training!

Secure your seat for inHEALTH’s 2024 Winter Virtual Training Session! 

• SABS Expedited: February 26th – March 1st, 2024

*Eligible Participants receive 9 Substantive – CPD hours upon course completion

Course details & register here +

Factor: CT Scan of Wrist Fracture Contradicts Medical Opinion

In Saccoccia v. Economical Insurance Company (21-010260), Fulvia Saccoccia was involved in an automobile accident on December 19, 2017 submitting she ought to be removed from the MIG owing to a fractured pisiform in her left wrist relying on the CT scan report of her left wrist, dated January 4, 2018.

Economical takes the position that there was no fracture but rather a wrist sprain. Although a left wrist fracture was initially suspected it was later ruled out by Dr. Stephen Halman, Saccoccia ’s treating orthopedic surgeon. They rely on the CNR of Saccoccia family doctor, Dr. Daniel Corazzola, dated December 20, 2017, x-rays of the left wrist and hand, dated December 20, 2017, clinical note and record of Dr. Halman, dated January 18, 2018, and imaging report of the left wrist, dated January 18, 2018.

The Tribunal held:

• • While the December 2017 x-ray of Saccoccia’s left wrist did not reveal a fracture, the January 4, 2018 CT scan report of the left wrist revealed an undisplaced fracture through the pisiform.
    
  • ‘I acknowledge the respondent’s position that Dr. Halman ruled out any fractures of the applicant’s left wrist; however, I disagree that it is clear that he reviewed the CT scan report of the left wrist, dated January 4, 2018. On January 18, 2018, Dr. Halman noted that previous x-rays were suggestive of a scaphoid fracture and that a follow up CT scan report failed to identify any fractures, but he did not identify the date of the CT scan report. Moreover, Dr. Halman made no reference to the undisplaced fracture in the pisiform as noted in the CT scan report, dated January 4, 2018, nor did he explain why the CT scan report might have stated that there was a fracture if there was none.”
    
  • The imaging of Saccoccia’s left wrist, dated January 18, 2018, revealed a nondisplaced fracture of the scaphoid however, Dr. Halman’s opinion that there is no fracture, is contradicted by the CT scan report, dated January 4, 2018, which revealed a fracture of the pisiform.
  • The CT scan report of the left wrist, dated January 4, 2018 clearly stated “there is an undisplaced fracture…”, which was definitive and not suggestive as advanced by Economical. “Moreover, in my view if the result was suggestive, the CT scan report would have stated that there was a potential or it was unclear that the applicant sustained an undisplaced fracture, which was not the case here.”
  • Economical did not point to any evidence that rebuts or undermines the results of the January 4, 2018 CT scan report, as it is unlikely that Dr. Halman reviewed this during his consultation.

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.

Inform your position & present persuasive arguments. Include an Outcome Analysis Report (OAR) in your case evaluation complete with For/Against cases. Need an OAR?