MIG Update – July 21, 2025
Provisional PTSD Diagnosis Suffices for MIG Escape
This week we review a MIG escape case involving an alleged psychological injury, with the Tribunal considering the Applicant’s evidence indicating a possible diagnosis of Post-Traumatic Stress Disorder (PTSD), in contrast to the Respondent’s Independent Examiner (IE) who provided a provisional PTSD diagnosis. The Tribunal held that the Applicant’s possible diagnosis was sufficient to establish that a genuine issue existed, warranting further investigation. As such, the Tribunal found that the psychological assessment sought by the Applicant was both reasonable and necessary under the circumstances.
Virtual Training – *NEW* Upcoming Fall Sessions
Secure your seat for inHEALTH’s 2025 upcoming Virtual Training sessions! Buy one seat and get one seat 50% OFF on all courses until August 31st, 2025!
- SABS Expedited: October 6-10, 2025
- BI Fundamentals: December 1-5, 2025
*Eligible Participants receive 9 Substantive – CPD hours upon course completion
Course details & register here +
In Banton v. Belair (23-003259), Damian Banton was injured in an accident on February 1, 2020 and sought entitlement to three Treatment Plans for physiotherapy services, a chronic pain and a psychological assessment, totalling $5,928.10. Having exhausted the $3500 MIG limit he sought removal from the MIG based on a pre-existing (chronic low back pain) condition, a psychological impairment, and a chronic pain diagnosis.
Banton directed the Tribunal to the May 2021 CNRs of family physician Dr. Cheung, that confirmed reported nightmares, anxiety, and sleeping difficulties, and assessed anxiety and possible PTSD. Further that Dr. Cheung suggested a treatment plan of related therapy and medication. He also relied on the psychologist Dr. Direnfeld’s June 2021 IE report, which endorsed symptoms for a provisional PTSD diagnosis.
Belair argued there was no compelling medical evidence documenting a pre-existing condition. Further that Dr. Direnfeld’s June 2021 IE report did not endorse sufficient clinically significant symptoms for a DSM-5 diagnosis of PTSD, and that Dr. Cheung’s CNRs did not mention possible PTSD until May 2021, 14 months after the accident. It also highlighted that Banton replied “no” when Dr. Direnfeld asked if he needed psychological treatment.
Get Your Stats Report!
inHEALTH’s Statistical Reports provide insights and analysis on the outcomes of Licence Appeal Tribunal (LAT) and court decisions.
Customize success rate reports on any variable relating to disputed AB claims captured in LAT and court decisions!
Decisions By Top 10 Insurers
*Sample Chart
Statistical Report fees are based on the complexity of your data request
Learn More & Get a Quote Here >
The Tribunal found:
- The family physician Dr. Cheung’s May 2021 assessment of Banton’s anxiety and possible PTSD compelling, as it was corroborated by psychologist Dr. Direnfeld’s June 2021 IE report, which endorsed symptoms for a provisional PTSD diagnosis and noted consistency with DSM-5 Criterion A for PTSD.
- Dr. Direnfeld also stated Banton “had endorsed the most severe or second most severe option for each of the 20 symptoms on the PTSD Checklist for DSM-5 (PCL-5). On the Beck Anxiety Inventory, the applicant exhibited low levels of anxiety, and on the Beck Depression Inventory II, the applicant scored in the range for moderate symptoms of depression. Scores on the Work and Social Adjustment Scale between 10 and 20 suggest significant functional impairment. The applicant scored 15 on this questionnaire.”
- As for Banton’s response when asked if he needed psychological treatment for anxiety, Dr. Direnfeld noted that inappropriate responses or inconsistent responses were possibly attributable to attempts at impression management.
- The treatment plan for the psychological assessment submitted October 2022 was reasonable and necessary as Banton “provided sufficient compelling evidence indicating there are grounds on which to believe a condition exists, such that further investigation is warranted. The CNRs of Dr. Cheung, to which I am pointed, note sleeping difficulties, nightmares, and anxiety.”
Need a briefing on recent MIG trends or a case law training session for your team? We can help.
Contact us today or reach out on live chat to set up a tailored session or request a stat report and summary of recent MIG rulings.
Inform your position & present persuasive arguments. Include an Outcome Analysis Report (OAR) in your case evaluation complete with For/Against cases. Get an OAR!