MIG Update – July 28, 2025
CTS Diagnosis Confirmed?
This week a MIG escape case involving a diagnosis of carpal tunnel syndrome (CTS), the Tribunal considered both the neurological opinion presented by the Applicant and the supporting diagnostic tests in reaching its conclusion. Although CTS is not commonly linked to motor vehicle accidents, what evidence and factual circumstances did the Tribunal rely upon?
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In Lachapelle v. Intact Insurance Company (23-010054), Daniel Lachapelle was involved in an accident on August 13, 2020 and sought entitlement to two Treatment Plans totaling $6,351.53. He submitted that he should be removed from the MIG, as he was diagnosed with left carpal tunnel syndrome.
Lachapelle relied upon the CNRs of family doctor Dr. Ames, who noted complaints of neck, left shoulder and back pain and numbness extending into his arms following the accident, for which he was referred to a neurologist. The assessment of neurologist Dr. Safinia dated February 2021, following the EMG studies of the left arm, diagnosed him with mild to moderate carpal tunnel syndrome.
Lachapelle also submitted that he experienced difficulties at work due to ongoing symptoms and pain affecting his activity tolerance. He continued to feel pain at his neck and left side back, as well as symptoms of tripping and dragging feet. A second referral to Dr. Safinia revealed bulging discs in his low back affecting his nerve roots.
Intact stated that Dr. Ames’ handwriting was illegible and should be afforded little weight because the reader was forced to guess what was written. It stated that Lachapelle did not provide pinpoint evidence linking his injuries to the accident. It relied on the IE reports of Dr. Khaled dated August 2021 and April 2023 where Dr. Khaled reiterated his first diagnosis of mechanical low back pain, as well as pain only in the fingertips of the fingers of the left hand, a presentation that was consistent with residual symptoms from myofascial sprains.and that there was no evidence of ongoing, permanent musculoskeletal impairment related to the accident.
In April 2023 Dr. Khaled opined that Lacheapelle had a mild left foot drop after fatigue and exertion which may be accident related. He recommended bilateral lower extremity EMG or nerve conduction studies to rule out evidence of mild lumbar radiculopathy.
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The Tribunal found:
- The CNR’s of Dr. Ames, although handwritten, could be tolerably read which indicated on several occasions following the accident that Lachapelle complained of finger numbness and sharp pain in his neck.
- Both Dr. Ames and Dr. Safinia noted that Lachapelle’s complaints started shortly after the accident.
- Dr. Safinia, February 3, 2021 following the left hand and neck EMG studies diagnosed Lachapelle with mild to moderate carpal tunnel syndrome.
- “As much as I agree with the respondent’s observation that Dr. Khaled not mentioning carpal tunnel syndrome in his diagnosis may be of significance, I am not entirely persuaded that this absence warrants discounting the applicant’s assertion of having the carpal tunnel syndrome. This is because of the corroborating records of Dr. Ames and Dr. Safinia, that indicate that the applicant has carpal tunnel syndrome. Further, the applicant’s subsequent visit with Dr. Khaled does not change his earlier claim that the applicant had carpal tunnel syndrome.”
- “Further, even though Dr. Khaled did not get an opportunity to review Dr. Safinia’s report dated May 12, 2023, wherein she noted that the applicant has a mild left foot drop after exertion, in his report, dated April 24, 2023, Dr. Khaled had the same conclusion. He also recommended that the applicant undergo bilateral lower extremity EMG or nerve conduction studies.I find that Dr. Khaled’s acknowledgement that there is a requirement to investigate the applicant’s nerve issues significant. And the diagnosis of carpal tunnel syndrome by Dr. Safinia in her report of February 3, 2021, is not refuted.”
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