MIG Update – June 2, 2025
Late Onset (Two Years) Shoulder Pain Remains in MIG
This week’s MIG hold case, the Tribunal considered whether a right shoulder condition that included a chondral defect requiring surgery was caused by the subject accident. The Tribunal weighed the evidence as to the onset of the complaint and conflicting expert opinion on whether the injury was accident related. What were the determining factors?
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Factor: Pre-Existing Condition
In Lawrence v. Economical Insurance (23-011248), Leston Lawrence, was injured in an accident on December 1, 2020 and sought entitlement to three Treatment Plans for physiotherapy, OT services and an in-home assessment as well as ACBs. He claimed he ought to be removed from the MIG as he sustained injuries to his right shoulder in the accident that required surgical intervention, including a chondral defect on the humeral head.
Lawrence relied on a letter from his treating orthopaedic surgeon Dr. Lapner from January 2024 who noted the following:
“Mr. Lawrence suffered an injury to his right shoulder. The injury was very distinctive in that the chondral defect that he sustained on his humeral head is a rare lesion that requires a significant amount of force, applied in a particular direction, to produce. This lesion was very much in keeping with the shoulder being struck with high force against something hard such as would occur in a car crash. […] The likely cause as described above was the car crash. Given that a) there was no other history of injury and b) I have very rarely seen this type of pathology associated with a more conventional mechanism of injury, I feel strongly that it is highly unlikely that that [sic] there is an alternative explanation for the pathology.”
Economical on the other hand argued that Larence’s right shoulder injuries were not caused by the accident, as he did not complain of right shoulder pain until December 2022, when he indicated to family physician Dr. Baranick that he had been experiencing right shoulder pain for one month. Dr. Baranick’s note from that date also indicated that this pain was work-related.
Economical, further relied on the IE report of GP Dr. Bansal dated May 2022, which noted soft tissue injuries and that on examination Larence’s active shoulder range of movement was full bilaterally without mention of pain or discomfort. On causation, the opinion of orthopedic surgeon Dr. Simon dated April 2024…” the type of shoulder injury the applicant sustained is pathognomonic for an episode of shoulder instability, for example frank dislocation of the shoulder”. However, there was nothing in the records that suggested an episode of acute shoulder instability or dislocation arising from the accident.
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The Tribunal found:
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- There was no mention of right shoulder pain in the clinical records prior to December 2022, despite visiting multiple treatment clinics. The December 2022 clinical note indicated that the onset of right shoulder pain was only one month prior.
- The notes from those clinics prior to December 2022, only mention left shoulder pain, neck pain, and back pain. This was further corroborated by the OCF-1 dated December 2020 and OCF-3 dated November 2021. Further, upon referral from family physician Dr. Baranick, he visited Dr. Habib in March 2022 but reported no issues with his right shoulder.
- The opinion of orthopedic surgeon Dr. Lapner’s with respect to causation was based on Lawrence’s self-reporting and was not corroborated by the contemporaneous medical records.
- Dr. Lapner did not explain why Lawrence would not have experienced issues with his right shoulder for two years, especially given the severity of the injury.
- Lawrence failed to provide any insight or clarification with respect to whether his right shoulder injury was work-related, as indicated by family physician Dr. Baranick.
- The April 2024 IE opinion of orthopedic surgeon Dr. Simon was persuasive as he reviewed the medical documentation and he took into account the medical documentation and Lawrence’s complaints prior to the December 5, 2022, visit with Dr. Baranick.
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