MIG Update – November 20, 2023
Radiculopathy Complaint Requires a Diagnosis
This week, a MIG hold where the Tribunal considered the applicants complaints of radiculopathy and recurring lower extremity radiculopathy, aggravated pre-existing injuries from a prior accident, chronic pain and a psychological injury. What evidence was considered and what was found lacking in attempting to establish the claim as outside of the MIG?
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Factor: Radiculopathy Complaint
In Boney v. Co-operators General Insurance Company (21-005468), Nicholas Boney was involved in an accident on March 11, 2019 and sought removal from the MIG on the grounds of ongoing pre-existing back and left leg injury resulting from a prior accident in 2014; chronic pain and recurring lumbar radiculopathy and psychological injuries. He was seeking entitlement to $7500 in chiropractic treatment, psychological and chronic pain assessment, all consistently requested until about July 2020.
To support his position, Boney relied on a Disability Certificate (“OCF-3”) completed by Dr. Singh, chiropractor, dated March 19, 2019, the records of his family doctor, Dr. Voros and the pre-screen interviews of Natalia Nosova, psychotherapist, and Anna Kozina, psychological associate November 2019.
Co-operators relied on the IE opinion of Dr. Saplys February 25, 2020 and took the position that there was no objective evidence to support Dr. Singh’s radiculopathy diagnosis. Further they relied on the March 25, 2020 opinion of their IE assessor Dr. Chan who concluded Boney did not have a psychological injury. Moreover, there was no evidence of any psychological concern in Dr. Voros records which reflected solely a diagnosis of whiplash and strain injuries. As for the claim of chronic pain, again there was no medical evidence in support of a chronic pain diagnosis and Boney failed to demonstrate he met the criteria for chronic pain outlined in the AMA Guides.
The Tribunal found:
- Despite Boney’s complaints of pain radiating down his legs, Dr. Voros did not refer for any diagnostic imaging, nerve root tests or a referral to a specialist to determine a diagnosis of radiculopathy nor did he diagnose Boney with radiculopathy. Furthermore, the diagnosis of radiculopathy by Dr. Singh is out of the scope of practice for a chiropractor.
- Dr. Saplys conducted objective testing which revealed no neurological deficits in Boney’s lower and upper extremities, and noted that there were no nerve root tension signs.
- Although the x-rays conducted in May and July of 2021 revealed some minor degenerative changes, Boney failed to provide any medical opinion that linked the x-rays findings to the subject accident.
- Dr. Chan’s opinion dated March 25, 2020 that there was no psychological injury which included psychological tests was preferred to the provisional diagnosis made by Natalia Nosova, psychotherapist and Anna Kozina,psychological associate who did not conduct any psychological testing and based their conclusion on Boney’s self-reporting. Also, they did not review the clinical notes and records of Dr. Voros.
- “On July 4, 2019, Dr. Voros noted that the applicant appeared to be asking for a form to be completed for a psychological assessment, but he was unsure if this was needed for the applicant. Further, Dr. Voros did not diagnose the applicant with a psychological impairment, nor did he refer him for psychological treatment.”
- On the complaint of chronic pain, there was no medical evidence found in the records of Dr. Voros, who saw Boney sporadically following the subject accident and diagnosed him with whiplash, back and knee soft tissue injuries and did not diagnose chronic pain or chronic pain syndrome.
- Boney reported to both Dr. Saplys and Dr. Chan in early 2020 that he had resumed his pre-accident activities of: cycling, walking, and driving, but he no longer played basketball. Further he had resumed his pre-accident housekeeping tasks but required assistance from his sons to complete these tasks. This together with the absence of medical evidence did not demonstrate functional limitations associated with the chronic pain complaint.
- With respect to the pre-existing injuries, they were documented as required but, there was no compelling evidence that they were aggravated as a result of the subject accident found in Dr. Voros records.
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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