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  MIG Update – September 16, 2024



Self Reporting Accepted for Psych MIG Escape

This week, a MIG escape where the Tribunal considered the competing opinions of the psychological experts on DSM-5 diagnosis. The Insurer’s expert could not provide a diagnosis due to over-reporting or negative response bias but found the Applicant did exhibit some psychological symptoms as a result of the subject accident. Conversely there are many MIG holds where the Applicant’s self-reports are not considered. What was the difference in this case?



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Factor: Self Reporting

In Ahmed v. Certas Home and Auto Insurance (21-002552) Amira Ahmed was involved in a motor vehicle accident on December 22, 2019 and sought entitlement to three Treatment Plans for psychological assessment and services, as well as a laptop, totalling $7,111. She contended that she should not be held to the MIG due to psychological impairments.

She relied on the report of psychologist Dr. Steiner dated April 2020, which diagnosed her with major depressive disorder, somatic symptom disorder, and specific phobia and recommended treatment for three to four months. She submitted that the IE report of psychologist Dr. Salerno dated December 2020, noted the same symptoms and added that cultural nuances may have played a role in her responses to the doctor which affected his ability to make a proper determination. She did in fact undergo 12 psychotherapy sessions as recommended by Dr. Steiner in June 2021 and noted that she was interested in continuing with an additional twelve sessions to bring her back to pre-accident level of functioning. Further the need for the laptop was because the psychotherapy sessions had to be done virtually due to COVID.

Certas did not agree that the Ahmed met her burden of providing she had a psychological impairment as a result of the subject accident, It argued the CNRs of her family doctor dated January and March 2020 did not mention any psychological concerns, and submitted there was no evidence that she followed through on a psychiatric referral made by her family doctor in January 2022. Moreover, the Tribunal should not give any weight to Dr. Steiner’s report dated April 2020 because he did not meet Ahmed in person and relied solely on her self reporting. Relying as well on the Insurer’s Examination report of psychologist Dr. Solerno dated December 2020, which opined that he was not able to make an objective determination that met the DSM-5 criteria. As for the laptop it was not reasonable and necessary because it did not address an accident-related impairment and the need for the laptop was due to the COVID lockdowns. They relied on the IE report of Mr. Livadas dated December 2020, which opined that there was no need for assistive devices.




The Tribunal found:

    • The reports of psychologists Dr. Steiner dated April 2020 and Dr. Solerno dated December 2020 did not reach the same conclusion as argued by Ahmed, as they were both based on Ahmed’s self-reporting, not objective findings. However, Ahmed’s self-reports of psychological impairments were consistent to both psychologists.
    • The consistent self-reports by Ahmed included difficulty sleeping, feeling triggered when she sees another accident, feeling nervous and sad, decreased appetite, a diminished desire to socialize, and increased anxiety around driving and reported that her “…..mood and personality changes are extreme”. As a result, accepted Dr. Steiner’s diagnosis of major depressive disorder, somatic symptom disorder, and specific phobia.
    • “The conclusion in Dr. Salerno’s report is that he could not provide a DSM-5 diagnosis, but I find that he did not entirely rule out a psychological impairment. Given the lack of objective data due to over-reporting or negative response bias, Dr. Salerno determined that the applicant provided insufficient objective evidence to make a DSM-5 diagnosis. However, when asked by the respondent “What injuries did the client sustain as a direct result of the accident” Dr. Salerno’s response was: “In my opinion when considering all points of reference from today’s examination, Ms. Ahmed likely exhibits some psychological symptoms as a direct result of the subject accident…”
    • As for Certas’ argument that Ahmed did not attend any psychological treatment post 2022 as per the referral of her doctor, there could be many explanations for this and determined Ahmed was entitled to the two Treatment Plans for psychological assessment and treatment totaling $5,841.
    • Ahmed was entitled to the laptop recommendation in the amount of $1270 because she sought psychological treatment at a time where in person appointments were occurring at best minimally and without a laptop she may have not been able to access treatment.


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?

 

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