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MIG Update – March 29, 2021

OCF-18s as Evidence for MIG Removal

The relevance of treatment plan evidence is discussed in the two cases reviewed this week. The notable difference was in the consistency of the information presented on the OCF forms.

• In the 1st case, the progress and recovery information (normally found under Part 9 on the OCF-18) was highlighted as relevant evidence
• In the 2nd case, the Treatment Plan was discounted as ‘not medical evidence’
  

Factor: OCF-18s as Evidence for MIG Removal

In R.N. v Aviva (18-009117), R.N. sought removal from the MIG on the basis of ongoing pain and accompanying psychological changes that have negatively affected his life for at least 2.5 years. The progression of the R.N.’s recovery reported in each OCF-18 was found to align with R.N.’s other medical evidence together with functional impact on his life.

‘MIG escape’ – The Tribunal’s finding turned on:

• The treating chiropractors reported in the disputed Treatment Plans that the goals and limited results (slowly resolving ranges of motion) and barriers to recovery (predominantly mood and sleep issues) are consistent and ongoing. The prognosis has also been consistently reported as poor.
• Pain complaints were recorded in the CNRs of both the treating providers and family doctor immediately after the accident and are consistent over time
• The fact that R.N. incurred all recommended treatment and paid out of pocket for additional care “speaks to both the persistence of his symptoms and the need for greater attention to other forms of treatment.”
  

In Torchia v Aviva (19-014589), Torchia sought removal from the MIG on the basis that she meets three of the six criteria for chronic pain as provided by the AMA Guides. She relied on the additional comments section of the OCF-18 in dispute that recommends a chronic pain assessment, where the assessor diagnosed Torchia with “multiple chronic injuries”.

The Tribunal found that the Treatment Plan itself for a chronic pain assessment was “not objective medical evidence” in establishing Torchia’s burden of proof.

‘MIG hold’ – The Tribunal’s finding turned on:

• “It is well-settled that treatment plans are not medical evidence and the treatment plan was seemingly not accompanied by a report that would provide more analysis to support the diagnosis.”
• Many of the impairments in the OCF-18 are not corroborated elsewhere, including family doctor’s CNRs
  
• Torchia returned to work full-time and reported to IE assessor that she is capable of completing many of her household and personal tasks
  

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