MIG Update – December 9, 2024
Pre-Existing Conditions MIG Escapes?
Over the next few issues we will focus on contrasting MIG hold/escapes to assist our readers with their analysis and case management.
This week, we reviewed two MIG cases involving pre-existing conditions, one was kept to the MIG the other was not. In both cases, the medical evidence established pre-existing conditions; however, the Tribunal considered the impact of those conditions on the Applicant’s recovery if they were to be kept to the MIG.
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Factor: Pre-Existing Conditions
Pre-existing Knee Condition
In Spyropoulos v. Intact Insurance (21-014242), George Spyropoulos was involved in a motor vehicle accident on June 23, 2019 and sought entitlement to two Treatment Plans for chiropractic services totalling $2397.72. He argued that he should be removed from the MIG due to exacerbation of pre-existing knee pain and osteoarthritis.
Spyropoulos suffered from pre-existing degenerative osteoarthritis, medial meniscus tears and other conditions that necessitated steroid injections and arthroscopic surgeries, and then following the accident, he sustained quadriceps inhibition, dislocations, and chondral degeneration which were treated by corticosteroid injections and physiotherapy.
Intact relied on the report of Dr. Stewart dated December 2020 which opined that Spyropoulos had no pre-existing conditions that would warrant removal from the MIG, and that his pre-existing knee pain had resolved.
The Tribunal found:
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- The report of Dr. Stewart was inconsistent with the rest of the medical records, specifically the CNR’s of Dr. Deliakis and report of orthopedic surgeon Dr. Atrey which both opined on the complexity and severity of Spyropoulos’s post-accident injuries and complications. Although Dr. Deliakis noted in August 2020 that he was doing better and walking, he noted in October 2020 that he regressed and the left knee tear persisted.
- Two years later, in March 2022, Dr. Atrey, the orthopedic surgeon, noted patellofemoral osteoarthritis and quadriceps inhibition. Recurrent dislocation and meniscal injuries were also noted by Dr. Deliakis later that same year.
- “Clinical notes and records show that the conditions as a result of the accident included quadriceps inhibition, dislocations, and chondral degeneration. Treatments post-accident included corticosteroid injections and physiotherapy. There is significant evidence to suggest that the applicant was precluded from recovery within the MIG because the injuries were worsened due to the accident and he required additional treatments which precluded his recovery within the MIG.
Pre-existing Right Shoulder Full thickness Tear
In Nguyen v Intact Insurance Company (22-002646), Tam Nguyen was involved in a motor vehicle accident on December 4, 2019 and sought entitlement to five OCF-18s for physiotherapy, as well as orthopaedic, chronic pain and psychological assessments. Nguyen claimed that he should not be held within the MIG due to a complete tear in his right shoulder, exacerbated pre-existing injuries, chronic pain largely due to his right shoulder pain, and a psychological impairment as a result of the accident.
The evidence led by Nguyen from both his family doctor Dr. Dong and orthopedic surgeon Dr. Halman indicated the right shoulder pain had been an issue for more than a year pre-dating the subject accident. Further an ultrasound (report not provided) failed to persuasively connect the complete tear in his right shoulder to the accident.
Intact relied on a March 2020 IE report from physician Dr. Hershberg which concluded that Nguyen’s right shoulder tear pre-dated the accident and that his symptoms were likely exacerbated by the accident. However, Dr. Hershberg observed that Nguyen demonstrated good ROM and strength and concluded that he sustained a minor injury in the accident. In July 2021 IE physician Dr. Gelman acknowledged Nguyen’s pre-existing health condition but found that he could be treated within the MIG and that his accident-related exacerbation had resolved.
The Tribunal found:
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- “I find no evidence in Dr. Dong’s CNRs indicating that the Applicant’s pre-existing health status, including the pre-existing full thickness tear in his right shoulder, will impact his recovery from soft tissue injuries sustained in the accident. While Dr. Dong noted the Applicant’s pre-existing neck, back, and shoulder complaints, the CNRs do not suggest that Dr. Dong or Dr. Halman had any concerns regarding the effects of the Applicant’s pre-accident condition on his recovery, and there is no evidence that the Applicant required additional post-accident care due to his pre-existing shoulder injury.”
- Given the right shoulder complaints pre-date the accident, the insurer is not liable for the chronic pain complaint relating to the right shoulder. Furthermore, he had returned to work, and was independent with his activities of daily living and self care. The medical records do not indicate that he is deconditioned due to disuse, nor do they indicate any reliance on healthcare providers or family members.
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 33% of the decisions so far. Each case is nuanced, but with similar factors.
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