MIG Update – February 28, 2022
Psychometric Testing Not Required
In this week’s edition we review a MIG escape case where the Tribunal distinguishes between the family doctor’s diagnosis of PTSD versus the psychological validity testing conducted by the insurer’s assessor. Is psychometric testing required for a valid psychiatric diagnosis?
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Factor: Psychometric Testing
In Sermez v. Economical Mutual Insurance Company (20-006039), Sermez claimed he suffered from psychological impairment and chronic pain as a result of the motor vehicle accident on August 22, 2018. Semerz relied on the records and reports of family physician, Dr. Pham-Nguyen and psychologist, Dr. Singh, in support of his claim.
On March 6, 2019, Dr. Pham-Nguyen, diagnosed Sermez with post-traumatic stress disorder as a result of the accident. Dr. Pham-Nguyen discussed medication versus counseling for the treatment of PTSD. Semerez preferred medication and was prescribed escitalopram.
Economical had Semerez assessed by Dr. Mandel on May 13, 2019 who conducted a clinical interview and performed 3 psychometric tests to conclude there was a lack of consistent findings to support a DSM V diagnosis. The 3 psychometric tests:
- Personality Assessment Inventory (PAI) – which assesses personality traits and characteristics
- Multidimensional Pain Inventory (MPI) – which assesses the chronic pain experience
- Structured Inventory of Malingered Symptoms (SIMS) – which assesses psychosis, neurologic impairment, amnestic disorders, low intelligence and affective disorders.
The Tribunal held:
- Economical did not lead any evidence to show that psychometric testing is required for a valid psychiatric diagnosis.
- Semerez’s family doctor, Dr. Pham-Nguyen’s clinical notes and records do not appear on the list of documentation reviewed by Dr. Mandel. The CNR’s also were also not referenced in the paper review dated July 31, 2019 conducted by Dr. Mandel.
- “The fact that the CNR’s were not available to be considered by Dr. Mandel undermines the reliability of his report”
- It was unclear from Dr. Mendel’s clinical interview summary whether Semerez specifically denied the presence of symptoms when directly asked about them, or failed to volunteer this information. “The absence of reported symptoms is not the same as the reported absence of symptoms. This ambiguity is troubling because the applicant reported to Dr. Mandel that he had been prescribed escitalopram by his family doctor.”
- Semerez’ reporting of the prescription escitalopram “should reasonably have prompted focused inquiry by the assessor”. Rather the conclusions by Dr. Mandel were found to be vague and inconclusive.
- “None of the psychometric tests administered by Dr. Mandel are targeted at diagnosing post-traumatic stress disorder. Rather The testing was targeted at assessing personality disorders, dimensions of his chronic pain experience, and symptom malingering.”
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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