MIG Update – January 15, 2024
Chronic Pain Diagnosis Contradicted by Self-Reports
This week, in contrast to last week’s featured, MIG Escape case, the Tribunal considered the veracity of the applicant’s chronic pain diagnosis, once again in absence of a competing medical opinion to reach their conclusion of a MIG hold. What did the Tribunal identify as the shortfall in the applicant’s evidence to make their determination?
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Factor: Chronic Pain Diagnosis Contradicted by Self-Reports
In Wahedi v. Wawanesa Mutual Insurance Company (21-009228), Kochi Wahedi was involved in a motor vehicle accident on October 24, 2019 and claimed entitlement to a Treatment Plan for physiotherapy. She claimed that she should be removed from the MIG due to chronic pain.
Wahedi relied on a chronic pain assessment by Dr. Wilderman dated January 2023 which diagnosed her with chronic pain syndrome, bilateral sacroiliac joint dysfunction and adjustment disorder. As well as the CNRs from her family doctor Dr. Hamami and physiotherapy treatment clinic records demonstrated her ongoing pain complaints. She submitted that the Tribunal must accept Dr. Wilderman’s report because the Respondent did not schedule an IE to assess her.
Wawanesa disputed that Wahedi developed accident-related chronic pain, submitting that the family doctors’ CNR’s do not reference Wahedi making any pain complaints until October 2021 nor did she report any psychological symptoms. Further, Dr. Wilderman’s diagnosis of chronic pain should be given limited weight as it was largely based on Wahedi’s self-report and not consistent with the medical records.
The Tribunal found:
- There were limited reports of ongoing pain to the family doctors. Despite regular attendances no mention of pain symptoms until December 2022. These limited reports were not compelling evidence of severe, chronic pain. Likewise, the list of medications were for unrelated conditions.
- The report of ongoing pain found in the physiotherapy records varied during the course of treatment and by January 2020 she only complained of tension in her back.
- “Further, a chronic pain diagnosis or ongoing pain by itself does not remove the applicant from the MIG. It must be accompanied by some functional impairment, 16-000438 v The Personal Insurance Company. For chronic pain to be more than sequelae from soft tissue injuries, it must be: (1) continuous, or chronic pain syndrome; and (2) it must be of a severity that it causes suffering and distress accompanied by functional impairment or disability. A diagnosis of chronic pain without any discussion of the level of pain, its effect on the person’s function, or whether the pain is bearable without treatment will not meet the applicant’s burden to show that chronic pain is more than mere sequelae. Unless the applicant provides evidence that the pain she experiences contains these elements, the pain is sequelae of a MIG injury.”
- Despite Wahedi testing in the minimal range for anxiety and depression Dr. Wilderman diagnosis of adjustment disorder was contradictory and no basis was provided for this diagnosis other than reference to Wahedi’s self-reports of feeling distressed.
- Dr. Wilderman’s findings of functional limitation due to pain were based on Wahedi’s report of reduced working hours and difficulty performing housekeeping tasks and decreased memory and concentration.
- No evidence was provided from Wahidi’s employer to indicate any workplace restrictions Moreover, the family doctor’s records do not indicate any report of functional limitation until 2 years post accident.
- Section 38 of the Schedule does not say a s44 assessment must be conducted. The onus being that of Wahedi to lead sufficient compelling evidence of chronic pain with functional impairment or disability, which she has not established as sufficient for a removal from the MIG.
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?