MIG Update – January 20, 2025
GP’s Diagnosis of “Head Injury” Prevails
This week’s MIG case, an escape, wherein the Tribunal considers a head injury diagnosis in the absence of confirming diagnostics. What evidence did they accept and why?
With 1700+ MIG decisions determined by the LAT so far… we provide research support that gives you answers.
Virtual Training – New – Upcoming Sessions!
Secure your seat for inHEALTH’s 2025 Winter Virtual Training session!
- SABS Expedited: February 10th – 14th, 2025
*Eligible Participants receive 9 Substantive – CPD hours upon course completion
Course details & register here +
In Zurkiyeh v. Economical Insurance Company, (21-007996), Mohammed Zurkiyeh was involved in a motor vehicle accident on June 4, 2019 and sought entitlement to attendant care benefits and seven OCF-18s including an in-home assessment, psychological assessment, occupational therapy, and physiotherapy totaling $13,812.09.
Zurkiyeh submitted that he should be removed from the MIG due to his post-accident neuropathy, his chronic pain, head injury and psychological impairments. Our focus in this review is on the head injury claim.
Zurkiyeh relied on the CNRs and OCF 3 of his family physician Dr. Silver, who diagnosed him with a head injury, ordered a CT scan of the head and referred him to an ophthalmologist in September 2019 for the continued complaint of pressure behind his right eye. His CNRs also recorded the Applicant’s reports of significant pain and neuropathy in his right hand, for which he wore a splint and reported worsening pain and functional restrictions over the next few months.
Economical disputed that Zurkiyeh sustained a head injury or concussion as a result of the accident. It noted that the ambulance report did not specify that he hit his head and that Dr. Silver’s diagnosis was based on Zurkiyeh’s self-reports and Dr. Silver did not make any further findings of a head injury. Further, Zurkiyeh reported that the ophthalmologist had told him that there “was nothing to worry about”. Economical further argued that he did not continue to report post-concussive symptoms. It cites two Tribunal decisions, Cruz v Certas Direct Insurance Company, (20-008727) 2022 CanLII 120017 (ON LAT) and Gill v. Travelers Insurance (20-001150 2021 CanLII 37845 to argue that the singular notation of a head injury and the lack of hospital records do not support a finding of a concussion or head injury.
The Tribunal found:
-
- The family doctor, Dr. Silver’s diagnosis of ‘head injury’ was referenced more than once in the records and was not limited to Zurkiyeh’s self report as argued by Economical.
- On June 27, 2019 Dr. Silver provided a head injury diagnosis and made a referral for a CT scan. On the OCF 3 dated July 16, 2019 Dr. Silver listed ‘head injury’ as the first accident-related injury. It was appropriate to place significant weight on Dr. Silver’s diagnosis, as the treating family physician.
- The continued report of right eye pressure throughout August and September 2019 and referral to an ophthalmologist despite the specialist relaying to Zurkiyeh there was “nothing to worry about” does not necessarily preclude a head injury diagnosis.
- “I further agree with the applicant that the decisions cited by the respondent are distinguishable from the present matter. In Cruz v. Certas, the Tribunal found that the family physician had only raised the possibility of a concussion, rather than providing a concussion diagnosis. In the present matter Dr. Silver clearly provided a diagnosis of a head injury. Further, unlike in the present matter, the claimant in Cruz had not been referred for any follow-up diagnostic imaging. Similarly, in Gill v. Travelers, the Tribunal noted that the OCF-3 provided by the family physician did not refer to a concussion. This can similarly be distinguished from the case at hand”.
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.
Inform your position & present persuasive arguments. Include an Outcome Analysis Report (OAR) in your case evaluation complete with For/Against cases. Get an OAR!