MIG Update – November 11, 2024
GP Concussion Diagnosis Accepted as Legitimate
This week, a MIG escape where the Tribunal considered precedent decisions advanced by the Respondent refuting a concussion diagnosis. Does there have to be imaging and or a diagnosis by a neurologist confirming the injury?
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Factor: Diagnosis
In Macadangdang v. Economical Insurance Company (22-006786) Cesario Macadangdang was involved in an accident on October 7, 2020, and sought entitlement to eight Treatment Plans for physiotherapy services and attendant care, psychological and neurological assessments for a total of $12,925.44. He submitted he should be removed from the MIG because of a concussion, anxiety and chronic pain. At issue being whether there was a confirmed concussion diagnosis.
Macadangdang submitted that he was diagnosed with concussion by his family doctor, Dr. Atwal on the day of the accident following complaints of headaches, that he hit his head and possibly lost consciousness. That treating neurologist Dr. Basile, in February 2021, diagnosed him with post concussive syndrome. He pointed to telling the IE assessor Dr. McCutcheon in June 2021 that he had blurred vision, occasional hearing loss, would forget appointments, lose items and was worried about memory issues. He submitted he was entitled to a psychological assessment because Dr. Atwal’s CNRs indicated he had driving anxiety, he reported anger, vehicle anxiety, worry and memory issues to Dr. McCutcheon, and scored “moderate” in depression in Dr. Levy’s IE. Further, psychiatrist Dr. Neger diagnosed him with Adjustment Disorder with Anxiety in June 2023.
Economical submitted that Dr. Atwal only mentioned concussion once, and did not test or order a CT scan or specialist investigation. It relied on Stone v. BelairDirect (20-008352) and Ly v. Aviva (20-012558) where the Tribunal questioned a concussion diagnosis made by a family physician in similar instances. It submitted that Dr. Basile’s report should be given less weight as it was unclear if the assessment was virtual or in person, the diagnosis, one year post-accident, lacked support from Dr. Atwal’s CNRs, and Macadangdang did not report the same symptoms to Dr. Atwal. Further, he did not follow Dr. Basile’s recommendations of taking medication for headaches, and undergoing further testing.
The Tribunal found:
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- The cases Econcomial relied upon were distinguishable from Macadangdang’s case. Firstly, in Stone, the concussion diagnosis was made by the family physician more than two weeks after the accident and not verified by a neurologist whereas here, the family doctor made the diagnosis on the same day as the accident and a neurologist assessed and made the diagnosis as well.
- ‘In Ly, the Tribunal questioned the diagnosis of the family physician because the only treatment suggested was rest and physiotherapy, no referral was made to a concussion clinic, a concussion diagnosis is usually made by a neurologist, and CT scans and x-rays of the applicant’s spine and head were normal. I am not bound by other Tribunal decisions, and I disagree with the assertions made in that case. A concussion diagnosis does not have to be made by a neurologist in order for it to be legitimate, and I am not persuaded that such a diagnosis is necessarily contingent on positive imaging. In any event, the decision in Ly was subsequently canceled and a new hearing was ordered.”
- On the argument that Dr. Basile assessment was virtual and that Macadangdang didn’t follow Dr. Basile recommendation to take medication and undergo MRI and EMG testing, Dr. Basile’s assessment was conducted four months post-accident, not one year and was in person, as he completed a physical examination, including strength testing and a sensory examination.
- “I agree that Dr. Atwal’s records did not mention concussion symptoms after his diagnosis. However, I am not persuaded that this warrants a discounting of the diagnoses entirely, especially as the applicant also endorsed some of the same symptoms to Dr. McCutcheon. Further, whether the applicant followed Dr. Basile’s treatment recommendations does not take away from the fact that he was diagnosed with a concussion and postconcussive syndrome. Those diagnoses are what remove him from the MIG, not whether he complied with treatment recommendations.”
- The diagnoses were not refuted by other practitioners, including IE GP Dr. Levy, who summarized Dr, Atwal and Dr. Basile’s findings but did not comment on their diagnoses.
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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