MIG Update – October 21, 2024
Dental Work Required Not Caused by MVA
This week, a MIG hold case that involved a claim for dental services where the Applicant was claiming accident related dental trauma and a chronic ankle tear. The Tribunal considered the ‘but for’ causation test to determine if the accident in question was the necessary cause of the Applicant’s injuries.
Virtual Training – Fall Session!
Secure your seat for inHEALTH’s 2024 Fall Virtual Training session!
- BI Fundamentals: November 4th – 8th, 2024
*Eligible Participants receive 9 Substantive – CPD hours upon course completion
Course details & register here +
Factor: Causation
In Ovramenko v. Certas Home and Auto Insurance Company (22-008478) Maksym Ovramenko was involved in a motor vehicle accident on December 27, 2020 and sought entitlement to three OCF-18s for chiropractic treatment and an attendant care assessment totalling $5817.12 plus dental services in the amount of $49,174.00 on the basis that he sustained non-minor injuries as a result of the subject accident.
Overamenko submitted that suffered a chronic tear in his ankle, a possible mandibular fracture and extensive dental trauma along with significant soft tissue injuries that go beyond the MIG, which have led to chronic pain and psychological impairments.
Overamenko relied on his self-reporting and the records and reports of treating dentist Dr. Ko, family physicians Dr. Minoo and Dr. Greenwald, Mackenzie Health, chiropractors Dr. Pavacic and Dr. Chan’s May 2021 OCF-3. As part of his pre-accident records he submitted a February 2013 OCF-18 completed by Dr. Krolik and the doctors records of January 2024, which noted he required extensive dental work including root canal treatment, filings, removal of his teeth, and prosthetics with crowns.
Certas advanced that Oramenko’s injuries including dental, foot and ankle injuries were not caused by the subject accident. They relied on dental surgeon Dr. Ouanounou’s IE report dated February 2021, as well as Dr. Ko’s initial and addendum reports from February 2021.
The Tribunal found:
-
- It was unclear from his January 7, 2021 self-reports to registered nurse Ms. Arruda whether his cracked upper left tooth and a chipped tooth were caused by or aggravated by the accident as he did report to her that he had these issues before.
- The records produced from Dr. Krolik were not a complete set of pre-accident dental records and no x-rays were included. The records were insufficient evidence to establish whether the accident was a necessary cause of the dental issues.
- Ko’s reports February 5 and 16 2021 stated that it was difficult to determine whether the accident was the cause of the extensive dental work required without pre-accident dental records, including previous x-rays.
- “ I agree with both Drs. Ko and Ouanounou, that the complete pre-accident dental records and x-rays are required to determine whether the accident was a necessary cause of the dental issues that require the extensive dental work. I agree with these opinions, and without the complete pre-accident dental records, I am unable to make a determination of whether the accident was a necessary cause of these dental impairments. Thus, the applicant has not met his burden here.”
- Drs Minoo, Ko and Greenwald, despite noting Overamenko’s self-reported jaw pain, were unable to link the subject accident to his pain.
- On the issue of the possible mandible fracture, this was ruled out based on the entry from Dr. Greenwald, dated January 7, 2021 who recommended an outpatient dentistry referral as he may have some underlying dental injury.
- Oramenko did not refer to evidence to support his position that he sustained a chronic tear in his ankle which would also remove him from the MIG. The MRI of the right ankle, dated May 1, 2022, did not have a diagnosis of a chronic tear but flexor tenosynovitis.
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?