MIG Update – October 28, 2024
IE Fails to Explain Lack of Diagnosis
This week, a MIG escape, where the Tribunal considered the psychological validity testing relied upon by both parties and the interpretation of the results or the lack thereof. Of note, the Applicant’s report was submitted following the Respondent’s report and although not altogether clear it appears that the Respondent did not put the Applicant’s report back to their IE assessor for further comment.
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Factor: Psychological Validity Testing
In Pavliashvili v. Economical Insurance Company (22-008220) Nino Pavliashvili was involved in a motor vehicle accident on March 3, 2020, and sought entitlement to NEBs from March 14, 2021, to March 3, 2022; three OCF-18s for physiotherapy; and psychological, chronic pain, orthopaedic, neurological, and neurological assessments. She claimed that she should not be held within the MIG as she has documented pre-existing injuries, chronic pain, and a psychological condition.
What follows is the review of the parties position and outcome with respect to the psychological injury.
Pavliashvili relied on the March 2021 report prepared by registered psychotherapist Dr. Vintu, under the supervision of psychologist Dr. Waxer. She was diagnosed with Persistent Somatic Symptom Disorder with Predominant Pain: Severe, Chronic Adjustment Disorder with Mixed Anxiety and Depressed Mood, and Specific Phobia: Situational Type: Vehicular. She further relied on a March 2020 note from family physician, Dr. Milad where she reported insomnia and feeling stressed since the accident. As well as, the March 2020 OCF-3 where Dr. Nikols, chiropractor noted she was experiencing a loss of appetite, signs and symptoms of an emotional state, nervousness, and sleep disorder, and recommended a psychological assessment. Further the March 2020 record from 101 Physio that noted she reported having a loss of appetite, fear in a vehicle, and loss of sleep.
Economical disagreed, relying on the January 2021 IE report of psychologist, Dr. Mandel who found that there was “a lack of consistent objective information present that would support poor prognosis, DSM V diagnosis and/or suggest that she suffered clinically significant symptoms that would indicate a substantial psychological impairment or disability” as a result of the accident. Further submitting that Dr. Mandel’s report should be preferred over Dr. Vintu’s, as it screened for validity concerns, included a review of medical documentation, and was more consistent with the medical records.
Moreover, that Dr. Vintu’s diagnosis of “persistent somatic symptom disorder with predominant pain” is a catch-all for any set of symptoms that otherwise do not meet the full criteria for any disorders.” It argues that the DSM-V specifically states that it is not supposed to be used unless there are “decidedly unusual situations where there is insufficient information to make a more specific diagnosis.” Dr. Vintu did not explain any “decided unusual situations”.
The Tribunal found:
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- “Dr. Vintu noted Pavliashvili had a moderate level of depression on the Beck Depression Inventory, a moderate level of anxiety on the Beck Anxiety Inventory, and a diagnosis of “Dysfunctional” on the Multidimensional Pain Inventory (MPI), which indicated that she experienced high pain impact, affective distress, and severe functional limitations. Dr. Vintu also administered the Symptom-Checklist-90-revised questionnaire, and found that the applicant’s symptoms revealed a pattern and magnitude in the clinical range.”
- “Dr. Mandel administered the Personality Assessment Inventory (PAI), MPI, and Structured Inventory of Malingered Symptoms (SIMS). On the PAI, her clinical profile revealed “specific fears of anxiety surrounding some situations, likely experienced past trauma, discomforting level of anxiety and tension, an unusual degree of concern regarding physical function and health, and a significant depressive experience.” On the MPI, her results were generally in the average range, however it was significantly below average with respect to “General Activity…”
- They both administered the MPI test and the results were similar, however, unlike Dr. Vintu, Dr. Mandel did not provide a diagnosis or any explanation of what the results meant.
- “I also note that Dr. Mandel did not provide any reasons for his belief that the applicant’s condition did not merit a DSM-V diagnosis, despite the symptoms she reported to him. In fact, the applicant’s depression and anxiety appear to be in line with the symptoms Dr. Mandel described, and yet Dr. Mandel did not explain why he was unable to make a diagnosis. I prefer Dr. Vintu’s report as it was more detailed with respect to explaining her findings.”
- The records relied upon by Pavliashvili documented her complaints of insomnia and stress since the accident, her loss of appetite, signs and symptoms of an emotional state, nervousness, and sleep disorder and fear in a vehicle. Dr. Mandel described psychological symptoms in his report as well.
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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