July 4, 2018

M.G. and Primmum Insurance Company

On October 14, 2014, the applicant (”M.G.”) attempted to cross the intersection of Keele Street and Sheppard Avenue West in Toronto on foot. As she crossed, a vehicle made an improper right turn, hitting her on her knees and knocking her over. She applied for accident benefits under the Statutory Accident Benefits Schedule (the “SABS”).

After providing funding for initial treatment plans, Primmum denied two treatment plans related to psychological treatment and physiotherapy, based on its categorization of M.G.’s injuries as predominantly minor in nature. As it result, it capped treatment at $3500 pursuant to the Minor Injury Guideline (“MIG”).

 

In this hearing before Adjudicator Sewrattan, M.G. challenged her placement in the MIG based on psychological injuries she suffered following the collision.

The hearing centred on two psychological reports- one provided by M.G.’s treating psychologist Dr. Svetlana Gabidulina, and the other by Primmum’s Independent Medical Examiner, Dr. Shahriar Moshiri.

Dr. Gabidulina had diagnosed M.G. with a Major Depressive Disorder, Severe and Situational (isolated) Phobias (automobile anxiety- driver/passenger), based on tests identifying severe anxiety, depression and post traumatic stress.  She had recommended a treatment plan covering 12 sessions to address these disorders.

Dr. Moshiri was hired to determine whether the psychological treatment was reasonable and necessary, and whether the MIG applied to M.G.’s injuries.  He administered similar tests, and also identified severe levels of anxiety. However, based on M.G.’s self-report that she did not believe she experienced depression, anxiety or anger, he concluded that there was not enough objective evidence to warrant a formal diagnosis, and that the MIG applied to M.G.’s claim.  

Counsel for Primmum argued that Dr. Gabidulina’s report should hold less weight because she offered no opinion regarding M.G.’s MIG status.  Adjudicator Sewrattan rejected this argument. He found Dr. Moshiri’s position unacceptable in view of the test results that both psychologists had recorded.  Further, he insisted that the determination of whether a claimant should be classified under the MIG belonged entirely to the adjudicator and did not require expert opinion. Based on the diagnosis offered by Dr. Gabidulina, implicitly endorsed by the IME report of Dr. Moshiri, it was clear that M.G. had suffered a significant psychological impairment that took her out of the MIG.  As a result, the adjudicator found that the MIG did not apply, and that the proposed psychological treatment was reasonable and necessary. However, he did not have sufficient evidence that M.G.’s physical injuries were of such ongoing severity to warrant further physiotherapy, and therefore upheld the denial of that treatment plan.

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