Shortage of specialists highlights serious problems with new restrictions to the MIG

The Institute for Clinical Evaluative Sciences released a report on January 31, 2014, drawing attention to the urgent and growing need for more Rheumatologists to meet the needs of the rising number of people with arthritis. The Arthritis Society warns that one in six adult Canadians report having arthritis. The Arthritis Society has stated that osteoarthritis, the most prevalent form of arthritis, can be triggered by previous joint injury or trauma. The osteoarthritis can lead to permanent inability to work and reduction of activities around the home. Many people continue to suffer without being properly diagnosed due to the shortage in Rheumatologists.
The Arthritis Society’s warning about the expected increase in the incidence of arthritis illustrates what appears to be wrong with the recently released Revised Minor Injury Guideline, Superintendent’s Guideline No. 01/14, on January 24, 2014. The Guideline goes much further than Ontario Regulation 347/13 that established the new requirement that a pre-existing medical condition to be documented by a health practitioner before the accident. OTLA previously blogged and warned that, as a result of this Regulation, insureds who did not have a doctor, or failed to see a doctor for a condition or were waiting for months to see a specialist like a Rheumatologist, will not be able to escape the MIG, even if a health practitioner confirms that their condition was pre-existing and will prevent them from achieving maximal recovery.
The Revised MIG now holds that you also have to provide “compelling evidence” of a pre-existing medical condition. Even a documented, pre-existing condition like rheumatoid arthritis may not be sufficient to get you out of the MIG and therefore give you access to more treatment. The Revised MIG holds that the existence of any pre-existing condition will not automatically exclude a person’s impairment from the MIG. It states: “It is intended and expected that the vast majority of pre-existing conditions will not do so.” In case there is any doubt, the Revised MIG continues that “[o]nly in extremely limited instances” is a person excluded from the MIG where it is satisfactorily demonstrated by a health practitioner that a pre-existing condition was documented before an accident and that will prevent a person from achieving maximal recovery from his or her injuries. The Revised MIG states: “Exclusion of a person from this Guideline based on reasons or evidence falling short of this requirement is inconsistent with the intent of the SABS and this Guideline.”
It is not clear from the Revised MIG on what medical research the Superintendent based his expectations that the “vast majority of pre-existing conditions” will not prevent maximal recovery. It is clear that the Revised MIG continues to rely on the “Getting the Facts about Whiplash Brochure” attached and referenced as Appendix A to the Guideline. This brochure was first released in 2003 and endorsed, at the time, by the Insurance Bureau of Canada (IBC), a non-medical organization that represents insurers in Canada, the Ontario Chiropractic Association (OCA), Ontario Massage Therapists Association (OMTA), Ontario Physiotherapy Association (OPA) and the Ontario Society of Occupational Therapists (OSOT). Apart from the IBC, it is not clear whether these organizations would still endorse this brochure. OMTA has long changed into RMTAO. The OCA has posted links to updated (2010) research from the Canadian Chiropractic Association on its own website that concludes that many clients with WAD recover quickly and completely; however, chronic symptoms or disability affect others (19–60%) with up to half of WAD-1 or WAD-2 clients suffer neck pain and disability 6 months after injury (i.e. chronic WAD), and almost a quarter of these clients remain symptomatic after 1 year.
The Revised MIG and its reliance on the whiplash brochure does not appear to take into account updated research, greater awareness of health concerns and a noted shortage of appropriately trained medical professionals to diagnose pre-existing health conditions. It also appears that there was no consultation and that there is no endorsement from any Rheumatologist, Physiatrist, Neurologist or Family Doctor for the Revised MIG No. 01/14. Continued reliance on this 2003 brochure on whiplash by the Revised MIG No. 01/14 appears as appropriate as going to an electronics store now and having a salesperson forcing you to buy an 11 year old TV because less than half of those working in the industry 11 years ago thought it worked most of the time.
Roelf Swart is an OTLA member and a lawyer practising with Elkin Injury Law – Barristers, P.C. in St. Catharines, Ont.

Source:  http://otlablog.com/shortage-of-specialists-highlights-serious-problems-with-new-restrictions-to-the-mig/