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ONTARIO AUTO INSURANCE SABS 2010 W orking with the MINOR INJURY Guidelines

ONTARIO AUTO INSURANCE SABS 2010 W orking with the MINOR INJURY Guidelines. The New SABS – Osgoode Hall Law School , York University September 17, 2010 ARTHUR AMEIS MD FRCPC DABPMR [SUBSP CERT PAIN MEDICINE] d r.ameis@mdacentre.com. Minor injury Guideline (MIG). 3.(1)

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ONTARIO AUTO INSURANCE SABS 2010 W orking with the MINOR INJURY Guidelines

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  1. ONTARIO AUTO INSURANCE SABS 2010Workingwith the MINOR INJURY Guidelines The New SABS – Osgoode Hall Law School, York University September 17, 2010 ARTHUR AMEIS MD FRCPC DABPMR [SUBSP CERT PAIN MEDICINE] dr.ameis@mdacentre.com

  2. Minor injury Guideline (MIG) • 3.(1) • A guideline that: • (a) Is issued by the Superintendent and • (b) Establishes a treatmentframework in respect of one or more minor injuries

  3. MinorInjury • ‘minorinjury’ means a • sprain, strain, whiplashassociateddisorder, • contusion, abrasion, laceration, or subluxation • and • anyclinicallyassociatedsequelae

  4. Minor Injuries are defined as • Sprain: an injury to one or more tendons or ligaments or to one or more of each, including a partial but not a completetear(i.e. Grade I-II) • Strain: an injury to one or more muscles, including a partial but not a completetear(i.e. Grade I-II) • Subluxation: a partial but not complete dislocation of a joint

  5. Minor Injuries are defined as • whiplashassociateddisorder: a whiplashinjurythat • Does not exhibit objective, demonstrable, definable and clinically relevant neurologicalsigns(i.e. isnot W.A.D. III) • Does not exhibit a fracture in or dislocation of the spine(i.e. isnotW.A.D. IV) • whiplashinjurymeans an injurythatoccurs to a person’s neck following a suddenacceleration-deceleration force

  6. Minor Injuries undefined • contusion, abrasion, laceration • anyclinicallyassociatedsequelae

  7. Monetarylimitsremedical and rehabilitationbenefits • 18.(1) the sum of the med and rehabbenefits…impairmentthatispredominantly a minorinjuryshall not exceed$3500…less the sum of all amountspaid…in accordance with the MinorInjury Guideline.

  8. Exclusion from the MinorInjury$3500 limit • 18.(2) Despitesubsection (1), the $3500 limit…does not applyto an injuredperson if his/herhealthpractitioner (MD, Chir, DDS, OT, Opt, Psych, PT, RN-ext, SLE) • determines and providescompellingevidencethat the insuredperson has a pre-existingmedical condition thatwillprevent the insuredpersonfromachieving maximal recoveryfrom the minorinjuryif…subject to the $3500 limit or …limited to the goods and services authorizedunder the MIG.

  9. Determines and ProvidesCompellingEvidence • 18.(5) For the purposes of subsections (1) and (3), medical and rehabilitationbenefits payable…include all fees and expenses for conductingassessments and examinations and preparing reports (so, does the fee for an unsuccessfulsubsection (2) effort reduce the $3500 available for MIG?)

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  12. CompellingEvidence • The attendingHealthPractitioner must beretained to render a prioritywritten opinion • Likelyhe/shewill not befamiliarwith the goods and services providedunder the MIG • A report willbeneededthat states in a compellingfashionwhat the pre-existing condition is and why maximal medicalrecoverywill not beachievedthroughreceiving the goods and services of the MIG

  13. CompellingEvidence • Will a copy of prior records suffice? • Must therebe a history of visits to a specialist? • How can the post-MVA clinician document and thusprovidecompellingevidence of a prior condition? • What if the Insurerrequests confirmation from the GP or a priorattendingspecialist • Meanwhile the clockisticking

  14. CompellingEvidence • The reality isthatverylittleisknown for certain about whatprior conditions are relevant to outcome • Scholten-Peeters et al in Pain 2003 indicatethatfeatureswithat least limitedprognostic value for functionalrecoveryinclude ‘previouspsychologicalproblems’ • Nieto et al, DisabilRehabil 2010 Juneindicatethatcatastrophisingwas a significantpredictive variable

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  16. ClinicallyAssociatedSequelae • Crutebo et al – J. Rheumatol 2010 Jul The course of symptoms for whiplashassociateddisorders in Sweden: 6 monthfollow up study The mostcommonsymptomswere neck pain, reduced neck ROM, headache and low back pain. Baseline prevalence of depressionwas 5%; PTSD and anxietywere 19.7% and 11.7% in women, 13.2% and 8.6% in men.

  17. ClinicallyAssociatedSequelae Spine 2006: In addition to neck pain, theremaybe pain in one or botharms, between the shoulderblades, the face and even the lower back. Othersymptoms, usuallycalledwhiplashassociateddisorders (WAD) includeheaviness or tingling in the arms, dizziness, ringing in the ears, vision changes, fatigue, poor concentration or memory and difficulty sleeping. If pain does not getbetterafterseveralmonths, patients oftengetdepressed.

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