• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

IME

Shokat and AXA Insurance [+] Arbitration, 2014-10-03, Reg 403/96. Final Decision FSCO 4290.

https://www5.fsco.gov.on.ca/AD/4290

AXA’s medical evidence

AXA relies on two Insurer Examination (IE) reports: one by Dr. Urovitz dated August 25, 2010[16] and the other by Dr. Waisman dated August 23, 2010[17], which state that Mrs. Shokat does not suffer a substantial inability to engage in her pre-accident housekeeping duties.

Dr. E. Urovitz

Dr. Urovitz, an orthopaedic surgeon, who assessed Mrs. Shokat on behalf of AXA, stated in his report dated August 25, 2010[18] that Mrs. Shokat’s complains at the time of her visit were constant daily pain in her right wrist, right ankle, right fifth finger, central neck and central lower back. He diagnosed her with a “soft tissue injury to the right wrist and right ankle, contusional injury to the right lower extremity, neck strain … and lower back strain” … as a result of the motor vehicle accident.

He opined that Mrs. Shokat had suffered a soft tissue injury to her right wrist and that, from an orthopaedic perspective, Mrs. Shokat did not suffer a substantial inability to engage in her pre-accident housekeeping duties.

He however recommended an MRI of the right wrist because of the ongoing complaints to her wrist to rule out the possibility of an internal derangement particularly meniscal damage.

Dr. Waisman

Dr. Waisman, a psychiatrist, assessed Mrs. Shokat on behalf of AXA on July 30, 2010. In his report dated August 23, 2010[19], Dr. Waisman stated that Mrs. Shokat reported having mood fluctuations based on the degree of pain felt. She further reported having poor concentration and memory since the accident. He opined that Mrs. Shokat was not substantially unable to perform her pre-accident housekeeping tasks from a psychiatric perspective.

Findings on Disability

There is no evidence that Dr. Urovitz or any of AXA’s assessors reviewed the results of the MRI of December 2010 which revealed a triangular fibrocartilage tear to Mrs. Shokat’s right wrist.[20] I find it pertinent that the only assessors who had the benefit of reviewing the MRI of her wrist before forming an opinion on Mrs. Shokat’s physical injuries were her assessors.

Albeit, Dr. Schofield, who assessed Mrs. Shokat in October of 2011, seemed to have a different opinion from Dr. Tuli in that he did not think that surgery would be beneficial to Mrs. Shokat’s hand and instead recommended ongoing exercise to gradually improve her grip strength, I note that his report is indicative of the fact that her symptoms continued to persist at the time of her visit. Therefore, I find it reasonable to infer that resuming her pre-accident housekeeping tasks at that time would result in an exacerbation of her symptoms.

I find on a balance that the objective medical evidence does not support AXA’s evidence on Mrs. Shokat’s inability to perform her pre-accident housekeeping tasks, particularly Dr. Urovitz’s opinion. I find that the objective medical evidence supports the disability certificate − therefore, I prefer this evidence.

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