For claims professionals, disability managers, defence and plaintiff counsel, and employers across Canada
Sprains and strains are the highest-volume injury category in slip and fall claims and the hardest to adjudicate. There is rarely a fracture line to anchor the file. There is usually no surgical report. What there is instead is a claimant reporting persistent pain months after an injury that clinically should have resolved in weeks, a treating practitioner advocating for continued care, and imaging that either was not ordered or came back unremarkable.
The question on these files is almost never whether an injury occurred. It is whether the current presentation remains attributable to the fall, whether it is consistent with the reported mechanism, and what the person can actually do. This article sets out how to scope, time and instruct an independent medical evaluation that answers those three questions, what the evidence says about the limits of the tools involved, and where the regulatory changes of the past two years have shifted the stakes.
Why the volume is what it is
Falls are the dominant cause of injury hospitalization in Canada, and the current data identifies the slip-and-fall mechanism specifically rather than burying it in a general falls category.
In 2024-2025 there were approximately 291,000 acute inpatient hospitalizations due to injury in Canada, up from 284,000 the previous year, alongside over 2 million injury-related emergency department visits annually. Unintentional falls accounted for roughly 178,000 of those hospitalizations, close to 61 percent of the total. Within that, falls attributable to slipping, tripping and stumbling accounted for 38,197 hospitalizations, about 13 percent of all injury hospitalizations in the country, with a further 14,251 arising from falls on stairs and steps. Ontario carried the largest provincial share of the slipping, tripping and stumbling volume at 14,881, followed by British Columbia at 6,704.
Falls on ice produced 6,563 hospitalizations, and the age distribution is the figure worth holding onto. Roughly 2,843 of those, about 43 percent, occurred in the 18 to 64 age band, nearly matching the 3,023 recorded in the 65 to 84 band. The winter slip-and-fall cohort is not predominantly geriatric. Close to half of it consists of working-age adults with employment income, benefits coverage, and an accommodation or return-to-work question attached to the file.
These are hospitalization figures, meaning they capture only cases admitted for at least one night, and they therefore skew heavily toward fractures and other structural injuries. The sprain and strain caseload sits almost entirely in the emergency department and primary care volume beneath them, and in the claims that never generate a hospital record at all. CIHI notes that injury-related hospitalizations rose most sharply among people aged 65 to 84, a 6 percent increase driven by falls, which is a useful signal for reserving on the fracture side of the book. But the files that stay open longest, consume the most assessment budget and produce the most adjudication disputes are the soft tissue claims that never appear in a hospitalization table.
That is the sprain caseload. It rarely produces an admission, rarely produces definitive imaging, and disproportionately produces the files still open eighteen months later.
Source: Canadian Institute for Health Information. Injury and Trauma Emergency Department and Hospitalization Statistics, 2024-2025. Ottawa, ON: CIHI; 2026. Figures reflect final 2024-2025 data; emergency department figures rest on partial national coverage and some table cells are suppressed for confidentiality.
Definitions drive the money, and they differ by system
Terminology matters here more than in any other injury category, because the same word carries different consequences depending on which regime the file sits in.
Ontario’s Minor Injury Guideline, issued under the Statutory Accident Benefits Schedule, defines a sprain as an injury to one or more tendons or ligaments, including a partial but not a complete tear, and a strain as an injury to one or more muscles, again including a partial but not a complete tear. Subluxation is defined as a partial but not a complete dislocation. Minor injury also captures whiplash-associated disorder, contusion, abrasion, laceration, and any clinically associated sequelae. Where an impairment is predominantly a minor injury, medical and rehabilitation benefits are capped at $3,500 for one accident.
The critical distinction for this article is jurisdictional. The MIG is an auto insurance instrument. A slip and fall on commercial premises or a sidewalk is an occupiers’ liability matter, not a SABS claim, and the $3,500 cap does not apply to it. But the definitional architecture has trained a generation of Canadian claims professionals to think in partial-versus-complete-tear terms, and that distinction remains genuinely load-bearing in tort files, because it is frequently the line between a soft tissue injury with a predictable recovery curve and a structural injury carrying a permanent impairment argument. Adjusters running mixed portfolios should keep the definitional framework and discard the cap reasoning when the file is a premises claim.
Under the Occupiers’ Liability Act, an occupier owes a duty to take such care as in all the circumstances is reasonable to see that persons entering the premises are reasonably safe. Commentary on the Act describes section 3(1) as imposing an affirmative duty to take reasonable care to make premises reasonably safe, rather than a guarantee of safety. Amendments to the Act also require written notice within 60 days for slip-and-fall claims caused by snow or ice, with separate and shorter municipal notice requirements reported by practitioner commentary. That deadline is not a medical question, but it compresses the early file timeline considerably and should be confirmed before assessment strategy is discussed.
This is general information rather than legal advice, and counsel should verify the applicable notice and limitation requirements in the relevant jurisdiction.
Why the MIG now decides sprain files it previously only shaped
For the auto side of your book, the position changed materially on July 1, 2026. Under O. Reg. 383/24, only medical, rehabilitation and attendant care remain mandatory on every Ontario policy. Income replacement, non-earner, caregiver, housekeeping and several other categories are now optional coverage the named insured must actively purchase.
The consequence for sprain files specifically is that MIG designation has moved from consequential to close to determinative. Against a $65,000 non-catastrophic medical and rehabilitation limit, the $3,500 cap was always significant. On a mandatory-only policy where medical and rehabilitation is the entire accident benefits claim, a claimant seeking to escape the MIG is arguing for the difference between $3,500 and the whole of their remaining recourse under the policy. Expect more escape attempts and more sophisticated medical evidence supporting them.
Two escape routes matter for sprain files. The first is the pre-existing condition exception, available only where compelling evidence, documented by a health practitioner before the accident, demonstrates the claimant will not achieve maximal recovery from the minor injury if subject to the cap. The Guideline itself describes this as applying only in extremely limited instances, and in MM v. Wawanesa the adjudicator found that pre-existing records documenting no substantial health problems, with no practitioner concluding that those problems prevented maximal recovery, did not take the claimant outside the MIG. The existence of a pre-existing condition does not automatically do it.
The second route is chronic pain. The Licence Appeal Tribunal has held that chronic pain falls outside the MIG, and psychological impairment has similarly been found to place claimants outside its scope. Practitioner case summaries record decisions in which a chronic pain diagnosis took a claimant outside the MIG notwithstanding pre-existing pain at the same site. This is the single most common trajectory by which a $3,500 sprain file becomes a $65,000 file, and it is a trajectory driven partly by time, which is why assessment timing is not an administrative detail.
The commissioning implication is uncomfortable but important. The $3,500 cap is inclusive of assessment costs, which means the assessment that decides whether the cap applies consumes part of the cap it is deciding. That compounds the pressure to scope one properly constructed assessment rather than sequencing several narrow ones, and it makes a thin report on a contested MIG file a false economy that will be tested at the Tribunal. Where a MIG designation is genuinely contestable, the referral should address the escape argument the claimant has already advanced in writing. A report establishing that the injury is a sprain, which does not address the documented pre-existing condition or the asserted psychological component, has not resolved the dispute it was commissioned to resolve.
Our complete guide to the 2026 SABS changes sets out the section 38 and section 44 procedural mechanics in detail.
The clinical baseline – what recovery should look like
Defensible opinion on a sprain file depends on knowing what the expected trajectory is, because the entire causation analysis turns on whether this claimant has diverged from it and why.
Published clinical guidance on ankle sprains, the archetypal slip-and-fall sprain, describes recovery of roughly one to three weeks for Grade 1, several weeks for Grade 2, with sources citing three to eight weeks or four to six, and several months for Grade 3, with complete return to function at the upper end running three to six months. Rehabilitation literature adds a point that is regularly missed on both sides of a file: injured ligaments require protection against excess strain forces for six to twelve weeks for moderate healing, and more than one year for complete healing to occur. Expected functional recovery and complete tissue healing are not the same date.
| Grade | Pathology | Reported recovery | Assessment implication |
|---|---|---|---|
| Grade 1 | Ligament stretched | 1 to 3 weeks | Persistence past 6 to 8 weeks is a divergence worth explaining |
| Grade 2 | Partial tear | 3 to 8 weeks reported; 4 to 6 also cited | Highest-volume disputed category; functional testing most useful |
| Grade 3 | Complete tear | 3 to 6 months to full function | Complete tear falls outside the MIG sprain definition; verify classification |
That last row deserves emphasis. If the injury is a complete tear, it is not a sprain within the MIG definition, and a designation premised on sprain is exposed. Confirming the grade is not a clinical nicety; it is the coverage analysis.
The persistence data is the part most often absent from claims-side thinking. Roughly 20 percent of acute ankle sprain patients develop chronic ankle instability, and a prospective cohort study found a CAI prevalence of 40 percent one year after a first-time lateral ankle sprain, though the review reporting it notes that estimate is likely high. A separate study found a 30 percent recurrence of sprains within a year of injury. A claimant who is functional at eight weeks but still symptomatic at six months is not, on this evidence, automatically exaggerating. Chronic ankle instability is also associated with a range of genuine secondary pathology, including sinus tarsi syndrome, osteochondral defects of the talus, peroneal tendinopathy and subtalar instability, several of which can only be identified on targeted examination or MRI.
There is also a predictive literature that claims professionals rarely use and should. In a prospective cohort analysis, inability to complete jumping and landing tasks within two weeks of a first-time lateral ankle sprain, and poorer dynamic postural control together with lower self-reported function at six months, were predictive of eventual chronic ankle instability. The Star Excursion Balance Test, particularly posteromedial reach, has been reported as having valuable predictive capacity, and a low score on the Foot and Ankle Ability Measure activity of daily living subscale in conjunction with SEBT reach is described as likely to predict CAI.
For an insurer or employer, that means the question “is this file going to become a chronic one” is partly answerable at the six-month mark using measurable instruments, rather than at eighteen months by inference.
What imaging can and cannot do here
In a fracture file, imaging carries the evidentiary weight. In a sprain file it frequently shows very little, and that absence gets misread in both directions: as proof no injury occurred, or as proof that subjective report must be accepted wholesale.
MRI is described as most useful for chronic ankle instability, where ligament injury appears as swelling, discontinuity of fibre, a lax or wavy ligament, or non-visualisation, with positioning in neutral or slight plantar flexion to align the relevant ligaments. Its stated limitations are cost, time, availability, motion artefact, and an inability to accurately predict chronic sequelae following acute injury. That final limitation is the one to put in front of anyone treating an MRI as the answer to a prognosis question. Imaging is most valuable for ruling out fracture or complete tear, which would remove the injury from the sprain category entirely, and for identifying secondary pathology in the chronic phase. It is a poor instrument for adjudicating capability.
Physical examination carries more weight than it is usually given credit for. On clinical examination of suspected chronic ankle instability, hindfoot motion should be recorded, peroneal muscle strength tested, ligamentous laxity checked, and stability tests including the anterior drawer and talar tilt performed. Proprioception is often abnormal, and the literature records that 86 percent of patients with grade III ankle sprains have peroneal nerve and 83 percent tibial nerve stretch injury.
An examination that omits stability and proprioceptive testing on a chronic sprain file has not examined the thing in dispute.
The evidence on functional testing, stated honestly
For employers and disability managers, diagnosis is nearly beside the point. The operative question is what the person can do, measured against actual job demands. This is where a physician-only IME frequently underdelivers and where a functional abilities evaluation earns its cost.
RIDM’s FAE protocols objectively measure positional tolerances for sitting, standing and walking; strength tolerances for lifting, carrying and pushing or pulling; dexterity including fingering, handling and feeling; and endurance via aerobic capacity. Testing is administered by certified kinesiologists, chiropractors and occupational therapists trained on standardised objective protocols, in one, two or three day formats, with mobile assessment units available where fixed locations are not accessible. The multi-day option deserves specific attention in chronic sprain files, because a single-session snapshot cannot detect post-exertional symptom escalation, which is frequently the entire dispute. Standardisation across sites is also what makes findings comparable across a portfolio and harder to characterise as assessor-dependent.
Being straight about what this evidence will and will not support is what makes a report survive challenge. The most rigorous Canadian work on this question, conducted with the Workers’ Compensation Board of Alberta on the Isernhagen Work Systems protocol, followed 336 claimants with upper extremity disorders. Higher weight lifted was consistently but modestly associated with faster suspension of time-loss benefits and claim closure, explaining between roughly 1 and 11 percent of variation in those outcomes. Whether a claimant’s performance was rated as meeting or exceeding physical job demands was unrelated to future return to work. No FCE indicator was associated with future recurrence after controlling for confounders, and the one-year recurrence rate was 39 percent. Of the twelve subjects rated as meeting or exceeding job requirements on every item, four subsequently experienced a recurrence. The authors’ stated policy implication is that compensation boards and insurers should not rely solely on FCE information to determine work readiness. Earlier work by the same group on chronic low back pain found the protocol a modest predictor of timely return to work and a poor predictor of sustained recovery.
Two consequences follow, and neither is that functional testing lacks value. The first is that an FAE is strong evidence of demonstrated current capability and weak evidence of future durability, so a report should be written and read that way. A denial premised on an FAE as proof the claimant will not re-injure is arguing something the literature does not support. The second is subtler and useful: the authors observe that their findings support conceptualising performance-based functional tests as behavioural assessments rather than strict physical capacity tests. An FAE documents what someone demonstrated on a given day under observation, which is precisely the objective record a contested file lacks, without being a prediction.
That is also the answer to the question of why commission one at all. On a sprain file the alternative is not better evidence; it is competing assertion.
Effort, consistency and the instruments to avoid over-reading
Sprain files inevitably raise the question of effort and symptom magnification, and the instruments commonly reached for are weaker than their reputation.
Waddell signs were developed to detect what has been described as psychogenic, and sometimes inappropriately labelled non-organic, manifestations of low back pain. Physiopedia’s review states plainly that Waddell signs do not identify psychogenic pain and do not differentiate organic from non-organic problems, and that the term non-organic pain is not accurate. Separate research has found significant evidence of an association between elevated Waddell scores and somatic over-reporting, and a further study examined reliability on the basis that little was known about it despite widespread use. The defensible position is that these signs may flag a presentation worth examining more carefully and cannot carry a credibility conclusion on their own.
The same caution applies to grading systems used on associated injuries. The Quebec Task Force classification of whiplash-associated disorders, developed in 1995 and directly relevant because WAD I and WAD II are minor injuries under the MIG, has been extensively criticised. Published analysis found limited objective and quantifiable evidence supporting its use and limited prognostic value, with one review noting no available research indicating the classification was indicative of long-term WAD outcomes, and describing its inter-rater reliability as unknown. Reliability is also reported to vary with clinician experience, and the original classification does not specify how to interpret the grades. The classification is described as most useful when completed within the first week after injury, and the greatest risk of long-term symptoms is seen in the grade II group. Where a sprain file carries a WAD component, our article on IMEs in motor vehicle accident whiplash cases covers that overlap.
For assessors and for those instructing them, the practical rule is that an opinion built on a single instrument of contested reliability is the easiest opinion in the file to dismantle. An opinion built on convergence across history, examination findings, standardised functional measurement and the documentary record is not.
Timing – the variable you actually control
Most of what goes wrong on sprain IMEs is a scheduling problem rather than a clinical one.
Assess too early and you capture the acute phase, with guarding, swelling and antalgic movement patterns that are entirely appropriate at three weeks and say nothing about eventual capacity. Assess too late and the original injury has been overlaid by deconditioning, work absence, and in some cases pain that has become chronic and self-sustaining, at which point separating the fall from everything downstream becomes genuinely difficult. Given that chronic pain has been held to fall outside the MIG, delay on the auto side is not neutral; it is a route by which a capped file becomes an uncapped one while no independent record is being created.
The productive window generally opens once the expected recovery period for the graded severity has passed without resolution, meaning the file has diverged from the clinical baseline, rather than at the first treatment plan you would prefer to deny. Note also that the Alberta cohort described above was drawn from claimants who had met or surpassed expected healing times and plateaued with medical and rehabilitative intervention, which is the right trigger point for functional testing and a useful benchmark for setting your own.
There is a separate structural point for auto files. Where a policy carries mandatory benefits only, no section 44 insurer examination record will be generated by income replacement adjudication during the early recovery period, which means the tort defendant’s earliest medical evidence becomes a defence medical conducted years later. On a sprain file, where the whole dispute concerns a recovery curve that unfolded in the first six months, that gap is severe. Flag it at intake.
RIDM books appointments within four hours of referral, provides confirmation to the referral source immediately, and secures dates within whatever timeframes the referral source stipulates. The practical consequence is that the constraint on your file is your own trigger criteria rather than provider capacity, which argues for a diary date tied to the graded injury type rather than reactive referral.
Scoping and instructing the assessment
Choosing the right assessment type is the first half of commissioning. The second half is asking a question the assessor can answer.
A referral asking whether treatment is reasonable and necessary asks the assessor to state the legal conclusion the adjudicator must reach. The useful referral asks the clinical questions that support it: what is the diagnosis, what grade is the injury and is it a partial or complete tear, what impairment is attributable to the fall, what functional limitations are demonstrated on examination, what treatment is clinically indicated, what is the expected trajectory, and whether the presentation is consistent with the reported mechanism.
Mechanism deserves a specific instruction, because it is the question a sprain file turns on and the one most often left implicit. A lateral ankle inversion sprain is consistent with a misstep off an icy curb. Bilateral symptoms, or an injury pattern that does not match the described loss of footing, warrants scrutiny. The assessor needs the incident description, not only the clinical records, to speak to this at all.
Pre-existing condition analysis requires pre-incident records, without exception. Degenerative change, prior sprains at the same site and prior claims are common and are not disqualifying, but they change the question from whether the fall caused the condition to whether it aggravated a pre-existing one and by how much. Given the 30 percent one-year recurrence figure for ankle sprains, a prior sprain at the same site is close to an expected finding rather than a suspicious one. An assessor working from post-accident documentation alone can describe the current presentation but cannot credibly apportion. Obtaining prior records before the assessment is the highest-value piece of file preparation available, and it is entirely within the commissioning party’s control.
Send the record complete. An assessment conducted on partial records is vulnerable on the ground that the assessor lacked the material necessary to form the opinion. Where records are incomplete because they have not been produced, say so in the referral so the report documents the limitation rather than appearing to have overlooked it. Selective disclosure, meaning sending only the records that support a preferred outcome, converts a clinical dispute into a credibility dispute and is the most damaging thing a commissioning party can do to its own evidence.
Scope to the discipline. A sprain file that has acquired a chronic pain or psychological overlay is not one assessment; it is a physical assessment and potentially a separate psychological one. An orthopaedic assessor asked to opine on psychological barriers will either decline, weakening the report’s apparent completeness, or answer, weakening its defensibility. RIDM maintains assessors across all specialties nationally, which makes properly constituted multi-discipline scoping practical rather than a sequence of separate procurement exercises, and our independent multidisciplinary and catastrophic assessment service exists for files where coordination across disciplines is itself the deliverable.
Finally, resist signalling the desired conclusion. Referral language telegraphing an expected outcome is discoverable, it is routinely put to the assessor in cross-examination, and it taints an otherwise sound report.
Return to work, and the form that is not an assessment
For employers and disability managers, the deliverable is a return-to-work plan, not a diagnosis.
Ontario’s WSIB Functional Abilities Form is completed by the worker’s own treating health professional and is designed as a tool to facilitate return-to-work discussions between employer and worker. The WSIB’s musculoskeletal program of care guidance directs documentation of the injured person’s abilities, limitations, restrictions and accommodations to support return-to-work planning, and the WSIB’s own materials note that most workers experiencing soft tissue injury are able to remain at work. That last point is worth holding onto on sprain files: continued attendance with modified duties is the expected pathway, not the exception.
An FAF is not an independent assessment, and treating it as one is a common error. Where employer and treating practitioner disagree on capability, or where a return-to-work plan has stalled, independent functional testing is the appropriate escalation. Our guides to the WSIB Functional Abilities Form and to provincial differences in functional abilities evaluation across Canada cover the distinction, and provincial workers’ compensation assessment rules matter because a protocol acceptable in one jurisdiction may not satisfy another board’s requirements.
Where a claimant cannot return to pre-injury duties, vocational evaluation and return-to-work planning provides an objective review of employability before and after the onset of disability. FAE results can also address housekeeping, home maintenance and caregiving tolerances, which matters in tort files where those heads of damage are pleaded and, on the auto side, where housekeeping benefits were not purchased and the underlying need has migrated elsewhere.
What makes a sprain report defensible
Defensibility is more usefully understood as a property of the process that produced the report than of the individual assessor, and it fails in identifiable ways.
Procedural compliance comes first, and on auto files it is frequently where reports are lost for reasons having nothing to do with clinical content. Section 44(5) requires notice setting out the medical and other reasons for the examination, section 44(6) requires the insurer to specify the benefit entitlements being assessed at least five business days beforehand, with the LAT having limited the use of reports where that notice was deficient, and the report must be provided to the insured person within ten business days of receipt. Templates built around the pre-July-2026 benefit structure may reference entitlements no longer on the file. Privacy obligations apply throughout, and our guide to PIPEDA compliance and IMEs and to provincial legal requirements for conducting IMEs set out what varies by jurisdiction.
On content, a defensible sprain report states the records reviewed and identifies what was not available. It describes the mechanism and reasons, rather than asserts, why findings are or are not consistent with it. It grades the injury and specifies partial versus complete tear. It situates the current presentation against the expected recovery trajectory for that grade and explains any divergence, including by reference to the recognised chronic sequelae rather than treating persistence as inherently suspect. It addresses pre-existing conditions directly instead of leaving them as an implication. It distinguishes what was measured from what was reported. It ties functional tolerances to specific job demands rather than to generic light-duty categories. It does not over-read instruments of contested reliability. And it stays within the assessor’s actual area of expertise.
Structural independence is the criterion most often asserted and least often examined. An assessment provider that also operates treatment clinics has a commercial relationship with the treatment side of the system it is evaluating, and that is a question that can be put to the assessor. RIDM holds CARF International accreditation, which requires documented and audited processes for assessor credentialing, report review, complaint handling and quality assurance, and is independent of any treatment provider network.
On a contested sprain file where the cap turns on a single report, one fewer line of challenge is worth having.
The honest limitations
Independent assessment is not a lie detector, and sprain files expose that plainly. Pain is a subjective experience and no protocol measures it directly. A single evaluation captures one point in time in a condition that fluctuates. The functional testing literature reviewed above shows that better performance predicts faster claim closure only modestly and does not predict sustained recovery at all. Grading systems in adjacent injury categories have documented reliability problems. Two qualified assessors can reasonably differ on causation from the same records, and opposing counsel will find that difference.
The critique that assessors retained repeatedly by one class of payer may develop orientation effects is not frivolous. It is answered by standardised protocols, transparent reasoning, disclosure of what was and was not reviewed, structural independence from treatment revenue, and assessors prepared to defend a conclusion unhelpful to the referral source.
Used well, an IME on a sprain file does something narrower but more valuable than resolving the claim. It converts a file being argued on competing assertion into one being argued on documented findings, which is what allows fair settlement, appropriate accommodation and defensible denial to be told apart.
Frequently asked questions
Does the Minor Injury Guideline’s $3,500 cap apply to a slip and fall?
No. The MIG operates under the Statutory Accident Benefits Schedule and applies to auto accident claims. A slip and fall on premises is an occupiers’ liability matter. The MIG’s definitions of sprain and strain remain analytically useful, but the cap does not apply.
How does the MIG define sprain and strain?
A sprain is an injury to one or more tendons or ligaments, including a partial but not a complete tear. A strain is an injury to one or more muscles, again including a partial but not a complete tear. Subluxation is a partial but not a complete dislocation. Benefits are capped where the impairment is predominantly a minor injury.
Why does the 2026 SABS reform matter on a sprain file?
Because medical and rehabilitation is now the only benefit category guaranteed on every new Ontario policy, MIG designation is close to determinative of the whole accident benefits exposure rather than one component of it. Escape attempts should be expected to rise in volume and sophistication.
Does the assessment cost count against the $3,500 cap?
On auto files, yes. The MIG cap is inclusive of assessment costs, which is why sequencing several narrow examinations is worse than commissioning one properly scoped assessment.
When should we refer a sprain file?
Generally once the expected recovery window for the graded injury has passed without resolution, which means roughly one to three weeks for Grade 1 and substantially longer for Grades 2 and 3. Referring during the acute phase produces findings reflecting guarding rather than capacity. Delaying past the point at which pain becomes chronic risks a designation change while no independent record exists.
Is imaging necessary?
It is often uninformative on sprain files, which is why objective functional measurement carries more weight. Imaging is most useful for ruling out fracture or complete tear, either of which removes the injury from the sprain category, and for identifying secondary pathology in the chronic phase. MRI is expressly described in the literature as unable to accurately predict chronic sequelae following acute injury.
A claimant is still symptomatic six months after a Grade 2 sprain. Is that inconsistent?
Not on the published evidence. Roughly 20 percent of acute ankle sprain patients develop chronic ankle instability, one prospective cohort reported 40 percent prevalence at one year after a first lateral ankle sprain, and a 30 percent recurrence rate within a year has been reported. Persistence requires explanation, not dismissal.
IME or functional abilities evaluation?
An IME addresses diagnosis, causation, grading and prognosis. An FAE measures demonstrated physical capability against job demands. Return-to-work and accommodation disputes usually need the FAE; causation and apportionment disputes need the IME. Many sprain files benefit from both.
Can an FAE tell us whether the claimant will re-injure?
No, and a report should not be read as though it can. The Alberta research on the Isernhagen protocol found no FCE indicator associated with future recurrence after controlling for confounders, with a one-year recurrence rate of 39 percent. The authors’ stated policy implication is that insurers and compensation boards should not rely solely on FCE to determine work readiness.
How is an FAE different from the WSIB Functional Abilities Form?
The FAF is completed by the worker’s own treating health professional to facilitate return-to-work discussion. An FAE is an independent, standardised, protocol-driven measurement by a third-party assessor. They are complementary rather than interchangeable.
Can a pre-existing condition be separated from a new injury?
Only with pre-incident records. Without them an assessor can describe the present condition but cannot credibly apportion. Note also that under the MIG, a documented pre-existing condition does not automatically remove a claimant from the guideline; compelling evidence that it will prevent maximal recovery is required, and the Guideline describes this as applying only in extremely limited instances.
What should we do about a chronic pain or psychological overlay?
Scope it as a separate assessment by an appropriately qualified assessor. The LAT has held chronic pain to fall outside the MIG, and an orthopaedic assessor opining on psychological barriers produces an opinion that can be dismantled without engaging its substance.
Commissioning an assessment on a disputed sprain file?
RIDM has provided independent assessment and disability management services to Canadian insurers, employers, benefits providers and legal professionals since 1986. We are CARF-accredited, wholly Canadian-owned, and independent of any treatment provider network, with assessors in all specialties coast to coast, appointments booked within four hours of referral, and mobile assessment units where fixed locations are not accessible. Our coordinators can scope a referral to the specific questions in dispute on your file. Contact us, or review our IME information hub.
Related reading in this series: IME assessments for slip and fall shoulder injuries, slip and fall knee injury cases, slip and fall bone fracture cases, and slip and fall concussion cases. See also Independent Medical Examinations in Ontario and trends shaping orthopedic IMEs.
This article is general information about the assessment process and is not medical or legal advice. Regulatory requirements vary by province and change over time; verify current requirements for your jurisdiction.
