Ontario’s Licence Appeal Tribunal has rejected a claim for auto accident benefits arising from psychological symptoms, finding that while these symptoms happened after the crash, they were not caused by the crash.
Also, the adjudicator found the injured insured’s doctors relied too heavily on her self-reporting.
Eleonor Quinn was involved in two automobile accidents, one on Aug. 6, 2017, and a second on Sept. 15, 2019. She sought various accident benefits for physical and psychological impairments from both collisions. Her auto insurer, Security National Insurance Company, denied certain benefits, arguing the accidents did not cause or exacerbate her psychological symptoms.
LAT sided with the insurer.
“I accept that [Quinn] described psychological symptoms in the months following the 2017 accident,” LAT adjudicator Terry Prowse wrote in a decision released last Monday. “However, the evidence does not establish, to a degree of probability, that the symptoms were a result of the 2017 accident itself, as much as they were the result of issues with personal relationships.
“[Quinn] had also become aware of a medical issue that she was concurrently dealing with. She also reported issues with money, testifying that she had been working multiple jobs to make $50,000 to $60,000, to sponsor and support her family to come to Canada.”
The adjudicator noted the medical file “reflects that [Quinn] did not complain of psychological symptoms immediately following the accident, or during a follow-up with her doctor on Aug. 8, 2017.”
Nine days later, however, she reported complaints about sleeping, appetite, agitation, and a lack of interest in daily activities.
On Sept. 21, 2017, she complained to her family physician about having trouble sleeping since the accident. Her doctor “wrote that the applicant felt anxious that she was unable to send money to her family in the Philippines, needed to maintain her income and felt that her plans had been deterred because of the accident,” the LAT decision reads.
About a year later, on Aug. 15, 2018, a psychologist assessed Quinn for an insurer’s examination. “The doctor described the applicant denying any psychological impairment that interfered with her ability to perform the duties required of her [at work],” the decision says. “[The doctor] also wrote that the applicant denied any symptoms of anxiety that interfered with her overall functioning.”
The psychologist diagnosed Quinn with a depressed mood, but did not link the diagnosis to the car accident.
Related: Where the burden of proof lies in accident claim adjudications
As for the psychological symptoms after the second accident, the LAT adjudicator found the doctors’ reports either did not follow up on self-reported claims, or they did not explain inconsistencies.
“The applicant contends that while the 2017 accident started her psychological issues, the 2019 accident made them worse,” Prowse wrote. “She points to various medical records and psychological reports, predominantly from her treating [clinical] psychologist, Dr. Pillai, as evidence of continuing or worsening symptoms.”
In December 2018, Dr. Arunkumar Pillai diagnosed the applicant with major depressive disorder, features of PTSD, and features of a pain disorder.
“However, in reaching his diagnoses, Dr. Pillai referred to self-reporting by the applicant of significant psychological symptoms from the 2017 accident that were never reported previously by her, including to her family physician,” the LAT adjudicator wrote. “It does not appear that Dr. Pillai reviewed her medical file but instead relied on the applicant’s rendition of the accident and her resulting symptoms, which was not historically accurate or investigated further by him. As such, I give Dr. Pillai’s report little weight.”
Similarly, in January 2019, a psychiatrist concluded Quinn suffered from psychological issues related to the 2017 accident, including PTSD. But the adjudicator noted the doctor simply described that Quinn reported “…experiencing infrequent flashbacks of the motor vehicle accident with physiological and psychological re-experiencing and she would panic whenever a transport truck was on the driver’s side of her car….”
This, the adjudicator observed, “was inconsistent with [Quinn’s] reports/complaints for the majority of the previous year. [Dr. Gwyneth Zai, a psychiatrist] did not question or explain the contradictions.”
The medical reports “predominantly describe personal issues that the applicant was dealing with at the time, like with employment, relationships, family, finances, and her belief that the accident made the issues worse because it caused her to lose money that she otherwise would have made,” Prowse wrote.
“That is not a description of issues that would not have occurred ‘but for’ the accident. In the background of such significant life events/stressors, there is insufficient objective medical evidence to support that either accident caused or worsened the applicant’s mental health.”
Feature image courtesy of iStock.com/ftwitty
