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 Volume. 6 Issue. 34 – August 31, 2022



In ‘No Laughing Matter’ the Tribunal considers the appropriate award to be levied in the face of an eighteen year delay in paying ACB. It is also noted that the interest payable on the delayed payments far exceeded the modest monthly ACB amount.


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Post 104 IRB Ongoing Despite Career in Comedy

No Laughing Matter – In 20-014497 v Intact, the Applicant Lynch, struck as a pedestrian in an April 2018 accident, sought entitlement to post 104 IRB in addition to a CAT designation.

With respect to IRB, Intact argued both causation, suggesting that his mental health issues were “too attenuated to be as a result of the accident”, as well as the fact that Lynch was actively working in a promising comedy career.

As for causation, the Tribunal cited a previous decision, wherein “one overarching fact stands out”, at the time of the accident, the applicant was employed and intended to continue working for the indefinite future, but hasn’t been able to return, with “the accident standing as bright line in [the applicant’s] life.” The subject accident was said to have set Lynch “on a downward spiral’, and as a result he had not been able to work in any consistent fashion, despite several attempts.

The Tribunal found that Lynch was “unable to meet reasonable standards of productivity in a competitive marketplace.” The impediments to a work return were the “inability to do extended computer work, his alcoholism, and his mental health, which leaves him prone to depression, outbursts, and suicidal ideation.” The Tribunal further did not find that Lynch’s comedy activities established abilities inconsistent with a “complete inability. This, despite agreeing with Intact that Lynch “exhibits a good amount of initiative, organization, responsibility and even functional abilities, such as securing a line-up of local comics, securing a venue, updating posters, posting them up, running a show, and dealing with the finances.” However, “the argument falls short when the activities are viewed in context.”

The activities themselves were described as “sporadic, conducted as short tasks of up to two hours, spread out over a course of a few days, preformed at Lynch’s will. While Lynch. hasn’t missed any shows, they are all in the evening, so Lynch’s depression and inability to get started on some days is covered-up.” Therefore, the activities “do not translate into an ability to show-up everyday to work at an employer’s schedule and consistently work and maintain working relationships.” As a result, while Lynch “sincerely desires to and has attempted to return to work”, he remained at present as suffering from a complete inability.

With respect to a CAT designation, Lynch submitted that he sustained the requisite three class 4 marked impairments in the domains of ADLs, Social Functioning, and Adaptation, with a class 3 impairment in Concentration. The Tribunal agreeing with Intact, that if Lynch failed to establish a marked impairment in any one of the three domains, then he fails to meet the test.

Intact focussed on ADLs, and successfully established that Lynch did not suffer from a marked impairment. The Tribunal found in fact that Lynch failed to meet the class 4 criteria from two perspectives. First, while generally accepting the evidence of Lynch’s psychological expert, the finding of a class 4 impairment was largely based upon a description provided in an OT report, said report indicated as “noticeably overstated compared to the overall evidence presented in the hearing”.

Secondly, and a focus of the hearing, was how to properly rate Lynch’s “function in ADLs given the gap in his functional abilities between his regular “good” days and his acute periods when his mental health issues are symptomatic.” It was confirmed that “the evidence was overwhelmingly clear that most of the time, (Lynch) performs his ADLs with little or no impairment.” This however contrasted with Lynch’s submissions that “when his mental health issues are symptomatic, his abilities and performance are substantially decreased, such when he is hospitalized or suffering a depressive episode.”

Ultimately, the Tribunal found that combining Lynch’s “very mild functional limitations on most days in his ADL with his limitations on his acute periods, produces an overall ADL rating in the high-end of a class 2 impairment or possibly low end of a class 3, but in any event, definitively short of a class 4 marked impairment.” This conclusion was reached as “because on most days – 28 out of 30 days a month – he is high functioning in this domain, and the acute days are a relatively short periods of each month. As well, even during the depressive stages, he is still independent in his ADLs, albeit delayed.”



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Archive of LAT Updates

April 24, 2024: Wilful Misrepresentation Abounds on IRB Repayments

IRB

April 22, 2024: Records Alone Do Not Warrant MIG Removal on Pre-Existing

MIG

April 15, 2024: Demands of Child-birth Pre-Existing Condition?

MIG

April 10, 2024: Court Upholds Tribunal Decision That a MIG Removal is a Complete MIG Removal

Divisional Court, MIG

April 8, 2024: Psychiatric Diagnosis Prevails over Psychological Opinion

MIG

April 3, 2024: Court Sends Matter Back to Tribunal Concerning “Accident”

Definition Accident, Divisional Court

April 1, 2024: Ortho Opinion Prevails on Origins of a Fracture

MIG

March 27, 2024: Supreme Court Takes Issue with Tribunal, Divisional Court & Court of Appeal

Limitation Period, Reconsideration, Supreme Court

March 25, 2024: Expert’s Conclusory Statement Insufficient on Pre-existing Condition

MIG

March 20, 2024: Non-Compliance by Both Parties Impacts IRB and Medical Claims

IRB

March 18, 2024: No Weight Afforded to Handwritten Illegible CNR’s

MIG

March 13, 2024: Denials Deficient and Pain Relief Validates Treatment Plans

Treatment Plans

March 11, 2024: “Radicular Irritation” & MRI Findings Not MVA Related

MIG

March 6, 2024: Tribunal Upholds Decision Excluding Improperly Secured IEs From the Evidence

Evidence, IE, Reconsideration

March 4, 2024: Concussion and Chronic Pain Diagnoses Require Expertise

MIG

February 28, 2024: Prior Health Concerns Complicate Claim for CAT

CAT

February 26, 2024: Unchallenged Virtual Chronic Pain Assessment Accepted

MIG

February 21, 2024: Consent by Parties for Adjournment Not Determinative

Adjournment, Procedure

February 14, 2024: Tribunal Does Not Accept the CAT Findings of Either Party

CAT

February 12, 2024: MIG Escape on Concussion Diagnosis Despite Resolution of Symptoms

MIG

February 7, 2024: Financial Hardship Not A Defense for Repayment Responsibility

IRB

February 5, 2024: CT Scan of Wrist Fracture Contradicts Medical Opinion

MIG

January 29, 2024: Concussion Despite No Head Injury?

MIG

January 24, 2024: One Assessment Process Produces Two Discrete Reports

CAT, Productions

January 22, 2024: Defective Notices Do Not Trigger Limitation

MIG

January 17, 2024: Election Not Required, LAT Act Invoked & Limits Exhausted?

Award, Limitation Period

January 15, 2024: Chronic Pain Diagnosis Contradicted by Self-Reports

MIG

January 10, 2024: NEB Reinstated After Six Years Generates Award

Award, NEB

January 8, 2024: Undisputed Psychological Diagnosis Prevails

MIG

January 3, 2024: Significant & Competing Price of Non-Compliance for Both Parties

Non-Compliance

December 20, 2023 (Throwback Edition): Statutory Relief Within Tribunal’s Jurisdiction

Jurisdiction

December 18, 2023: ‘Incident’ of Viewing Video Not Use and Operation

MIG

December 13, 2023 (Throwback Edition): Employed Applicant Remains Entitled to Post 104 IRB

IRB

December 11, 2023: Chronic Pain Diagnosis In Absence of Physical Exam?

MIG

December 6, 2023: Four Marked Impairments for 2010 MVA

CAT

December 4, 2023: No Adverse Inference Drawn Despite Lack of pre MVA CNRs

MIG

November 29, 2023 (THROWBACK EDITION): 18 Month Delayed Notice Reasonable, However 7 Month Delay is Not

Limitation Period

November 27, 2023: Confirmed High Bar to Escape MIG on Pre-Existing

MIG

November 22, 2023: Multiple IEs Excluded From Evidence

IE, Evidence

November 20, 2023: Radiculopathy Complaint Requires a Diagnosis

MIG

November 15, 2023: Court Applies Tomec & CAT Decision Varied

CAT, Limitation Period

November 13, 2023: Insurer Expert Conclusion Inconsistent with Findings

MIG

November 8, 2023: Maximum Award in Excess of $60K on CAT Case

CAT

November 6, 2023: Medical Evidence Overrides Legal Referrals

MIG

November 1, 2023: Eighteen Month Delayed Notice Reasonable However Seven Month Delay is Not

Limitation Period

October 30, 2023: Which MVA Exacerbated Injuries?

MIG

October 25, 2023: Application Seeking CAT Determination an Abuse of Process

CAT

October 23, 2023: Functional Disability Despite 50 Hour Work Week

MIG

October 18, 2023: Statutory Relief Renders Equitable Remedy Moot

Div Court

October 16, 2023: Injuries Not Static - MIG Determined Again

MIG

October 11, 2023: CERB is Income However Not “Gross Employment Income”

IRB

October 4, 2023: Employed Applicant Remains Entitled to Post 104 IRB

IRB

October 2, 2023: ‘IE’ Does Not Establish Causation

MIG

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