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Gamble v Allstate Insurance Company of Canada (20-010512)

  • July 27, 2022

The claimant was found to be entitled to post-104 week IRBs for psychological reasons. The insurer terminated the claimant’s entitlement to IRBs pursuant to section 57(2) of the SABS, on the basis that she had failed to seek psychological treatment. Section 57(2) requires a person to obtain treatment that is reasonable, available, and necessary to allow them to engage in employment or self-employment. The claimant argued that she was engaging in psychological treatment with her family physician. Adjudicator Kepman agreed with the insurer that the claimant had not complied with section 57(2). The claimant’s family physician was not qualified to provide psychiatric care, and had suggested that the claimant attend supportive psychotherapy and referred the claimant to a psychiatrist. The claimant had provided no explanation as to why she had not attended any type of psychological services, despite it being suggested to her several times. As such, the claimant was not entitled to IRBs for the period in dispute.

Full decision here

TGP Analysis

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