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Islam v. Toronto Transit Commission Insurance Company (20-014052)

  • May 30, 2022

The claimant applied to the LAT for a catastrophic impairment designation. Vice Chair Flude concluded that the claimant did not meet the definition, as she did not have a combined physical and mental impairment exceeding 55 percent WPI , and did not suffer at least one Class 4 Marked Impairment. The claimant’s assessor wrote that the claimant had Class 4 Marked Impairments in all four spheres of function and had a combined 53 percent WPI. Vice Chair Flude found that the claimant’s recovery did not support those conclusions. The claimant was able to return to her studies at Humber and graduate three years after the accident with a B average; she had returned to working out at a modified level; she tolerated a long commute from home to school; she started at Ryerson in 2020 just as COVID-19 hit; she worked two summer jobs while in school – one at Tim Horton’s and one as a camp counsellor; and she continued to socialize when her studies allowed it. The claimant’s psychological assessor ignored most of this objective evidence. Vice Chair Flude preferred the IE assessor’s opinion that the claimant suffered (at most) Class 2 Mild Impairments in each of the four spheres of function, which was equivalent to a 10 percent WPI. Regarding physical impairments, Vice Chair Flude did not accept that the claimant suffered neurological impairments, as the immediate post-accident records did not suggest any loss of consciousness, dizziness, blurring, amnesia, or other concussion-type symptoms. The 15 percent WPI assigned by the claimant’s assessor was rejected. The overall WPI accepted by Vice Chair Flude was 10 percent for emotional and behavioural, and 16 percent WPI for physical impairment, which did not combine to 55 percent WPI. The cost of CAT assessments totaling $2,400 was awarded, as it was reasonable for the claimant to investigate whether she suffered a catastrophic impairment. Vice Chair Flude also noted that the denial did not include proper medical reasons, contrary to section 38(8).

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment, CAT Assessments
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