Rocco Stabile v. Economical Insurance Company, 2022 CanLII 65551

Stabile v. Economical Insurance Company

Citation: Stabile v. Economical Insurance Company, 2022 ONLAT 20-010690/AABS Licence Appeal Tribunal File Number: 20-010690/AABS

In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.

Between: Rocco Stabile (Applicant) and Economical Insurance Company (Respondent)

DECISION

VICE-CHAIR: Ian Maedel

APPEARANCES: For the Applicant: James D. Armstrong, Counsel For the Respondent: Devan Marr, Counsel

HEARD: By Way of Written Submissions

BACKGROUND

1The applicant was involved in an automobile accident on June 5, 2015, and the applicant sought benefits pursuant to the Statutory Accident Benefits Schedule Effective September 1, 2010 (including amendments effective June 1, 2016) (“Schedule”). The applicant was denied certain benefits by the respondent and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).

ISSUES

[2] In an addition to an award and interest, the following substantive issues are in dispute: i. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline (“MIG”)? ii. Is the applicant entitled to $2,833.14 for psychological services recommended by Centre for Psychological Assessment Treatment Education Inc. in a treatment plan (“OCF-18”) submitted July 6, 2020? iii. Is the applicant entitled to $2,400.00 for a chronic pain assessment recommended by Shoreham Chronic Pain Clinic in an OCF-18 submitted on August 28, 2018? iv. Is the applicant entitled to $1,481.00 for a workplace assessment, recommended by Joanna Romas and Associates in an OCF-18 submitted May 23, 2019? v. Is the applicant entitled to $2,365.00 for psychological services recommended by Centre for Psychological Assessment Treatment Education Inc. in an OCF-18 submitted on November 12, 2019?

RESULT

3The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule, and therefore subject to treatment within the $3,500.00 MIG limit. Similarly, the treatment plans and assessments at issue are not reasonable or necessary pursuant to the Schedule. As a result, no award or interest is payable.

ANALYSIS

Credibility Issues

4This application is in relation to alleged impairments sustained in the accident dated June 5, 2015.

5However, the clinical notes and records (“CNRs”) clearly indicate the applicant was involved in a subsequent accident on November 12, 2016. This subsequent accident was not reported to any of the assessors who provided reports for this matter, except to Dr. A. Marino, Clinical Psychologist, who conducted a s. 25 psychological assessment. The applicant dismissed this as minor “fender bender” to Dr. Marino¹, yet the notes of his Family Physician, Dr. Forte, indicate it was a more serious collision.²

6Dr. Forte noted the November 2016 was a collision at 55 km an hour, in which his vehicles’ airbags were activated, the applicant sought medical attention at the Emergency Room, reported neck pain to Dr. Forte, and was diagnosed with whiplash.³ Not only was it not reported to the majority of expert assessors, but it was also not mentioned in the five years of chiropractic records provided by Dr. D. M. Stambolich, Chiropractor.

7The lack of reporting of this subsequent accident colours the subsequent evidence and reports relied upon by both parties. The omission of this subsequent accident and its possible effect on the applicant’s physical and psychological health cannot be quantified. It obfuscates what impairments may be attributable to the June 2015 accident. Furthermore, it leads me to place less weight upon the veracity of applicant’s self-reporting related to the potential impairments as a result of the June 2015 accident. Particularly because it was not reported the majority of the experts who provided reports for this matter.

8The applicant also reported a pre-accident history of neck and shoulder pain. On October 5, 2014, the applicant reported pre-accident neck and shoulder pain which Dr. Forte termed as “chronic and recurrent”⁴ as the applicant had a prior history of dislocation. Dr. Forte noted it was probably related to strain and OA (osteoarthritis).⁵ On April 9, 2015, the applicant reported pain in his right shoulder or deltoid region, and it was concluded there was no strain, but the pain was likely muscular.⁶ Similarly, x-rays taken on the date of the 2015 accident illustrate degenerative disc disease, arthritis, and degenerative changes in the applicant’s cervical spine.⁷ These inconsistencies and varied reporting all go directly to credibility and the weight apportioned to the applicant’s self-reporting.

The Minor Injury Guideline

9The MIG establishes a framework available to injured persons who sustain a minor injury as a result of an accident. A “minor injury” is defined in s. 3(1) of the Schedule as, “one or more of a strain, sprain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.” The terms, “strain,” “sprain,” “subluxation,” and “whiplash associated disorder” are defined in the Schedule.

10Section 18(1) limits funding for medical and rehabilitation benefits for predominantly minor injuries to a cap of $3,500.00. An applicant may receive payment for treatment beyond the $3,500.00 cap if they can demonstrate that a pre-existing condition, documented by a medical practitioner, prevents maximal medical recovery under the MIG or if they provide evidence of a psychological impairment or chronic pain with a functional impairment.

11It is the applicant’s burden to establish entitlement to coverage beyond the $3,500.00 cap on a balance of probabilities.⁸

12On June 5, 2015, the applicant’s vehicle was impacted by a tow truck on the rear/passenger side. He did not lose consciousness, nor did the air bags inflate. The Ambulance Call Report and Emergency Room records indicate he was anxious, had lower back pain and some muscular soreness in the neck.⁹ Following x-rays to his back, he was released from the hospital on the same date and prescribed Tylenol 3 and Naproxen.

13The applicant immigrated to Canada from Italy in 1973 at the age of 17. He has a grade 6 education and worked in the construction industry for more than 40 years.

14Overall, based on the totality of the evidence, including issues of credibility related to the alleged physical and psychological impairments, I cannot conclude the applicant has demonstrated on a balance of probabilities that his accident-related impairments warrant removal from the MIG.

Physical Impairments, Chronic Pain, and the MIG

15The applicant submits he suffered physical impairments as a result of the accident. The Disability Certificate (“OCF-3”) by Physician Dr. S. Litsos on August 3, 2015 indicates he suffered lower back pain, mid-back pain, and constant headaches.¹⁰ To substantiate these physical impairments, the applicant relies on the CNRs of Dr. Forte, the records of Advantage Physiotherapy, the records of Dr. Stambolich, and the Chronic Pain Assessment by Dr. H. Ta, Anesthesiologist.

16The applicant visited Dr. Forte 4 days post-accident on June 9, 2015. The applicant reported he couldn’t sleep, was suffering neck pain, and low back pain. Dr. Forte indicated he was suffering from muscle strain and post-traumatic stress.¹¹ On June 23, 2015, the applicant reported to Dr. Forte he was suffering from insomnia from as a result of pain in his lower back and up to mid-back, due to the accident. Again, Dr. Forte diagnosed him with “muscle strain with employment anxiety”.¹² The only additional report of pain to Dr. Forte was on January 2, 2020, when the applicant stated he was suffering from right leg pain to the right hip, however, this pain was not linked to the subject accident.¹³ No additional specialist referrals or diagnostic imaging were ordered by Dr. Forte in relation to any accident-related impairments.

17The records of Advantage Physiotherapy between June and August 2015 indicate the applicant had minor improvements but was still suffering neck and back pain and had trouble sleeping.¹⁴

18The CNRs provided by Dr. Stombolich indicate he sought chiropractic treatment 65 times between 2015 and 2020. He reported wrist pain in June 2017 and February 2018—pain unrelated to the accident.¹⁵ On November 5, 2018, he reported left neck pain and lower back pain as a result of the 2015 accident. On November 14, 2019, he reported neck strain on the left and right, related to the 2015 accident.¹⁶ Otherwise, there are unrelated entries that relate to the purchase of compression stockings, plantar fasciitis, and foot swelling.

19In the Chronic Pain Assessment Report by Dr. Ta, dated September 21, 2018, the applicant reported physical injuries in the form of neck and bilateral shoulder pain, back pain, left hip pain, left wrist pain as a result of gripping the steering wheel at impact.¹⁷ As a result of pain, the applicant reported difficulties standing and sitting.

20Dr. Ta diagnosed the applicant with the following physical injuries as result of the 2015 accident; left shoulder dysfunction consistent with adhesive capsulitis, whiplash associated disorder of the neck, shoulders, and back (WAD II), left sacroiliitis, left proximal biceps tendonitis, left greater occipital nerve neuritis, bilateral medial and lateral epicondylitis of both elbows, and left joint inflammation of the left hand/wrist.¹⁸

21He recommended a chronic pain program combined with medical management with both physical and psychological treatments. He also indicated the applicant should undergo an MRI to the left shoulder and lumbar spine, a referral to a hand surgeon, and bone scan of the hand and wrist.¹⁹ Dr. Ta did not mention the applicability of the MIG, only referencing impact of the impairments on activities of daily living, housekeeping, and participation in hobbies or sports.

22The respondent relies on the Insurer’s Examination (“IE”) report provided by Dr. R. A. Williams, Physiatrist, dated October 4, 2018.²⁰ The applicant reported pain in the shoulders—bilateral upper fibres of the trapezius, left wrist, and low back pain. The applicant further reported he was independent in all his activities of daily living, and, from a social and recreational perspective, the applicant paced himself according to fatigue and pain levels. From a vocational perspective, the applicant reported he was working full-time without modification.²¹

23Dr. Williams diagnosed the applicant with cervical spine strain/sprain (WAD II), left wrist sprain and strain, lumbar spine strain/sprain. He indicated the applicant’s prognosis was poor, as no further improvement or resolution of symptoms was reasonably expected.²² Otherwise, Dr. Williams stated there were no outside factors that would prevent him from achieving maximal medical recovery, as these injuries were minor as defined by the MIG.²³

24A diagnosis of chronic pain would merit the applicant’s removal from the MIG. However, regarding physical impairments, I place the more weight upon the Physiatry IE report provided by Dr. Williams than the report of Dr. Ta.

25Given that Dr. Williams is a Physiatrist, I place more weight on his conclusions than the physical diagnoses provided in Dr. Ta’s report, who is an Anesthesiologist. Similarly, the diagnoses reached in Dr. Ta’s report are simply unsupported by the clinical records. While I do not doubt the applicant suffered from pain in the neck and back immediately following the 2015 accident, the last reported incident of accident-related pain to Dr. Forte was on June 23, 2015.²⁴ Similarly, although the applicant visited Dr. Stombolich 65 times between 2015 and 2020 for chiropractic treatment, there was only one entry related to the 2015 accident, i.e., November 5, 2018.²⁵

26The left wrist pain the applicant attributed to gripping the steering wheel during the accident as reported to Dr. Ta²⁶ was not listed in any records until June 17, 2017, more than two years post-accident. In relation to the wrist pain, Dr. Stombolich noted the applicant was “not sure where he injured it – maybe [a] combination of work/leisure”²⁷. There was otherwise no nexus between this reported pain and the 2015 accident at issue.

27Dr. Forte’s CNRs also indicate a history of pre-existing neck and shoulder pain. The applicant’s assessors either did not review the medical CNRs or dismissed these prior complaints, regardless, they were reflected in neither Dr. Ta’s or Dr. Marino’s reports. Curiously, during the physiatry IE conducted by Dr. Williams, the applicant commented that he did not suffer from any neck or back pain prior to the motor vehicle accident.²⁸

28The last reported accident-related reporting to Dr. Forte, was on June 23, 2015, or 18 days post-accident. Initially, the applicant reported lower back pain in the lumbar spine related to the accident. The applicant reported lumbar pain in January 2020, but there was no connection made to the accident, and upon examination was noted he had full range of motion and no limitations were noted, physiotherapy was recommended.²⁹ However, by mid-August 2015, the applicant had stopped attending Active Physiotherapy. Similarly, in the chiropractic notes from Dr. Stambolich, there was only a single reference to pain related to the 2015 accident in November 2018.³⁰ In my opinion, these varied, sporadic reports of pain between June 2015 and January 2020 do not otherwise demonstrate a pattern or chronicity of ongoing pain symptoms.

29I place more weight on the CNRs before me than Dr. Ta’s report. Put simply, Dr. Ta’s two-hour assessment is outweighed by seven years of CNRs that detail the applicant’s medical condition between 2013 and 2020—CNRs that do not demonstrate the applicant had continuing pain attributable to the June 2015 accident. The applicant was never referred to a psychological medical professional by Dr. Forte, nor was he prescribed any psychotropic medications. These claims of chronic pain and chronic pain syndrome are also, as noted above, significantly weakened due to the subsequent accident in November 2016. Dr. Ta failed to address the applicant’s pre-existing complaints of neck and shoulder pain, or the subsequent accident, despite having reviewed the CNRs of Dr. Forte.

30Given this competing and more compelling evidence, I place little weight on Dr. Ta’s diagnosis of chronic pain syndrome. Overall, on a balance of probabilities, I am not satisfied the applicant has met his burden in relation to accident-related physical impairments. I am persuaded these physical injuries comprise of soft tissue sprains and strains (or their sequelae). These injuries all fall directly within the definition of a “minor injury”.

Psychological Impairment

31Psychological impairments, if established, fall outside of the MIG because such impairments are not included in the prescribed definition of “minor injuries”.

32The applicant asserts that he suffered a psychological impairment as a result of the accident. The applicant relies on the Psychological Assessment report by Dr. Marino, dated July 15, 2020.³¹

33Dr. Marino indicated the clinical interview and assessment was conducted in the English and Italian languages. Once the applicant and Dr. Marino established a rapport, the applicant was able to articulate his emotional concerns and difficulties since the 2015 accident. The applicant indicated his concerns were related to ongoing pain and functionality, including: disrupted sleep, fatigue, irritability, and frustration following the accident.³² Psychometric testing revealed he fell within a moderate range for depression, minimal range for anxious symptomology, and within an average range for depression and anxiety.³³

34Dr. Marino diagnosed him with chronic adjustment disorder with depressed mood, moderate severity related to the index accident.³⁴ He also indicated he was suffering from chronic pain in the lumbar area leading to various physical restrictions over five years after the accident.³⁵ Otherwise, Dr Marino states the applicant’s lack of engagement in previous counselling or psychological services was likely the result of cultural variables. He concluded that due to the chronicity of his injuries and his age, the applicant’s impairment is serious and permanent. Dr. Marino recommended a course of 12 sessions of psychological treatment conducted in the Italian language.³⁶ While he commented on his employability and activities of daily living, Dr. Marino made no comment about the MIG.

35The respondent relies on the Psychological Report provided by Dr. C. West, Psychologist, dated October 4, 2018.³⁷

36In his self-reporting to Dr. West, the applicant indicated he continued to work full-time in construction and had no psychological or emotional difficulties. He participated in activities in largely the same fashion as prior to the accident, with no limitations or restriction attributable to mental health impairments.³⁸ Dr. West also noted the applicant was not participating in any type of counselling or psychotherapy, nor has he been utilizing any psychotropic medications.³⁹ The applicant reported pain in his neck, upper back, lower back, left wrist, and disturbed sleep.

37During the clinical interview, it was noted he was co-operative, compliant and well-engaged in the assessment procedure. There was, however, a disclaimer imposing a level of caution when interpreting the psychological test data for anyone whose first language was not English or from a North American culture.⁴⁰

38In the specific measure for identification and detection of malingering, the applicant’s score exceeded the maximum acceptable cut off for suspected malingering. Specifically, some symptoms and impairment were highly atypical of individuals with a genuine psychiatric and cognitive disorder. This was noted as a potential symptom of amplification.⁴¹

39Dr. West concluded the applicant was not evincing any clinically significant accident-related mental health symptomology, sequelae, or impairment, nor did the applicant meet the criteria for any specific DSM-IV or DSM-5 diagnoses.⁴² Dr. West was not aware of any outside factors that would otherwise prevent the applicant from achieving maximum medical recovery from a mental health perspective and indicated he fell within the MIG from purely a mental health perspective.⁴³

40I am not persuaded the applicant suffers a psychological impairment that would otherwise remove him from the treatment limit of the MIG.

41To reach this conclusion, I place significant weight upon the report provided by Dr. West. Other than comments provided by Dr. Marino, I have no evidence to suspect the results of the psychometric testing or any of the assessments conducted were affected by the applicant’s use of the Italian language or perceived cultural differences. This issue never arose in any of the other four assessments completed on behalf of the parties. In fact, Dr. Williams specifically indicated an interpreter was not required to complete the physiatry IE.⁴⁴

42Although Dr. Forte did initially indicate the applicant was suffering from “post-traumatic stress”⁴⁵ four days post-accident on June 9, 2015, there was no referral or prescription for any psychotropic medication in the medical and prescription history provided. This supports the conclusions drawn by Dr. West that indicated there was no diagnosable psychological impairments. The applicant relies on both the reports of Dr. Ta and Dr. Marino to place the applicant outside of the treatment limits of the MIG, yet neither commented on whether he could be treated within the confines of the MIG. In contrast to the CNRs provided and other assessment reports provided, I view the reports provided by Dr. Ta and Dr. Marino as outliers.

Psychological Services Treatment Plans

43Sections 15 and 16 of the Schedule provide that the insurer shall pay medical benefits to, or on behalf of, an applicant so long as the applicant sustains an impairment as a result of an accident and the medical benefit is a “reasonable and necessary” expense incurred by the applicant as a result of the accident.

44The applicant bears the onus of proving entitlement to the proposed treatment by proving the OCF-18s are reasonable and necessary, on a balance of probabilities.⁴⁶

45For the reasons above, I have determined there is a lack of medical evidence in the clinical notes and records to support a claim for psychological services in the amount of $2,833.14 or $2,365.00. Briefly, I am not persuaded by the applicant’s assessment reports (provided by Dr. Ta and Dr. Marino), and I rather place more weight upon the findings of Dr. West. This psychological assessor found the applicant did not have a diagnosable mental disorder and he fell within the MIG from purely a mental health perspective.⁴⁷ Thus, the applicant has not established, on a balance of probabilities, that this psychological treatment is reasonable and necessary pursuant to the Schedule.

Assessments at Issue

46In determining whether an assessment is reasonable and necessary, it must also be noted that assessments, by their nature, are speculative. The purpose of an assessment is to determine if a condition exists. Notwithstanding their speculative nature, the applicant still bears the onus of establishing on a balance of probabilities that an assessment is reasonable and necessary. To do so, the applicant must point to objective evidence that there are grounds to suspect he has the condition for which he seeks the assessment.

47Again, I am not persuaded the applicant suffers from chronic pain based on the CNRs tendered. I place no weight upon Dr. Ta’s diagnosis of chronic pain syndrome⁴⁸, and the applicant has not otherwise established his functionality was affected by pain. It is clear from the evidence tendered that the applicant returned to full-time construction work for a period of four years following the accident and remained independent with his activities of daily living, as detailed in Dr. Williams’s Physiatry Report.⁴⁹ Thus, I do not find a chronic pain assessment is reasonable and necessary.

48Similarly, I am not persuaded the workplace assessment in the amount of $1,481.00 is reasonable or necessary, pursuant to the Schedule. Once again, the applicant returned to full-time construction work with no restrictions following the 2015 accident for a period of four years. He left the position when he retired. I am not persuaded that an assessment was necessary to determine the demands of his employment, nor the prospects of potential accommodations. Even if I determined that the applicant required employment accommodation due to pain, the evidence provided does not establish which potential accident caused the impairment. Regardless, I have determined the applicant falls within the treatment limits of the MIG, and this assessment is not required at this time.

Award and Interest

49Given that no benefits are payable, the respondent cannot be found to have unreasonably withheld or delayed payment of benefits, pursuant to s. 10 of Regulation 664. Also, without any outstanding payments, the applicant is not entitled to interest, pursuant to s. 51 of the Schedule.

ORDER

[50] The application is dismissed, and I find that: i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule, and therefore subject to treatment within the $3,500.00 MIG limit; ii. The applicant is not entitled to $2,833.14 for psychological services, as these benefits are not reasonable and necessary pursuant to the Schedule; iii. The applicant is not entitled to $2,400.00 for a chronic pain assessment, as this assessment is not reasonable and necessary pursuant to the Schedule; iv. The applicant is not entitled to $1,481.00 for a workplace assessment, as this assessment is not reasonable and necessary pursuant to the Schedule; v. The applicant is not entitled to $2,365.00 for psychological services, as these benefits are not reasonable and necessary pursuant to the Schedule; vi. An award pursuant to Ontario Regulation 664 is not payable; vii. No interest is payable.

Footnotes

1. 1Submissions of the Applicant, Tab 2, Psychological Consultation by Dr. A. Marino dated July 15, 2020, pg. 5.
2. 2Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, November 13, 2016.
3. 3Ibid. November 13, 2016.
4. 4Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, October 24, 2014.
5. 5Ibid.
6. 6Ibid. April 9, 2015.
7. 7Submissions of the Applicant, Tab 3, Clinical Notes and Records of Woodbridge Medical Centre, Diagnostic Imaging Report Dr. N. Ganguli, June 5, 2015.
8. 8Scarlett v. Belair Insurance, 2015 ONSC 3635, para. 24 (Div. Ct.).
9. 9Submissions of the Applicant, Tab 4, Ambulance Call Report, Tab 5, Records of William Osler Health System dated June 5, 2015.
10. 10Respondent’s Document Brief, Tab 3, Disability Certificate (OCF-3) dated August 3, 2015.
11. 11Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, June 9, 2015.
12. 12Ibid. June 23, 2015.
13. 13Ibid. January 2, 2020.
14. 14Submissions of the Applicant, Tab 6, Records of Advantage Physiotherapy, August 5, 2015.
15. 15Submissions of the Applicant, Tab 8, Clinical Notes of Kleinburg Family Health Centre, Dr. Stambolich, November 5, 2018.
16. 16Ibid. November 14, 2019.
17. 17Submissions of the Applicant, Tab 1, Report of Dr. Hien Ta, December 21, 2018, pg. 4.
18. 18Ibid. pg. 11.
19. 19Ibid. pp. 13-14.
20. 20Respondent’s Document Brief, Tab 9, Insurer’s Examination – Dr. A. Williams (Physiatrist) of Dynamic Functional Solutions, October 4, 2018.
21. 21Ibid. pg. 7.
22. 22Ibid. pg. 9.
23. 23Ibid. pg. 9
24. 24Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, June 23, 2015.
25. 25Submissions of the Applicant, Tab 8, Clinical Notes of Kleinburg Family Health Centre, Dr. Stambolich, November 5, 2018.
26. 26Submissions of the Applicant, Tab 1, Report of Dr. Hien Ta, December 21, 2018, pg. 4
27. 27Submissions of the Applicant, Tab 8, Clinical Notes of Kleinburg Family Health Centre, Dr. Stambolich, June 17, 2017.
28. 28Respondent’s Document Brief, Tab 9, Insurer’s Examination – Dr. A. Williams (Physiatrist) of Dynamic Functional Solutions, October 4, 2018, pg. 6.
29. 29Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, January 2, 2020.
30. 30Submissions of the Applicant, Tab 8, Clinical Notes of Kleinburg Family Health Centre, Dr. Stambolich, November 5, 2018.
31. 31Submissions of the Applicant, Tab 2, Psychological Consultation by Dr. A. Marino dated July 15, 2020.
32. 32Ibid. pg. 7.
33. 33Ibid. pp. 8-9.
34. 34Ibid. pg. 10.
35. 35Ibid. pg. 11.
36. 36Ibid.
37. 37Respondent’s Document Brief, Tab 10, Insurer’s Examination – Psychology Evaluation prepared by Dr. C. West (Psychologist) of Dynamic Functional Solutions dated October 4, 2018.
38. 38Ibid. pg. 5.
39. 39Ibid. pg. 7.
40. 40Ibid. pp. 9.
41. 41Ibid. pg. 10.
42. 42Ibid. pg. 11
43. 43Ibid. pg. 11.
44. 44Respondent’s Document Brief, Tab 9, Insurer’s Examination – Dr. A. Williams (Physiatrist) of Dynamic Functional Solutions, October 4, 2018, pg. 4.
45. 45Respondent’s Document Brief, Tab 1, Combined Clinical Notes of Dr. Forte, Woodbridge Medical Centre, June 9, 2015.
46. 46Scarlett v. Belair Insurance, 2015 ONSC 3635 at paras. 20-24.
47. 47Respondent’s Document Brief, Tab 10, Insurer’s Examination – Psychology Evaluation prepared by Dr. C. West (Psychologist) of Dynamic Functional Solutions dated October 4, 2018, pg. 11.
48. 48Submissions of the Applicant, Tab 1, Report of Dr. Hien Ta, December 21, 2018, pg. 11.
49. 49Respondent’s Document Brief, Tab 10, Insurer’s Examination – Psychology Evaluation prepared by Dr. C. West (Psychologist) of Dynamic Functional Solutions dated October 4, 2018, pg. 6.