Citation: Nassan v. Intact Insurance Company, 2023 ONLAT 20-010691/AABS

Licence Appeal Tribunal File Number: 20-010691/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:

Ali Nassan

Applicant

and

Intact Insurance Company

Respondent

DECISION

ADJUDICATOR:

Sandra Driesel

APPEARANCES:

For the Applicant:

Ali Nassan, Applicant

Georgiana Masgras, Counsel

For the Respondent:

Joanna Lemon, Claims Representative

Lori J. Sprott, Counsel

Revathi Moturi, Associate Lawyer

Interpreter:

Amil Seif (in the Arabic language)

Court Reporter:

Breana Clancy

HEARD: by Videoconference:

December 6 to December 10, 2021

REASONS FOR DECISION

BACKGROUND

1The applicant was involved in an automobile accident and 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”).

2This proceeding arises out of a motor vehicle accident (“MVA”) that occurred on June 18, 2017. The applicant, Mr. Ali Nassan, was a passenger in the front seat of a pickup truck that reportedly lost control, hit a barrier and subsequently hit another vehicle. The applicant was wearing a seatbelt and the airbags did not deploy. The applicant testifies he was unconscious and dizzy so some of his recollection of the MVA is vague. He was attended by paramedics at the scene and was transported to the hospital where he was discharged the next day.

3The applicant began treatment for physical injuries shortly after this MVA. In September 2019, the applicant submitted an Application for the Determination of Catastrophic Impairment (“OCF-19”) to the respondent Intact Insurance Company (“Intact”) based on a mental and behavioural impairment (Criterion 8) as a result of this 2017 MVA.

4The respondent takes the position that Mr. Nassan has failed to meet the onus that his impairments are catastrophic, but admits the applicant may suffer some psychological impairment, not as a result of the MVA, but because of a documented history of unfortunate, stressful life events. The respondent further asserts that differences in any impairment classification amongst assessors may be attributed to the applicant’s inconsistent self-reporting on events or stressors related to both his pre- and post-MVA lifestyle.

ISSUES

5Has the applicant sustained a catastrophic impairment as defined by the Schedule?

RESULT

6I find the applicant has failed to satisfy the onus of proving that he sustained a catastrophic mental and behavioural impairment as a result of the MVA.

ANALYSIS

Catastrophic Impairment – The Law

7The applicant argues that he suffers from psychological and behavioural disorders that meet the definition of catastrophic (“CAT”) impairment, set out in the Schedule as follows:

3.1 (1) For the purposes of this Regulation, an impairment is a catastrophic impairment if an insured person sustains the impairment in an accident that occurs on or after June 1, 2016, and the impairment results in……

8. ….an impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (“Guides”) results in a class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 impairment (extreme impairment) in one of more areas of function that precludes useful functioning, due to mental or behavioural disorder. O. Reg. 251/15, s.3; O. Reg. 116/16, s.1.

8The Guides establish various criteria for establishing if someone is catastrophically impaired. Mental and behavioural impairments are rated according to how seriously they affect a person’s useful daily functioning. The Guides set out the four spheres of functioning and the levels of impairment as represented in the chart below:

Area or Aspect of Functioning

Class 1: NO Impairment

Class 2: MILD Impairment

Class 3: MODERATE Impairment

Class 4: MARKED Impairment

Class 5: EXTREME Impairment

Activities of Daily Living

No impairment is noted

Impairment levels are compatible with most useful functioning

Impairment levels are compatible with some, but not all useful functioning

Impairment levels significantly impede useful functioning

Impairment levels preclude useful functioning

Social Functioning

Concentration, Persistence and Pace

Adaption (in a work-life setting)

REVIEW OF EVIDENCE

9In order to meet the threshold for a CAT impairment under criterion 8, an individual must have sustained a marked (class 4) impairment as a result of the MVA in three of the four spheres (or “aspects”) of functioning or one extreme (class 5) impairment due to a mental and behavioural disorder. The applicant underwent CAT assessments to assess his impairments. The findings of each party are presented in the chart below:

Area or Aspect of Functioning

The Applicant’s Assessors’ finding:

The Respondent’s Assessors’ finding:

Activities of Daily Living

Class 4

Class 3

Social Functioning

Class 4

Class 3

Concentration, Persistence and Pace

Class 4

Class 2

Adaption (in a work-like setting)

Class 4

Class 3

10The parties submitted into evidence their independent CAT assessment reports in support of their positions:

The Applicant’s submissions:

The Respondent’s submissions:

Psychological Assessment, completed by: Dr. Romeo Vitelli, July 9, 2019¹

Psychological Assessment, completed by: Dr. Paul A. Derry, December 9, 2020²

Occupational Therapy Assessment, completed by: Julian Amchislavsky, OT, July 9, 2019³

In-Home Assessment, completed by: Matt Sutherland, OT, December 12, 2019⁴

Executive Summary, completed by: Dr. Tajedin Y. Getahan, Orthopaedic Surgeon, dated September 8, 2019⁵

Executive Summary, completed by: Dr. C. B. Paitch, B.Sc., M.D., FRCS, dated February 12, 2021⁶

The applicant’s testimony and reporting to assessors⁷:

Accounts of Pre- and Post-MVA life

11The applicant provides a very poignant history of his pre-MVA life. He explained that he was a highly skilled carpenter (he showed pictures of his craftsmanship) and a businessman in his home country of Syria. He says he originally left Syria in 2007 after being imprisoned and beaten, and his wife and two daughters were assaulted. He fled to Ottawa, Canada to work as a carpenter and possibly start his own business. When he found the business prospect wasn’t going to work out as he had hoped, he returned to Syria a few times for brief periods, and travelled to the USA and Africa for work.

12The applicant returned to the USA in 2009 and was working full-time as a special carpenter and designer until an earlier motor vehicle accident in July 2013 (“2013 MVA”). He sustained injuries to his shoulder, his neck, lower back and right ankle in the 2013 MVA, and required surgery on his right shoulder. Before and after surgery he received physiotherapy. He attempted to return to work after the surgery (approximately six months after the 2013 MVA) starting with two or three days per week. He states he returned to full-time work, about forty hours per week, in 2015 and 2016. He also stated that he had healed significantly since the 2013 MVA, but the subject MVA aggravated previous injuries.

13The applicant states he was working full-time up until 2 or 3 days prior to his entrance to Canada on November 8, 2016, when he walked across the bridge from the USA to enter the country. He states he came to Canada hopeful about his future and his ability to find work so that he could eventually bring his family here. The applicant states that he was working the day of the MVA, being driven home by a co-worker when the MVA occurred. He claims that prior to the subject MVA he was engaging in many activities of his daily living, such as meeting up with friends, praying at the local mosque, going for nature walks, and engaging in hobbies such as woodworking and plant arrangement.

14The applicant claims the subject MVA has reduced him to a “broken man” who cannot cope with the loss of what he once had. He can no longer work, his dreams dashed, and he is no longer able to work as a craftsman, something he was proud of and very good at. Post-MVA, he has become withdrawn and isolated. He doesn’t bother to bathe more than once a week. He doesn’t take care of himself or his household independently. He is terrified of getting into a car. The applicant claims to have hit his head in the MVA and subsequently developed cognitive deficiencies. He says he is unable to concentrate on anything for long because of his pain, anxiety, depression, lack of sleep, and the effects of by his pain medication. He states he suffers from adjustment disorder as well as other psychological symptoms.

Applicant’s Employment Status

15The applicant claims he was working full-time after the 2013 MVA and worked sporadically after arriving in Canada but had obtained what he believed would be full-time work just before the subject MVA. He states that when leaving the work site on the evening of the MVA he had every intention of continuing work through the same employer.

16The applicant states that on November 16, 2016, shortly after his arrival in Canada, he applied to Ontario Works⁸ (“OW”) believing OW would assist him in finding work. He then states that after six months, because he was unable to find work and on the advice of the OW caseworker, he applied to Ontario Disability Support Program⁹ (“ODSP”). Unlike OW, ODSP does not require recipients to undertake employment-related activities like job searching or vocational training. Entitlement to ODSP is determined through a subjective evaluation of four criteria that are defined within the ODSP Act¹⁰:

• The disability is continuous or recurrent.

• It is expected to last for a year or more.

• The disability significantly limits their ability to work, look after themselves, or get out in the community; and

• It has been verified by an approved health professional

17Section 8 of the ODSP Self Report Form, completed by the applicant February 28, 2017¹¹ indicates he had not worked in the last five years. In addition, in section 13 of this form he provides a reason for not working in the last five years as “The last 3 years I can’t work as I went through a car accident resulted with serious injuries”¹². In section 17 of this form the applicant indicates he is “Unable to do anything” when responding to the question “How much does your pain stop you from completing your daily activities?”.

18On July 25, 2017, the ODSP wrote to the applicant to confirm that it received his completed application on April 6, 2017, and that the Disability Adjudication Unit (“DAU”) reviewed his disability and found that he met the program’s definition of disability¹³. The “Initial Application Adjudication Summary¹⁴” report to approve ODSP benefits, provides details of a decision made July 19, 2017, that determined the applicant to be “a person with Disability”. This decision notes the review of medical records dating back to before the subject MVA including medical evidence that references a 2006 MVA, the 2013 MVA, a stroke in 2015, and a Nurse Practitioner report completed with the applicant on March 31, 2017¹⁵. This latter report, again prior to the subject MVA, indicates the applicant has medium or moderate limitations related to:

a. (9.) Physical strength commensurate with person’s age and sex

b. (10.) Ability to participate physically in sustained activity

c. (11.) Walks three blocks or more on level ground without need to rest (shows “cane”)

d. (22.) Ability to stand

19The applicant was questioned regarding his Application for Accident Benefits (“OCF-1”) that was completed on November 10, 2017. The OCF-1 appears to show a change in ‘Part 5 – Applicant Status’, to indicate the applicant was ‘unemployed’ at the time of the MVA¹⁶. In Part 9¹⁷ of this form, it indicates the applicant was receiving Social Assistance Benefits at the time of the MVA. The applicant confirmed during testimony that when this form was completed, he was receiving ODSP benefits.

20From the above, it is difficult to find the applicant was able or prepared to work before the subject MVA and certainly not in a full-time capacity. It appears that the applicant suffered from impairments that restricted his ability to work before the subject MVA occurred. Although he reports to having been working the day of the MVA, he fails to explain was he was collecting benefits under the proviso that he is ‘disabled and unable to work’.

Impairments/injuries

21The applicant states he doesn’t remember a lot about the subject accident, but he does remember police and ambulance attending the scene. He recalls waking up in the Joseph Brant Hospital with neck and back and head pain. Although he can’t recall, there is evidence of a CT scan of the applicant’s head, neck and back, being done the night of the MVA. The applicant states that although he had previous been involved in the 2013 MVA, he was mostly recovered from that accident and his current physical and emotional impairments are as a result of the subject MVA. He states he hit his head in this MVA and as a result he is suffering from cognitive impairment.

22The respondent takes the position that the applicant suffered from his current impairments for some time, several years before the subject MVA and I agree because of the following evidence.

23Through the applicant’s application for ODSP (in May 2017) medical records were collected and reviewed to determine if the applicant qualified for disability benefits. Dr. Christopher Ross Kitamura, Psychiatrist, assessed the applicant on December 14, 2016¹⁸, at Baycrest Hospital with an interpreter, for the Hamilton-Kitchener Refugee Law Office. Dr. Kitamura’s assessment included a review of several medical records (to be explained below). From the applicant’s self reporting, the doctor was provided historical background, including the applicant’s life in Syria before he fled that country. The applicant explained his 2013 MVA while in the USA and the resulting surgery. He reported having suffered a stroke in 2015 that left him with partial paralysis, numbness in his right arm, and speech problems (he notes in both English and Arabic). The applicant claimed to be forgetful since his stroke. During this assessment, the applicant reports that he does not derive pleasure from life, and that he has sleep issues and nightmares from flashbacks of the abuse he suffered in Syria. The applicant admitted to not seeing a psychiatrist or psychologist before the assessment with Dr. Kitamura, but he was taking antidepressant medication at that time. The Dr. reported the applicant’s medical history is positive for hypertension, chronic obstructive pulmonary disease and urinary incontinence. He had also received cognitive behaviours therapy for his memory loss.

24Dr. Kitamura performed cognitive testing and the applicant scored in a range that suggested mild impairment. The doctor also concluded that the applicant suffered from moderate-to-severe post traumatic stress disorder (“PTSD”), major depressive disorder, and “mild dementia (major neurocognitive disorder)”. Dr. Kitamura notes “collateral history from his previous family doctor and internist both support his cognitive problems.” Documents considered in Dr. Kitamura’s assessment included:

a. Outpatient records from Sidney Hillman and Phillips Family Practice, NY¹⁹. The records starting with June 28/2016 report the applicant has having:

i. History of CVA (cerebrovascular accident) in November 2015

ii. Paresthesia/numbness in arms, legs

iii. Memory problems

iv. COPD

v. Essential hypertension

vi. Urinary incontinence

b. A letter from Dr. Ramsey Joudeh, MD of NY²⁰ dated April 25, 2016, that states the applicant is under his care and that he often experiences loss of memory.

c. A letter from Dr. Ashrat Metwally, MD²¹, dated November 9, 2015, that says the applicant had been his patient since June 31, 2014, and has been diagnosed with:

i. Memory loss

ii. Hypertension

iii. Chronic Obstructive Pulmonary Disease (“COPD”)

25In the applicant’s Health Status Report, completed for the ODSP application on March 31, 2017, with a Nurse Practitioner, the applicant reports to experience chronic pain as a result of the MVA in 2006; and that he suffers from COPD; PTSD and CAD /CVA. Under various categories in the same Health Status Report, it is noted that the applicant experiences:

a. Unsafe or severe symptoms related to motion (affect, mood, anxiety and other emotions associated psychological disturbances, panic phobia)

b. A severe or complete limitations on most occasions to complete housekeeping (cleaning, laundry, meal preparation, shopping for essentials such as groceries, clothes, etc.)

26In records from the Refuge Hamilton Centre for Newcomer²² show that the applicant reported:

a. [January 11, 2017] Significant illness, right shoulder pain, back pain and ankles. Chronic illness, COPD and CVA – right sided weakness (2015). He reported the MVA of 2013 stating he injured his right shoulder, upper bank and ankles. He says pain in these areas is not being controlled. He has difficulty sleeping due to pain. The assessor noted the applicant walks with a cane.

b. [January 28, 2017] notes claim the applicant has medication for treatment of chronic health conditions and chronic pain. He hadn’t done recommended blood work because he tends to faint. He further explained his HTN, COPD, CVA chronic, and right shoulder surgical repair post MVA.

c. [March 13, 2017] He had a MVA in 2006. Had surgery on his shoulder. He suffers from burning pain in legs and feet, sleeping poorly because of nightmares. He was prescribed medication for nightmares & PTSD symptoms.

d. [March 20, 2017] Applicant was “struggling”. He has flashbacks and anxiety relating to his migration to Canada and his past in Syria. His complaint was burning pain in his legs related to motor vehicle accident.

e. [March 20, 2017] The applicant reports his problems started after the car accident on July 2, 2013, and he has had problems with his legs ever since.

27As applicant’s counsel has pointed out, there is no medical record to show the applicant had a stroke. The applicant consistently reports to having had a stroke in 2015. Page 466 of the Joint Document Brief includes “Progress Notes” from the Lutheran Medical Center dated November 26, 2015. This specifically reads “Work Copy – Unofficial – Not for Medical Record”, that states the primary diagnosis for the applicant was “Ischemic Stroke disorder”. It appears from this record that the applicant was admitted and discharged on the same day with instruction to take low dose aspirin; engage in a low fat/low cholesterol diet and gradually resume his regular activity.

Causation – “But For” test

28While it is not disputed that the applicant has some ongoing psychological impairments, on the evidence, I am unable to conclude on a balance of probabilities that he satisfied the causation test to prove that “but for” the accident²³, he would not have suffered the psychological or behavioural disorders that resulted in these impairments.

29The Divisional Court has confirmed that the “but for” test is the correct test to be used when determining causation in accident benefits cases²⁴ . Under the “but for” test, the accident need not be the sole cause nor the primary cause; however, it must have been necessary to bring about the injury²⁵. The applicant bears the burden of proving on a balance of probabilities that the accident was a necessary cause of his psychological or behaviour impairments.

30The respondent submits that the applicant’s current impairments were not caused by the subject accident, but through series of other life events dating back prior to the 2017 MVA, and that the applicant was not always consistent with his reporting to assessors which may be the reason their diagnoses or observations differ. However, the respondent has commented (and I agree) that there is no reason to believe the applicant was malingering or purposely misrepresenting any symptomology, it’s more likely his past medical issues and medication may have caused some confusion in the applicant’s recollection of facts. Mentions of PTSD, memory issues and possible dementia are mentioned in many assessments.

31As much as the applicant argues his current impairment is a result of the subject MVA his claims are not supported by evidence. The applicant claims that prior to the MVA he had improved from some previous impairments and was able to at least moderately function. The applicant states that but for the MVA he would not be suffering his current impairments that he believes resulted in a catastrophic impairment in Criterion 8. I find that his ODSP application (and the assessments related to that application) suggest his impairments existed prior to the subject MVA.

32In conclusion, for reasons above, I find the 2017 MVA was not a necessary cause bringing about the applicant’s psychological or behavioural impairments. I am satisfied that on a balance of probabilities the applicant’s psychological impairments were not cause by the MVA. Given the factors noted in the evidence, I do not find the 2017 MVA was necessary to bring about his current psychological or behavioural impairments.

Findings on catastrophic impairment

33For the reasons that follow, I find that the applicant has failed to prove he suffers a marked impairment (class 4) in at least three of the four spheres of functioning related to mental and behavioural impairments²⁶ as a result of the subject MVA.

34Dr. T. Getahun, Orthopaedic Surgeon, completed the Catastrophic Impairment Executive Summary Report for the applicant. Dr. Getahun reviewed a catastrophic impairment file by Dr. Moshini (dated May 30, 2019) and the psychological assessment by Dr. Vitelli. Dr. Getahun concluded that the applicant has a 39% whole person impairment rating and therefore does not satisfy Criterion 7 of the SABS for catastrophic impairment, she does however rely on Dr. Vitelli’s report that the applicant meets Criterion 8 having a class four marked impairment of three or more areas of function due to mental or behavioural disorder.

35Dr. Vitelli, Psychiatrist, testified in support of his assessment of the applicant completed on July 9, 2019. Dr. Vitelli stated that from his conversations with the applicant and from the Occupational Therapy Catastrophic Impairment Determination Report by Julian Amchislavsky that the understood the applicant to have been employed full time as a carpenter at the time of the subject MVA. The applicant did tell the doctor about the 2013 MVA but reported to be “80% healed” and had no major health issues prior to his accident. The applicant had denied any past psychiatric history or dealings with a psychiatrist or past suicide attempts. He reported that prior to the subject MVA he was physically active. The applicant reported that at the time of the assessment, he could manage his self-care, but slowly. He reported that prior to the MVA he performed household chores, cooking, cleaning, grocery shopping and outdoor maintenance.

36Dr. Vitelli notes that the applicant seemed preoccupied with the pain he was experiencing as well as somatic symptoms like tinnitus in both ears, blurred vision, headaches, numbness in fingers and thighs. He walked with a cane and reported frustration with interrupted sleep, stress memory difficulties, anxiety and depressive feelings. Dr. Vitelli includes in his assessment report that the applicant is experiencing strong depressive, anxious, post-traumatic and somatic symptoms. The doctor concludes in his report that the “[the 2017 MVA] contributed to a cascading series of events that led [the applicant] to collapse his defences, develop a major depressive disorder, moderate and non-psychotic PTSD and somatic symptoms disorder with predominate pain”. Dr. Vitelli admits that he assumed that the applicants’ concentration problems displayed at the assessment were also a result of the subject MVA. He determined the MVA to be the cause of the applicant’s impairments because he believed the applicant was fully functioning and working prior to the MVA. Dr. Vitelli did not know the applicant had applied for ODSP before the MVA or did he review various medical records and the applicant’s reporting as to his physical and mental status associated with his application. Dr. Vitelli confirmed in testimony that he was not aware of important and relevant pre-accident history related to the applicant as they were not included in the applicant’s self-reporting. Dr. Vitelli also admits that he did not review any pre 2017 MVA records, so his findings were mostly based on the applicant’s self-reporting. The doctor was unaware that the applicant had in fact seen a psychiatrist in the past. He was unaware of Dr. Kitamura’s assessment and report, December 19, 2016, and his diagnosis of PTSD. He was unaware of Dr. Rod Day’s psychological reports from August 29, 2018, and January 29, 2019. In his own admission, Dr. Vitelli stated some historical details should have been considered in his assessment.

37Dr. Paul Derry testified in support of his psychological assessment of December 9, 2020. As he wrote in his report, the applicant reported to have been working as a carpenter for five days when the MVA occurred. He also told the doctor that he wasn’t working at the time of the assessment and was receiving ODSP. The applicant claimed he couldn’t work due to pain and that he can’t walk. The applicant failed to advise Dr. Derry that he’d applied to ODSP before the MVA.

38Unlike Dr. Vitelli’s assessment, Dr. Derry had the benefit of previous medical history including psychological and/or psychiatric records and reports. He reviewed Dr. Kitamura’s psychiatric assessment in 2016 where psychiatric symptoms were identified long before the subject MVA. Dr. Derry summarizes his review of the July 31, 2018, report of Dr. J Pilowsky, Psychologist, where the applicant claims he had a stroke and that he had a previous 2013 MVA but was fully recovered by the subject MVA. He denied being treated by any psychiatrist. Dr. Derry referenced the September 13, 2018, Functional Abilities Evaluation (“FAE”) by Physiatrist Dr. Dilkas and included a psychology assessment by Dr. Rod Day. This FAE concludes the applicant is capable of using the toilet and showering himself. It notes “chronic pain issues predating the subject MVA”.

39In his summary, Dr. Derry states the applicant reported he is not working or employed because of back pain and being physically unable to walk as long as two minutes. He did not offer emotional, psychological or cognitive complains as the reason for his not working or as a reason for feeling restricted in completing most aspects of housekeeping, daily living or personal care. Given the history of medical reports and records on file that Dr. Derry was able to review, I am more compelled by his diagnosis that “From a psychological diagnostic point of view, this gentleman has posttraumatic stress disorder. This is consistent with the opinion from previous assessors, and it is abundantly clear that it was not in any way caused by his index motor vehicle accident”. I find, as I believe Dr. Derry did, that the applicant has had a history of the same physical and psychological symptomology since long before the subject MVA.

40While the applicant claims the subject MVA exacerbated his pre-existing conditions to the point he is suffering marked impairments in aspects of useful daily functioning, I find do not find evidence to support that any pre-existing condition had become worse because of the subject MVA or that there are new, or difference symptoms reported or diagnosed as a result of this MVA.

CONCLUSION

41The applicant did not sustain a catastrophic impairment as a result of the accident as defined in the Schedule. I dismiss the application.

Footnotes

1. 1Joint Document Brief: Tab 12, page 531
2. 2Joint Document Brief: Tab 13, page 618
3. 3Joint Document Brief: Tab 12, page 581
4. 4Joint Document Brief: Tab 13, page 665
5. 5Joint Document Brief: Tab 12, page 514
6. 6Joint Document Brief: Tab 13, page 610
7. 7Note: An interpreter, in the Arabic language was available, but the applicant requested we proceed in English, and he would advise if any translation was required.
8. 8Ontario Works provides temporary assistance towards the costs of housing and basic expenses if you’re not working or earning a very low income.
9. 9Ontario Disability Support Program provides income and employment support to people with disabilities.
10. 10Ontario Disability Support Program Act 1997, S.O. 1997
11. 11Page 481 of the Joint Document Brief
12. 12Page 483 of the Joint Document Brief
13. 13Page 492 of the Joint Document Brief
14. 14Page 489 of the Joint Document Brief
15. 15Page 438 of the Joint Document Brief
16. 16Page 798 of the Joint Document Brief
17. 17Page 800 of the Joint Document Brief
18. 18Page 455 of the Joint Document Brief, Dr. Kitamura’s report dated December 19, 2016
19. 19Page 459 of the Joint Document Brief
20. 20Page 462 of the Joint Document Brief
21. 21Page 467 of the Joint Document Brief
22. 22Page 452 of the Joint Document Brief
23. 23Subsection 2(1) of the Schedule defines “accident” to mean “an incident in which the use of operation of an automobile directly causes impairment or directly causes damage to any prescription, eyewear, denture, hearing aid, prosthesis or other medical or dental device”.
24. 24Sabadash v State Farm Mutual Insurance Co., 2019 ONCJ 656, [2019] OJ No 788 (Div. Court February 15, 2019)
25. 25Clements v Clements, 2012 SCC 32, [2012] 2 SCR 181
26. 26Area or Aspect of Functioning: (1) Activities of Daily Living; (2) Social Functioning; (3) Concentration, Persistence and Pace;(4) Adaption (in a work-like setting)