LAT Decision: Catastrophic Impairment Based on One Marked Impairment
On February 8, 2022, Madam Adjudicator Kate Grieves of the Ontario’s Licence Appeal Tribunal ruled in favour of Will Davidson LLP Managing Partner David Morin’s client, Carmen Teutloff. Ms. Teutloff was found to be catastrophically impaired after a motor vehicle accident due to having a marked mental or behavioural impairment.
The applicant sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (“Schedule”). The sole issue in dispute was whether Ms. Teutloff had sustained catastrophic impairment as a result of the accident.
The evidence of Ms. Teutloff’s neuropsychologist was found to be more credible compared to her insurer’s neuropsychologist report. This ultimately led Ms. Grieves to believe that Ms. Teutloff’s activities, function and level of impairment were much greater than what was described in the insurer’s reports.
You can read the full decision here.
Ms. Teutloff, was born in Costa Rica and moved to Canada at the age of 21. She resided in Huntsville, Ontario with her husband of nearly 40 years in the log home they built.
She was known as a hard worker, as she had her own cleaning company (where she worked 60 hours/week for 25 years); taught Spanish and had an Amway business. Moreover, both she and her husband owned a bed & breakfast in Costa Rica where they would travel to for four to six months of the year.
Her medical history prior to the accident was, as Madam Adjudicator Kate Grieves referred to it as, “largely unremarkable,” due to her having no significant psychiatric or cognitive issues. She had only had surgery on both wrists for carpal tunnel syndrome in 2011 and right knee pain/osteoarthritis (which required arthroscopic surgery).
On June 5, 2014, Ms. Teutloff was involved in an automobile accident while driving home on a rural road. She had lost control and swerved off the road where she crashed into a few trees which stopped her. After, she exited the vehicle, called a friend, and then the police. The police and a tow truck attended the scene, but she drove home while being followed by the police officer. There was no police report.
After the accident, Ms. Teutloff’s day-to-day life was beginning to be significantly affected by the trauma from the accident. On June 17, 2014, she was diagnosed by her family physician, Dr. Mathies, with a concussion, musculoskeletal bruises, and prescribed amitriptyline. She then returned on June 26, 2014, with reports of pounding head, nausea, inability to focus, reach or watch TV. This ultimately led the doctor to suggest she have a CT scan due to her poor balance and severe balance.
After a year had passed, the physician referred her to a neurologist for an MRI of her head as her condition had clearly regressed.
Pursuant to section 3(2)(f) of the Schedule for accidents that occurred prior to June 1, 2016, an impairment is catastrophic if, in accordance with the American Medical Associations Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (“Guides”), results in a Class 4: Marked Impairment or a Class 5: Extreme Impairment due to mental or behavioural disorder
It is important to remember that impairments are classified according to how seriously they affect a person’s useful daily function in four broad, overlapping, activity categories using word descriptions in a five-category scale that ranges from no impairment to extreme impairment.
Ms. Teutloff believed that she sustained a marked impairment in two domains: (1) Concentration, Persistence and Pace; and (2) Adaptation. The severity of her behavioural impairments had been assessed by medical specialists on both sides.
The deferring medical opinions certainly created an issue of credibility.
Impact of Impairments
Life after the accident quickly became more and more difficult, as simple tasks would prove to be too much to handle due to her regressing condition. This impacted her weekly routine with activities such as:
- Being unable to return to work at: her cleaning business, teaching her Spanish classes, or the Amway business with her husband – which resulted in her husband having to take over all financial responsibilities. They also were no longer able to operate their bed & breakfast.
- Prior to the accident, their granddaughter was living with them and was cared for by Ms. Teutloff; however, after the accident she was unable to tolerate the noise she would make as it would result in her having a headache and ultimately become angry.
- Weekly visits to her church every Sunday eventually became rare occurrences. She no longer volunteered at the church and did not socialize with her friends as often as she used to.
- Tasks like cooking and cleaning became safety issues as she began to forget about pots on the stove. This led to her husband taking full responsibility of cooking.
It was clear that the life Ms. Teutloff lived was not the same after the accident.
The final step in assessing the effect of the mental or behavioural disorder on Ms. Teutloff was to determine the severity of the impairment in each of the four spheres according to the criteria set out in the Guides.
Concentration, Persistence and Pace
According to the Guides, the following is to be evaluated under this category: “…the ability to sustain focused attention long enough to permit the timely completion of tasks commonly found in work settings. In activities of daily living, concentration may be reflected in terms of ability to complete everyday household tasks.”
Impairment in adaptation is defined by the Guides as the repeated failure to adapt to stressful circumstances.
Madam Adjudicator Kate Grieves saw the evidence for what it was and agreed that Ms. Teutloff sustained a catastrophic impairment based on a marked impairment in “Concentration, Persistence and Pace” as well as a marked impairment in “Adaptation”.
The evidence of Ms. Teutloff’s neuropsychologist was found to be more credible compared to her insurer’s neuropsychologist report. This ultimately led Ms. Grieves to believe that Ms. Teutloff’s inability to return to work was not adequately addressed in the insurer report. Ms. Greives found that Ms. Teutloff’s activities, function and level of impairment were much greater than what was described in the insurer’s reports.
We would like to offer our congratulations to David and his talented Huntsville team of Kathy Kormarniski and Tania Quinlan for this incredible result for their client.