Insurer ordered to pay rehab benefits to injured driver suffering post-accident “relapse”

Saskatchewan’s public auto insurer has been ordered to pay partial rehab benefits to an auto accident victim who suffered a relapse of his medical condition after initially showing “maximum medical improvement” following his accident, according to his doctors.

The injured driver had a medical pre-condition before his accident. Saskatchewan Government Insurance (SGI) argued his pre-condition caused the “relapse,” not the motor vehicle accident.

But Saskatchewan’s Court of Appeal found no error in the lower court’s finding that the accident exacerbated the symptoms of the medical pre-condition. The Appeal Court also agreed with the lower court’s ruling that the injured driver’s rehab benefits be cut in half, acknowledging the medical pre-condition meant the insurer would not be able to completely return the injured driver to his pre-accident state.

Rick Huber was involved in a motor vehicle accident in March 2017, when he suffered whiplash-style soft tissue injuries to his cervical, thoracic, and lumbar spine. Over the course of the next year, he received treatment for those injuries from medical practitioners including physiotherapists, a chiropractor, and his family doctor.

Huber attempted to return to work, but continued to suffer pain and loss of motion that hampered his ability to work. He applied for and received income replacement benefits and rehab benefits from SGI.

Later, in March 2018, Huber’s physiotherapist said he had achieved maximum medical improvement and discharged him from the treatment program. About a month later, SGI terminated Huber’s income replacement benefits, which Huber did not dispute.

But Huber continued to experience neck and back pain. He required regular chiropractic or massage treatment to continue to work. In May 2018, his family doctor wrote SGI to say that, despite Huber’s ability to work “as a result of his consistent therapy,” his accident-related symptoms had returned. The doctor said Huber required ongoing chiropractic treatment to “optimize his function and productivity.”

SGI denied Huber’s request in June 2018 and terminated his rehabilitation benefits entirely. The insurer noted Huber had reached maximum medical improvement by the time he was discharged in March 2018. Any ongoing pain and decline in functioning after that point was not due to the car accident, the insurer argued, but rather the result of a pre-existing degenerative condition.

The lower court disagreed, ordering the insurer pay 50% of Huber’s rehab benefits. The lower court found that while Huber did have a pre-existing medical condition, doctors agreed it was exacerbated by the car accident.

SGI took issue with the lower court’s finding that Huber suffered a “relapse” in May 2018. The insurer said the lower court should have figured out whether Huber’s condition fit within the specific definition of “relapse” found in Alberta’s Insurance Act. Not to do so was an error, SGI argued.

But the Appeal Court disagreed, upholding the lower court’s ruling.

“The issue before the commission was whether Mr. Huber was entitled to continue to receive rehabilitation benefits,” the Appeal Court noted. “Entitlement to rehabilitation benefits is governed by…s. 112 of the [Alberta Auto Insurance Act] and s. 12 of the Regulations. The word ‘relapse’ does not appear anywhere in those provisions….

“To state this plainly, Mr. Huber’s entitlement to rehabilitation benefits was not affected, one way or the other, by whether his medical condition amounted to a ‘relapse within the AAIA’s statutory definition of that term. Accordingly, there was no need for the commission to have conducted the sort of analysis that SGI says it failed to conduct.”

 

Feature photo courtesy of iStock.com/PinkForest