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AUTOMOBILE INSURANCE - Accident benefits

Tuesday, June 09, 2020 @ 9:27 AM  


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Appeal by Piche from a decision of the Automobile Injury Appeal Commission upholding the 2014 decision letter of Saskatchewan Government Insurance (SGI) terminating benefits paid to the appellant following a 2012 motor vehicle accident. The appellant claimed the accident aggravated an existing shoulder injury, pre-existing low back pain and caused bilateral knee pain, bilateral shoulder pain, increased body mass, groin pain, back of legs pain and hip joint pain. The appellant had a substantial and complicated prior medical history, including a low back injury, a tear on the cartilage of the left knee, a rotator cuff injury to the left shoulder and surgery thereon, chronic back pain radiating to the left testicle, tingling in his legs, shortness of breath, lack of energy and high blood pressure. He also had sleep apnea. SGI found the information supported that the appellant sustained a soft tissue injury which would have been healed long ago, that there was no evidence to suggest that there were significant injuries sustained in the motor vehicle collision and that there was no medical opinion supporting the appellant’s claim that the medical conditions he was experiencing were caused by the accident. Before the Commission, the appellant did not call any witnesses to speak to the issue of causation. He agreed that none of the medical practitioners in the medical reports he provided to SGI and tendered before the Commission supported his position that his then‑current medical condition was caused by the accident. The Commission concluded that it was not satisfied, based on the medical information provided to it, that the appellant’s current medical conditions were caused by the accident.

HELD: Appeal dismissed. The Commission did not place the burden of proof on the appellant. In the case of each injury to which SGI’s burden of proof applied, the Commission considered the issue of causation based on the testimony of the appellant, the medical information provided by him, and the evidence of SGI. The Commission spent considerable time weighing the evidence in coming to its conclusion. In the absence of other compelling evidence of causation, the Commission preferred the evidence of SGI and its medical expert that there were no objective findings in the appellant’s medical reports to support his claims of causation. The expert medical opinion relied on and accepted by the Commission respecting causation was properly admitted. The Commission did not err by relying on and basing its decision on the expert’s evidence. There was no indication that SGI breached its duty of good faith in the way it terminated benefits.

Piche v. Saskatchewan Government Insurance, [2020] S.J. No. 167, Saskatchewan Court of Appeal, R.K. Ottenbreit, L.M. Schwann and J.A. Tholl JJ.A., April 30, 2020. Digest No. TLD-June82020004