Ontario’s Licence Appeal Tribunal (LAT), the body in charge of resolving accident benefits disputes between injury victims and insurance companies, was consumed by controversy last month when a top-ranking official was revealed to have meddled in an insurance claim. The event seized the attention of other provincial adjudicating bodies and prompted concern from Ontario personal injury lawyers.
In 2012, Mary Shuttleworth suffered a traumatic brain injury and tissue damage in a two-car collision near Dundalk, Ontario. Her injuries left her with persistent nausea, vertigo, and stress. She is unable to work.
Despite her impairment, her insurance company, Peel Mutual, informed her that her injuries were not considered “catastrophic,” a designation that would have entitled her to up to $2-million in benefits. Her “non-catastrophic” injuries made her eligible to receive less than $90,000.
Shuttleworth appealed the insurer’s decision to the Licence Appeal Tribunal. It was the first dispute relating to catastrophic injury designation that the newly formed body was asked to resolve.
The LAT adjudicator for the case, Susan Sapin, eventually sided with the insurer and denied Shuttleworth’s claim for additional benefits.
In the months after Shuttleworth’s claim was denied, her legal team team received an anonymous letter accusing Linda Lamoureaux, head of the Safety, Licensing Appeals and Standards Tribunal, of interfering with Sapin’s decision.
“I have heard from reliable source that Sapin’s initial decision was that this was a catastrophic impairment. Linda Lamoureaux changed the decision to make the applicant not catastrophically impaired,” the letter read, per the CBC. “Thought you should know that the decision was not made by an independent decision maker who heard the evidence.”
Shuttleworth’s team filed a Freedom of Information and Protection of Privacy Act application for documents that would back up the letter’s allegations. The request produced an email chain showing that Lamoureaux’s unsolicited review of Sapin’s decision led to the ruling being changed.
After review by a three-judge Divisional Court panel, the LAT’s ruling on Shuttleworth’s claim was overturned.
“Justice must not only be done; it must be seen to be done,” wrote Justice Julie Thorburn. “An informed, cautious observer would have a reasonable basis to believe that the decision did not reflect the independent decision of the adjudicator.”
While Justice Thorburn stressed that the court found no evidence of “any actual impropriety having occurred,” the episode has shaken the trust of Ontario personal injury lawyers and their clients in the fairness of the system. Many injury victims already believe that the system is stacked against them, and this event will only worsen the relationship.
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