Ranjan v. Aviva General Insurance Company, 2026 CanLII 15058 (ON LAT)
The recent decision in Ranjan from the Licence Appeal Tribunal (LAT) is not only a victory for the applicant but also demonstrates that an insured can be found catastrophically impaired (CAT) when they suffer from psychological injuries and not just physical injuries.
The applicant was in a motor vehicle collision on December 31, 2021, and sought benefits pursuant to the Statutory Accident Benefits Schedule (SABS) as a result.
The main issue in dispute was whether the applicant sustained a catastrophic impairment as defined by the SABS. The remaining issues surrounded the applicant’s entitlement to non-earner benefits (NEBs), attendant care benefits (ACBs) and fourteen denied treatment plans including hearing aids, prescription eyewear services, counselling and therapy sessions and assistive devices amongst other things.
Catastrophic Impairment
The LAT found the applicant to be CAT under Criterion 8. To be CAT under Criterion 8, the insured person must sustain three or more class four impairments (marked impairments) or one or more class five impairments (extreme impairments). The applicant was deemed to have sustained marked impairments in each of the four aspects of functioning: activities of daily living (ADL); social functioning; concentration, persistence and pace (CPP) and adaptation.
Causation
The LAT found that the applicant sustained mental and behavioural injuries caused by the collision. While the applicant had a pre-existing history of post-traumatic stress disorder (PTSD), she was diagnosed post-collision with persistent depressive disorder, with persistent major depressive episode, moderate, PTSD and somatic symptom disorder with predominant pain, moderate and persistent. The LAT found that the applicant’s pre-existing psychological symptoms were exacerbated by the collision and thus, a casual link had been established.
Activities of Daily Living
The LAT was satisfied that the applicant was independent and highly functional before the collision, and that her inability to be independent post-collision demonstrated a significant change as she no longer cooks meals, has difficulty managing medications, no longer drives, relies on others for housekeeping and has difficulty completing other daily chores.
The applicant had previously stated that she could not do these tasks due to physical pain and so the respondent expert stated that it is not rateable. However, the LAT stressed that these statements must be considered alongside other evidence to have a more complete and contextual understanding of her limitations.
The LAT found that the applicant’s physical pain does not in fact prevent her from completing tasks such as housekeeping, rather it is more likely that mental health symptoms, such as anxiety associated with pain, prevents her from initiating any housekeeping. This demonstrated a significant impediment to her useful functioning.
Social Functioning
Pre-collision, the applicant had some challenges interacting with others appropriately, specifically with her family. About six weeks before the collision, she was seen by a crisis worker but was not involuntarily admitted. Post-collision, the applicant was involuntarily admitted for “bizarre behaviour.”
Post-collision the applicant started to have breaks from reality and experienced paranoid delusions, signally the worsening of her mental health symptoms. The LAT was satisfied that this change alongside other examples of the applicant’s inability to effectively communicate with others displayed a marked impairment.
Concentration, Persistence and Pace (CPP)
Pre-collision, the applicant was employed at certain times and was about to begin the clinical component of a midwifery program. Post-collision, the applicant has not returned to work, nor has she resumed her studies.
The evidence showed the applicant’s inability to focus and complete tasks, even basic ones, without support or being cued. The applicant was not physically unable to complete these tasks, rather, her mental health disorders and symptoms make her unable to independently initiate or complete such tasks, demonstrating a marked impairment.
Adaptation
Post-collision, the applicant had challenges in managing her symptoms and adapting to stressful circumstances. The LAT was pointed to an incident between the applicant and a neighbour where the applicant escalated the situation unnecessarily. The LAT also pointed to the exacerbation of her mental health symptoms following interactions with her family that escalated to the point that she began experiencing paranoid delusions resulting in the involuntary admission to the hospital for a psychiatric assessment.
Non-Earner Benefit
The LAT found that the applicant is not entitled to NEBs.
While the LAT agreed that the applicant has had substantial changes to her life since the collision, they did not agree that the applicant has a complete inability to carry on a normal life pursuant to section 3(7)(a) of the SABS and the guiding principles for NEB entitlement in Heath v. Economical Mut. Ins. Co., 2009 ONCA 391.
Attendant Care Benefit (ACB)
The LAT found that the applicant is not entitled to an ACB.
The respondent relied on a multidisciplinary report at the time of denial that included various reports, including the report of an occupation therapist who testified at the hearing. While the testimony of the occupational therapist at the hearing may have supported the applicant’s position, this evidence was not available at the time of denial and thus, could not be said to have been unreasonable to deny ACBs at the time.
Treatment Plans
The LAT found that the applicant is not entitled to the treatment plans in dispute.
The LAT was not satisfied that the applicant had met its burden to demonstrate that each of the impugned benefits were reasonable and necessary as a result of the accident. The CAT determination allows the applicant to access additional funding; however, the applicant must still meet the burden imposed on them in the SABS. The LAT stated that the applicant must make pinpoint references in the evidence and explain why this evidence meets the various factors needed to establish entitlement for each plan.
Conclusion
The applicant successfully argued that she was CAT under Criterion 8 of the SABS by demonstrating that her psychological injuries signified a marked impairment in all four aspects of functioning.
The respondent has requested a reconsideration for the CAT determination.