Full Decision
This case involves a Licence Appeal Tribunal (LAT) dispute between the Economical Mutual Insurance Company (Economical) and Ahmed Zeineddine. The applicant was involved in a serious motor-vehicle collision on January 20, 2020, and was diagnosed with a concussion at the Ottawa General Hospital the next day. The applicant followed up with his family physician on January 22, 2020, where concussion care was further discussed and he was referred for concussion rehabilitation. He was also diagnosed with post-traumatic stress disorder (PTSD) and depression by his treating physician, psychologist and psychiatrist.
Despite a well-documented diagnosis of concussion and psychological issues, Economical took the position that the applicant’s injuries fell within the Minor Injury Guideline (MIG) and denied a number of treatments for years. To bolster their position, Economical relied on a Section 44 of the Statutory Accident Benefits Schedule insurer’s medical examination that failed to acknowledge the applicant’s concussion diagnosis. The respondent retained Dr. Michael Aiello, a physician, who conducted his assessment on November 11, 2020, and concluded that the applicant’s injuries fell within the MIG. The LAT Adjudicator, Julian DiBattista, placed no weight on Dr. Aiello’s report and wrote in the decision that although the Ottawa General Hospital records were reviewed, Dr. Aiello does not reference the concussion diagnosis in those records.
Further, Economical relied on the psychological assessment conducted by Dr. Amena Syed, Neuropsychologist, on November 24, 2020, who wrote in her report that the applicant could be suffering from psychological concerns but still concluded that he was in the MIG. The adjudicator dismissed Dr. Syed’s report and placed the highest weight on the diagnosis of PTSD rendered by the applicant’s family physician, psychologist and treating psychiatrist.
The LAT ruled in favour of the applicant on key issues, removing him from the MIG and securing coverage for several disputed medical benefits. The decision underscores the power of strong medical evidence in challenging insurer denials and highlights the limitations of insurer-funded medical assessments. As a result, Ahmed was awarded funding for essential treatments, including occupational therapy, psychological assessment, massage therapy and social rehabilitative counseling, as well as accounting services related to income replacement benefits.
This case serves as a powerful example of how important it is to secure detailed existing medical documentation and how a well-documented medical case can overcome insurer resistance and unlock critical rehabilitation benefits for accident victims. It also highlights two practical takeaways for plaintiff-side personal injury lawyers:
- The LAT placed significant weight on the observations and clinical impressions of treating health professionals who assessed the applicant early, soon after the collision. These records were seen as more persuasive than the delayed, one-time assessments arranged by the insurer.
- The decision is a cautionary tale for defence experts—the failure to acknowledge or address critical evidence in an expert report can be fatal to its credibility and result in the LAT assigning it little or no weight.
