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Insurance (Auto) - Evidence. Wilson v. Intact Insurance Company
In Wilson v. Intact Insurance Company (Ont Div Ct, 2025) the Ontario Divisional Court allowed an insured's joint appeal/JR, this from a LAT SABS ruling that denied them catastrophic impairments benefit.
Here the court considered the 'American Medical Association’s Guides to the Evaluation of Permanent Impairment' ('AMA Guides') (with it's several 'Criteria') as medical evidence:[27] Also, the Adjudicator’s approach to the AMA Guides strikes me as unduly rigid. Previous decisions do not endorse such a rigid approach, but rather suggest a liberal interpretation consistent with their remedial purpose.[12] The AMA Guides themselves state:It should be understood that the Guides does not and cannot provide answers about every type and degree of impairment, because of the considerations noted above [about how objective data is not always available] and the infinite variety of human disease, and because the field of medicine and medical practice is characterized by a constant change in understanding disease and its manifestations, diagnosis, and treatment. Further, human functioning in everyday life is a highly dynamic process, one that presents a great challenge to those attempting to evaluate impairment.
The physician’s judgment and his or her experience, training, skill, and thoroughness in examining the patient and applying the findings to Guides criteria will be factors in estimating the degree of the patient’s impairment. These attributes compose part of the “art” of medicine, which, together with a foundation in science, constitute the essence of medical practice. The evaluator should understand that other considerations will also apply, such as the sensitivity, specificity, accuracy, reproducibility, and interpretation of laboratory tests and clinical procedures, and variability among observers’ interpretations of the tests and procedures.
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