An Ontario claimant's own words helped an insurer defeat a catastrophic impairment claim - even when experts on both sides partly agreed.
A recent decision from Ontario's Licence Appeal Tribunal shows how a catastrophic impairment dispute can turn on day-to-day evidence of how a claimant actually functions - and what that means for insurers assessing similar claims.
In Green v. Wawanesa Mutual Insurance Company, 2026 ONLAT 25-005835/AABS, released on April 22, 2026, Vice-Chair Henry Harris dismissed an application by Hewin Green, a retired painter seeking catastrophic impairment status after a December 29, 2017 motor vehicle accident. Green's vehicle was t-boned at an intersection when another car lost control in poor weather. Airbags did not deploy. He felt pain in his head, neck, shoulders and back but turned down hospital attendance at the scene.
Green went to a walk-in clinic the next day and was treated for pain symptoms and soft tissue injuries. He later saw his family doctor, who recommended physiotherapy. The Tribunal noted that Green did not report psychological complaints to his family doctor until April 2021 - more than three years after the collision.
The decision places those complaints against a detailed medical background. Green had health conditions that were unrelated to the accident, including complications of poorly controlled diabetes, peripheral neuropathy, kidney failure requiring dialysis three times a week, diabetic eye complications and age-consistent osteoarthritis and degenerative changes. In January 2025 clinical notes, his family doctor recorded that his main reported troubles related to diabetes, kidney failure and dialysis, and peripheral neuropathy. Green later had his right leg amputated in March 2025, also for reasons unrelated to the accident.
Green applied for a catastrophic impairment determination under Criterion 8 of the Statutory Accident Benefits Schedule. Under that provision, an applicant must show that an accident-related mental or behavioural disorder has produced at least three marked impairments, or one extreme impairment, across four areas of functioning described in the American Medical Association's Guides: activities of daily living, social functioning, concentration, persistence and pace, and adaptation.
Green relied on assessments by psychiatrist Dr. Shahzad Shahmalak and occupational therapist Lily Wainer. Dr. Shahmalak diagnosed Somatic Symptom Disorder with predominant pain, persistent, Major Depressive Disorder with anxious distress, and PTSD, and rated Green with marked impairments in all four areas. Wawanesa relied on assessments by psychologist Dr. Natasha Williams and occupational therapist Rodney Pritchell. Dr. Williams diagnosed Somatic Symptom Disorder with predominant pain and Major Depressive Disorder. She rated Green with marked impairments in concentration, persistence and pace, and in adaptation, but only moderate impairment in activities of daily living and social functioning.
Both sides' experts therefore agreed on two marked impairments. The dispute came down to whether the Tribunal would also find a marked impairment in either activities of daily living or social functioning.
On activities of daily living, the Tribunal concluded that Green did not meet that threshold. It noted that for more than five years after the accident, he lived independently, managed his personal care with little or no formal assistance, prepared simple meals, used the microwave, and bathed on his own, though not daily. He reported performing a home exercise program three times per week. He continued to drive until his amputation in 2025. In a July 31, 2025 functional driving assessment form, Green indicated that he typically drove daily, could access all roadways and drive in all weather conditions, and described himself as independent with his activities of daily living. He also scheduled medical appointments and attended them without being accompanied by family members.
On social functioning, Green testified that he maintained a "positive and loving relationship" with his five adult children and three grandchildren and continued to see them as often as before the accident. When asked whether he enjoyed spending time with them, he answered that they brought him joy. His daughter told the Tribunal that the frequency of phone calls had stayed the same and that Green continued to initiate calls as well. The Tribunal found that while Green reported social isolation to his assessors, this "underestimates the meaningful social interactions that he continues to have," and accepted Dr. Williams's view that the impairment in social functioning was moderate rather than marked.
Green also challenged unapproved portions of two treatment plans for catastrophic assessments. One plan, submitted November 20, 2023, sought additional funding for three CAT assessments. Another, dated November 21, 2023, sought funding for two occupational therapy CAT assessments. Each was partially approved up to the monetary limit in section 25(5) of the Schedule - $2,000 per assessment plus applicable HST. Green argued he was entitled to HST on the approved assessments. The Tribunal accepted that the statutory limit is subject to HST but found he had not pointed to evidence that HST had been claimed on the approved assessments, and he did not make submissions that the remaining balances were reasonable and necessary. Those amounts were therefore denied.
Because no benefits were found owing, the Tribunal dismissed Green's claim for interest. It also dismissed a claim for an award under section 10 of Regulation 664, noting there was no evidence that Wawanesa had unreasonably withheld or delayed payment of benefits.
For insurers and claims professionals, the decision underlines that, in Criterion 8 cases, consensus on some marked impairments is not enough. The Tribunal closely examined how Green lived, how he interacted with family and the community, and how those facts matched the Guides. In the end, his own descriptions of independence and ongoing relationships helped support the finding that he did not meet the catastrophic impairment threshold.
