In this edition of our Spring newsletter, we will be reviewing the case decision of MacLeod v. Intact Insurance Company, 2026 CanLii 2264 (ONLAT) [1], January 12, 2026.
Following a motor vehicle accident (MVA), a question which always arises for healthcare providers is: How injured is this person?
However, a more meaningful question, and one that is at the heart of MacLeod v. Intact Insurance Company is:
How is this person actually functioning in their real life after the accident?
Mr. MacLeod, the applicant, was involved in an automobile accident on November 5, 2020. Following the accident, Mr. MacLeod experienced physical, psychological, and cognitive symptoms which impacted his daily functioning.
Mr. MacLeod pursued CAT designation from Intact Insurance Company under the mental and behavioural impairments, which according to Chapter 14 of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition (the “Guides”), assess the following areas of function:
- * Activities of Daily Living
- * Social Functioning
- * Concentration, Persistence and Pace
- * Adaptation (Deterioration in a work-like setting)
The client and his assessment team, including a psychiatrist and an OT, with the assistance of evidence given by his treating SW and OTs argued that he had “sustained a class 4 (marked) impairment in four of the functional domains above”.
Following receipts of IE assessments from a neuropsychologist and an OT, Intact Insurance Company denied Mr. MacLeod CAT designation. Mr. MacLeod applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) to resolve the dispute.
This case centered around the severity of the applicant’s injuries and impairments, and whether those meet the threshold for certain benefits under the SABS.
In Mr. MacLeod’s case, an Occupational Therapist (OT) provides the data collected from situational assessments to a psychiatrist in order to rate the severity of the function on the 4 domains under Chapter 14 of the Guides.
Evidence from the applicant’s treating OT, CAT OT assessor, and OT that completed an IE upon the respondent’s request, all indicated that the applicant is physically capable of performing self-care and personal hygiene tasks independently, however “he routinely forgets, gets distracted, or has no motivation to do so” [1, para. 28]. Specifically, the treating OT noted that “various strategies aimed at cuing the applicant to remember basic self-care tasks, including the use of alarms and taping reminders ‘all over’ his house, have had limited success” [1, para. 28].
Additionally, Mr. MacLeod’s CAT OT assessor provided evidence in her report of the applicant “experiencing a panic attack and storming out of a grocery store eight minutes into a grocery errand assessment” [1, para. 31].
Relatedly, Mr. MacLeod resumed driving following the MVA, however he consistently reported to assessors and treating providers that he has been experiencing anxiety while driving and as such “does not drive daily, drives during less busy times, avoids night driving, stays close to the road shoulder and takes regular breaks if driving outside the community due to fatigue and loss of focus” [1, para. 33].
Moreover, Ms. MacLeod has reported to CAT assessors, treating OT providers, and his family physician, that his “sleep is frequently disrupted by anxiety and occasionally by nightmares” [1, para. 36].
When it comes to social functioning, social work records described the applicant playing music at a friend’s wedding but that “he stated that it took a lot out of him, and he realized he can only do one thing at a time” [1, para. 38].
Similarly, the OT who completed an IE on behalf of the respondent, noted that “after less than 45 minutes, the applicant was observed to be flushed, panting and constantly sighing, described a pounding headache, and was unable to recall multi-step commands” [1, para 41].
Both parties’ CAT OT assessors completed work related assessments to comment on the applicant’s performance in the area of Concentration, Persistence and Pace. The applicant’s OT noted the applicant “needed repeated instruction and experienced confusion when his cell phone buzzed, which disrupted his concentration” [1, para. 55].
The respondent’s OT assessor noted “his cognitive overload, coupled with anxious distress, resulted in a very poor working memory and the inability to effectively extract relevant information for the purpose of decision-making” [1, para. 55].
Evidence such as these provide support related to the impact of the MVA on Mr. MacLeod’s psychological functioning. Thus, OT assessment provides insight into the functional changes one experiences following the MVA.
The adjudicator was convinced by the compelling pieces of evidence provided by the treating OTs and OT CAT assessors. The adjudicator determined that the applicant, Mr. MacLeod sustained a CAT impairment under criterion 8, being s. 3.1(1)8 of the SABS, as a result of the MVA. The applicant was also entitled to proposed treatment plans for Social Work and Occupational Therapy services as well as driving sessions.
OTs are playing a major role in describing functional impairments through observation for several hours during CAT assessments. Treating OTs contribute important functional data through long term relationship and hours of observations and trialing strategies to improve independence. These details cannot be described by any other healthcare provider than an OT.
In addition, when discussing criterion 8, evidence from treating Social Workers are significantly important and valuable to understand the client’s emotional impairments, such as anxiety and their effect on daily functions, such as driving.
Our treating OTs and OT CAT assessors, as well as our treating Social Workers at GLA Rehab play a significant role in collecting data regarding client’s functional impairments in order to assist psychiatrists in reaching decisions related to rating on the 4 functional domains outlined under Chapter 14 of the Guides.
Please contact us for more information at www.gla-rehab.com.
References
[1] MacLeod v Intact Insurance Company, 2026 CanLII 2264 (ON LAT), <https://canlii.ca/t/khm8q>