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Insurance (Auto) - SABS - Chronic Pain. Dooman v. TD Insurance Co.
In Dooman v. TD Insurance Co. (Ont Divisional Ct, 2025) the Divisional Court dismissed a joint appeal-JR (Yatar) proceeding, here of a SABS LAT ruling denying "medical and rehabilitation benefits beyond the $3,500 funding limit for minor injuries".
Here the court addresses the issue of chronic pain (which here would have taken the appellant out of the definition of 'minor injury'):[41] As noted in the Decision, at para. 11, the AMA Guides require that for a person to be found to have chronic pain, at least three of the following criteria must be met:1. Use of prescription drugs beyond the recommended duration and/or abuse of or dependence on prescription drugs or other substances;
2. Excessive dependence on health care providers, spouse, or family;
3. Secondary physical de-conditioning due to disuse and/or fear-avoidance of physical activity due to pain;
4. Withdrawal from social milieu, including work, recreation, or other social contracts;
5. Failure to restore pre-injury function after a period of disability, such that the physical capacity is insufficient to pursue work, family or recreational needs;
6. Development of psychosocial sequelae after the initial incident, including anxiety, fear-avoidance, depression, or non-organic illness behaviors.
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