Simon's Legal Resources

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.