Loading...
HomeMy WebLinkAbout2000-71064 Benefits Claimant 00-12-10 Decision Included In the most recent collectIve agreement between the partIes are the folloWIng provIsIOns Article 22 - Grievance Procedure Article 22.9 - Insured Benefits Grievance 2291 An allegatIOn that the Employer has not provIded an Insured benefit that has been contracted for In thIS Agreement shall be pursued as a Umon gnevance filed under ArtIcle 22 13 (Umon Gnevance) 22 9 1 Any other complaInt or dIfference shall be referred to the Claims ReVIew SubcommIttee of JOInt Insurance Benefits RevIew CommIttee (JIBRC) establIshed under AppendIx 4 (JOInt Insurance Benefits RevIew CommIttee) for resolutIOn. Appendix 4 JOINT INSURANCE BENEFITS REVIEW COMMITTEE 1 Name of Committee The CommIttee shall be referred to as the JOInt Insurance Benefits RevIew CommIttee 2. Purpose of Committee The purpose of thIS CommIttee IS to facIlItate commumcatIOns between the Employer and the OPSEU on the subJect of Group Insurance, IncludIng BaSIC LIfe Insurance, Supplementary LIfe Insurance, Extended Health Insurance Long Term Income ProtectIOn Insurance, and such other negotIated benefits as may from tIme to tIme, be Included In the Group Insurance Plane It IS understood that the Group Insurance benefits to be provIded to employees and the cost shanng arrangements between the Employer and ItS employees shall be as set out In any applIcable collectIve agreement or arbItratIOn award, and the matters for consIderatIOn by thIS CommIttee shall be only as set out In these terms of reference 3 Composition of Committee The CommIttee shall be composed of an equal number of representatIves from the Employer and from the OPSEU wIth not more than eIght (8) representatIves In total At meetIngs of the CommIttee, each party may be accompamed by an Actuary to provIde techmcal advIce and counsel 4 Duties of the Committee The dutIes of the CommIttee shall consIst of the folloWIng CLAIM # 71064 (I) Development of the specIficatIOns for the publIc tendenng of any negotIated benefits whIch may be Included In the Group Insurance Plan (to cover the bargaInIng umt onl y) (iI) DetermInatIOn of the manner In whIch the specIficatIOns wIll be made avaIlable for publIc tendenng; (ill)ConsIderatIOn and eXamInatIOn of all tenders submItted In response the specIficatIOns for tender and preparatIOn of a report thereon, (iv)RecommendatIOn to the Government of Ontano on the selectIOn of the Insurance carner or carners to underwnte the Group Insurance Plans (v) ReVIew of the semI-annual financIal reports on the Group Insurance Plan, and (vI)RevIew of contentIOus claims and recommendatIOns thereon, when such claim problems have not been resolved through the eXIstIng admInIstratIve procedures The specIficatIOns for tender wIll descnbe the benefits to be provIded, the cost shanng arrangement between the Employer and ItS employees, the past financIal hIStory of the Insurance plans, the employee data, the format for the retentIOn IllustratIOn for each coverage and the financIal reportIng reqUIrements Tenders shall be entertaIned by the CommIttee from any IndIVIdual Insurance carner actIng solely on ItS own behalf ThIS shall not preclude such carner from arrangIng reInsurance as may be necessary The basIs for recommendatIOn of an Insurance carner(s) wIll Include the abIlIty of the carner(s) to underwnte the plan, complIance of the carner's quotatIOn wIth the specIficatIOns for tender the carner's servIce capabIlItIes and the expected long term net cost of the benefits to be provIded. 1 Experience Review 2. Claims Review Subcommittee (a) There shall be a subcommIttee whose mandate IS to reVIew and make decIsIOns on, complaInts or dIfferences InvolvIng the demal of Insured benefits under the Central CollectIve Agreement, when such Issues have not been resolved through the eXIstIng admInIstratIve procedures, save and except a complaInt or dIfference ansIng under ArtIcle 22 9 1 (Insured Benefits Gnevance) of the Central CollectIve Agreement. The subcommIttee shall be composed of two (2) representatIves selected by the Employer two (2) representatIves selected by OPSEU and an Independent thIrd party who IS agreed to by both partIes (b) Appropnate ImpartIal medIcal consultants shall be avaIlable to the subcommIttee In an advIsory capacIty to provIde InformatIOn on the nature of specIfic Illnesses or dIsabIlItIes CLAIM # 71064 (c ) MembershIp on the subcommIttee shall be for one (1) year penod, and IS renewable at the dIscretIOn of the nomInatIng party or partIes In the case of the renewal of the term of the Independent thIrd party (d) DeCISIOns of the subcommIttee are final and bIndIng. (e) The fees and expenses of the medIcal consultants referred to In clause (b), and the Independent thIrd party referred to In clause (a) shall be dIvIded equally between the Employer and the Umon. Article 42 - Long Term Income Protection Total dIsabIlIty means the contInUOUS InabIlIty as the result of Illness, mental dIsorder or InJury of the Insured employee to perform the essentIal dutIes of hIS or her normal occupatIOn dunng the qualIficatIOn penod, and dunng the first twenty-four months of the benefit penod' and thereafter dunng the balance of the benefit penod, the InabIlIty of the employee to perform the essentIal dutIes of any gaInful occupatIOn for whIch he or she IS reasonably fitted by educatIOn, traInIng or expenence Subsequent to the sIgmng of thIS collectIve agreement the partIes negotIated and sIgned terms of reference regardIng the establIshment of a subcommIttee to deal wIth dIsputes between the partIes regardIng Long Term Income ProtectIOn (hereInafter referred to as "LTIP") That memorandum stated JIBRIC CLAIMS REVIEW SUBCOMMITTEE TERMS OF REFERENCE AUTHORITY The JIBRC subcommIttee IS establIshed under ArtIcle 229.2 and AppendIx 4 of the collectIve agreement between The Crown In RIght of Ontano and the Ontano PublIc ServIce Employees Umon. PURPOSE OF SUBCOMMITTEE To reVIew and make decIsIOns on appeals from employees on claims InvolvIng the demal of Insured benefits under the collectIve agreement whIch have prevIOusly been removed from JIBRC REFERRAL TO THE SUBCOMMITTEE CLAIM # 71064 Employees wIth claims that have been removed from JIBRC wIll be notIfied of such, In a tImely manner by letter (referred to as the "NotIce Letter") to theIr last known address An employee whose claim has been removed, has 45 days, from the date of the notIce letter to submIt a request In wntIng to OPSEU askIng that OPSEU refer theIr case to the subcommIttee ThIS letter must be copIed to the Management Co-Chair of the JIBRC OPSEU has 90 days from the date of the notIce letter to advIse the Management Co-Chair of JIBRC of theIr decIsIOn to agree or deny the request to appeal If notIce IS not receIved from OPSEU wIthIn 90 days from the notIce letter then the claim wIll be deemed to be wIthdrawn. SCOPE OF COMMITTEE The SubcommIttee represents the final stage In the appeal process The SubcommIttee wIll clanfy medIcal eVIdence as needed, wIth a medIcal consultant agreed to by both MBS and OPSEU DeCISIOns of the SubcommIttee are final and bIndIng. Upon receIpt of the decIsIOn, a Memorandum of Settlement (as attached) wIll be prepared and sIgned by the partIes and forwarded to the Insurer SUBCOMMITTEE MEMBERSHIp. The subcommIttee wIll consIst of resource representatIves from OPSEU and MBS and an Independent thIrd party "Chair" to be named by MBS and OPSEU ROLE OF THE CHAIR" To reVIew case representatIOns from MBS and OPSEU To make a determInatIOns In wntIng wIth respect to each case DeCISIOns must be In accordance wIth the OPS CollectIve Agreement between the Employer and OPSEU and consIstent WIth the group Insurance plans In place at the tIme facts gIVIng nse to the dIspute arose ROLE OF MEDICAL CONSULTANTS Appropnate ImpartIal medIcal consultants wIll be agreed by the partIes and shall be avaIlable to the SubcommIttee In an advIsory capacIty If the partIes cannot agree on a medIcal consultant, the Chair may call on a consultant from a roster supplIed by the College of PhysIcIans and Surgeons CLAIM # 71064 The medIcal consultants wIll provIde InformatIOn on the nature on of specIfic Illnesses or dIsabIlItIes The Chair may request an InterpretatIOn of medIcal reports, test results and other medIcal documentatIOn on file The medIcal consultant IS not a member of the commIttee and wIll not provIde an OpInIOn related to a decIsIOn on the appeal FEES Fees and expenses, as approved by the partIes, of medIcal consultants and the Chair shall be dIvIded equally between MBS and OPSEU FORMA T OF MEETINGS Each appeal wIll be dealt wIth separately Both partIes, through theIr representatIves wIll provIde full dIsclosure of the supportIng documentatIOn upon whIch they Intend to rely ThIS dIsclosure wIll take place at least two weeks In advance of the meetIng of the subcommIttee dealIng wIth the subJect matter of the appeal If the Chair reqUIres clanficatIOn of medIcal eVIdence, a meetIng of the SubcommIttee wIll be arranged wIth a medIcal consultant agreed to by both MBS and OPSEU or faIlIng such agreement, wIth a medIcal consultant called by the Chair MBS and OPSEU wIll JOIntly present a statement of agreed upon facts (to the extent possIble) for the appeal to the Chair ASIde from the ImpartIal medIcal consultant dIscussed above, no other wItnesses wIll be called, except by request of the Chair However the IndIVIdual claimant wIll be allowed to file a wntten statement In lIeu of testIfYIng. If the IndIVIdual claimant chooses to file a statement It must be provIded to the Management Co-Chair of JIBRC at the same tIme as OPSEU's request for appeal MBS has the nght to Introduce a wntten response to thIS statement. OPSEU wIll present ItS posItIOn on the case wIth supportIng arguments to the Chair MBS wIll present ItS posItIOn on the case wIth supportIng arguments to the Chair and wIll respond to OPSEU's posItIOn. OPSEU wIll have nght of reply PresentatIOn by both partIes wIll be based upon the InfOrmatIOn/record on file before the Insurance carner at the tIme the matter IS removed from the JIBRC the employee statement If any and MBS's response to the statement. CLAIM # 71064 EIther party may If necessary request the attendance of the claimant, who shall be allowed a leave of absence wIthout pay wIth no loss of credIts, to attend the sub- commIttee meetIng as an observer only The Chair wIll render a wntten decIsIOn wIth supportIng ratIOnale FREQUENCY OF MEETINGS. On an as needed basIs as determIned by MBS and OPSEU JOIntly The partIes agree to these Terms of Reference In support of the ImplementatIOn of ArtIcle 22 9 2 and AppendIx of the collectIve agreement. Dunng the term of the prevIOUS collectIve agreement, the partIes attempted to resolve these dIsputes between themselves Not surpnsIngly there were a number of Instances whereIn they were unable to agree Those matters sImply remaIned unresolved. Those outstandIng matters are now beIng brought forward before the subcommIttee as set out above In accordance wIth the agreement of the partIes, ArbItrator FelIcIty Bnggs and I were asked to act as the thIrd party or Independent chair On the first day of heanng the partIes agreed that the Chair should render a decIsIOn statIng that the claim was properly or Improperly demed wIthout elaboratIng on the quantum of the remedy but remaIn seIzed of the matter Subsequent to the Issuance of the decIsIOn the partIes wIll negotIate and hopefully agree upon a memorandum of agreement as to the appropnate remedy There was also dIscussIOn between the partIes about the extent and content reqUIred In decIsIOns Issued by the ChaIr(s) I thInk IS It fair to say the partIes agreed that, at the begInmng the ChaIr(s) wIll attempt to set out In some detaIl the dIspute and the reasons for the decIsIOn. The partIes' antIcIpate that the ChaIr(s) wIll establIsh some pnncIples they can be gUIded by In asseSSIng future dIsputes It IS hoped that as the Junsprudence develops, there wIll be less need for lengthy decIsIOns because the fundamental pnncIples wIll have already been establIshed. In accordance wIth the agreed procedure, the partIes filed an agreed statement of facts It stated 1 Mr G.D was employed by the Ontano Mimstry of the SOlICItor General and CorrectIOnal ServIces from September 30 1991 2 He was workIng as a CorrectIOnal Officer 2 (General Duty Officer) when he began expenenCIng health dIfficultIes and he went off from work wIth Illness begInmng on February 20 1997 3 Mr G.D' s Short Term SIckness Plan benefits stopped on July 20 1997 CLAIM # 71064 4 He applIed for Long Term Income ProtectIOn wIth a dIagnosIs of anxIety dIsorder on June 19 1997 5 Mr G.D' s claim for benefits was demed by ManulIfe on August 1 1997 6 The demal of benefits was appealed on December 11 1997 by Mr G.D through hIS phYSICIan. 7 ManulIfe upheld the demal of benefits on December 19 1997 8 The further demal was appealed through the employer's medIcal consultant on January 15 1998 9 ManulIfe demed the further appeal on January 30 1998 10 On March 23 1998 ManulIfe agreed to arrange an IME 11 On Apnl 4 1998 Dr Cashman of Wellesley HospItal performed an Independent medIcal evaluatIOn. 12 On Apnl 23 1998 ManulIfe upheld the demal of benefits 13 On June 11 1998 Mr G.D ' s claim was removed from the table at JIBRC 14 Mr G.D seeks Insurance benefits for the penod July 20 1997 untIl hIS return to work. The Employer descnbed Mr G.D's Job dutIes as follows takIng charge of an area of the InstItutIOn, observIng for IrregulantIes affectIng secunty dIscIplIne, safety etc refernng to supervIsor or takIng appropnate actIOn In accordance wIth rules, regulatIOns, procedures and past practIces, safely operatIng and controllIng secunty eqUIpment, 1 e keys, handcuffs & leg Irons, searchIng Inmate's lIvIng umts, cells and other areas as reqUIred, keepIng log records, counts & ShIft actIvItIes, adVISIng Inmates of theIr nghts and oblIgatIOns warmng! counsellIng Inmates, laYIng mIsconduct reports and provIdIng oral & wntten reports as reqUIred, patrols of InstItutIOn & grounds to check for IrregulantIes dnvIng the InstItutIOn vehIcle as assIgned, actIng as an escort In transfer and movement of Inmates between InstItutIOns and the hospItal The first AttendIng PhysIcIan's Statement was completed by Dr FInkelsteIn, hIS general practItIOner and was dated June 30th, 1997 In It he stated that the claimant was suffenng from an anxIety dIsorder that commenced In February of 1997 and mamfested Itself In symptoms of anxIety tensIOn and frustratIOn. He had been reCeIVIng monthly treatments for a psychologIcal dIsorder SInce February and was, at the tIme of the report, unable to perform hIS dutIes as a CorrectIOnal Officer CLAIM # 71064 A subsequent letter was sent to Dr FinkelsteIn requestIng a detaIled report on the claimant's condItIOn, IncludIng precIpItatIng and perpetuatIng factors, stabIlIty dIagnostIc InVestIgatIOns, course of treatment, consultatIOns, abIlIty to return to work wIth or wIthout lImItatIOns His response was dated July 15 1997 and stated ThIS letter IS In response to your request for specIfic medIcal InfOrmatIOn regardIng G.D You have enqUIred as to the precIpItatIng and perpetuatIng factors In the present Illness Mr G.D found hImself In a very tense sItuatIOn at work. ThIS related to hIS InteractIOn wIth hIS co-workers and supervIsors He expenenced feelIngs of severe emotIOnal upset and frustratIOn. He finds the sItuatIOn Intolerable and unresolvable A change In work venue appears to be the only solutIOn to hIS problem His medIcal condItIOn IS now stable No diagnostIc testIng was conducted In regard to thIS problem Mr G.D was seen approxImately monthly Mr G.D has been referred to Dr Stephen Rivers, a psychologIst. You have enqUIred as to whether any medIcal harm would come to my patIent by now engagIng In occupatIOnal reIntegratIOn. I am unclear as to what you mean by occupatIOnal reIntegratIOn. In my OpInIOn, It would be reasonable for Mr G.D to return to gaInful employment so long as he does not find hImself back In hIS prevIOus work sItuatIOn or a sImIlar work sItuatIOn. You have enqUIred In questIOn 9 as to what temporary or permanent workplace accommodatIOn may enable your patIent to safely return to work dunng or after recovery It IS my OpInIOn that Mr G.D may return to work so long as he does not return to any work sItuatIOn InvolVIng the same personnel I trust thIS IS the InfOrmatIOn that you reqUIre and that I have been clear In the presentatIOn of same Dr Rivers was asked for a sImIlar report and responded on July 25 1997 as follows ThIS letter IS In response to your request for InfOrmatIOn concermng my treatment of Mr G.D who was referred by hIS physIcIan, Dr FinkelsteIn. I have now seen G.D on four occaSIOns between May 21 and July 23 1997 In dISCUSSIng thIS wIth G.D he felt that I should feel free to Include any relevant psychologIcal InfOrmatIOn requested, but because a number of personal Issues unrelated to hIS current InabIlIty to work at MimIco are entered sporadIcally throughout my seSSIOn notes, the notes should not be Included wIth thIS report. G.D presented as an artIculate, motIvated IndIVIdual who had, for all Intents and purposes, been functIOmng qUIte well In hIS lIfe before thIngs began "breakIng down" at work toward the end of last year After a penod of tIme where he felt stress bUIldIng at work through the detenoratIOn of management/worker relatIOnshIps and hIS role In that process, It got to the pOInt where he felt a "stress leave" was hIS only optIOn, as beIng at work became unbearable In response to your speCIfic Inqumes, based on the contact to date, my assessment IS a follows Psychiatric History none CLAIM # 71064 Mental Status presented as somewhat anxIOUS and angry wIth feelIngs of beIng malIgned at work, havIng been In the forefront of a dIspute wIth management for a number of months Although thInkIng was clear there was an element of grandIOsIty In hIS personalIty style Memory IS excellent and IntellIgence lIkely above average There was no suggestIOn of mood dIsorder or sUIcIdal Intent. Precipitating/Perpetuating Factors The sItuatIOn was preCIpItated by management staff conflIct In the workplace, culmInatIng In stnke actIOn and IdentIficatIOn of G.D as an InstIgator The "culture" of a correctIOnal InstItutIOn (i e a pnson) IS, from G.D's descnptIOn, repreSSIve extremely hIerarchIcal and "macho" corrupt, and ImmIcal to change It IS these factors whIch - to whatever extent they may be operatIng - are perpetuatIng hIS InabIlIty to contInue workIng In that envIronment. DSM-IV Category & GAF AdJustment DIsorder (chromc) wIth anxIety (309.24) GAP = 58 Medication History- None reported, check further wIth Dr FinkelsteIn, M.D Nature, Frequency & Severity of Current Symptoms Sleep dIsturbance, Increase In alcohol consumptIOn, problems wIth concentratIon, and dIsruptIOn In personal relatIOnshIps have accompamed thIS penod of stress Seventy of symptomatology IS moderate and IntermIttent. Management Plan IndIvIdual psychotherapy InsIght onented ImtIally wIth cogmtIve/behavIOural therapy to follow once pnontIes for change have been IdentIfied. Anticipated time to Improve 6-8 months Role of Motivation Appears very motIvated to seek help not only for current dIfficultIes but also to understand the possIble hIstoncal underpInmngs of hIS personalIty for makIng appropnate future decIsIOns If I can be of any further assIstance, or If you reqUIre elaboratIOn of the above InformatIOn, please feel free to call The claimant's applIcatIOn was demed on the basIs of those reports ManulIfe advIsed Mr G.D that Dr RIvers had descnbed hIS symptoms as moderate and IntermIttent. Dr FinkelsteIn had said hIS condItIOn was stable and that he could return to work but not wIth the personnel wIth whom he had been In conflIct. There was therefore no eVIdence of a totally dIsablIng psychIatnc condItIOn. A subsequent appeal of that demal of benefits was ImtIated by Dr Glancy a psychIatnst, who had been seeIng the claimant SInce September of 1997 His letter to ManulIfe, dated December 11 1997 stated ThIS letter IS an appeal of the cessatIOn of long-term dIsabIlIty benefits on the above named, accompamed by an authonzatIOn for release of medIcal InformatIOn. Mr G.D IS a 34 year old male whom I assessed ongInally on September 8th, 1997 He suffered from a maJor depressIve epIsode apparently wIth some paranOId Ideas whIch may be sItuatIOnal In nature There was some eVIdence of recent alcohol abuse, probably secondary to the depressIOn. CLAIM # 71064 The tentatIve treatment plan IS to see hIm approxImately every two weeks for a cOmbInatIOn of cogmtIve psychotherapy and pharmacotherapy He has responded somewhat to a cogmtIve therapy approach but may also need pharmacotherapy The DSM-IV dIagnosIs IS maJor depreSSIve epIsode wIth the possIbIlIty of some paranOId features There IS also the possIbIlIty of secondary alcohol abuse AXIS-l MaJor depressIve epIsode 2962 AXIS-11 Nil AXIS-111 Nil AXIS-l V Problems wIth pnmary support group (mantal separatIOn) OccupatIOnal problem Threat of Job loss DIfficult work condItIOns DISCord wIth co-workers (admInIstratIOn) AXIS- V Global assessment of functIOmng equals 60-70 The subJect's Illness appeared to begIn approxImately March 1996 His Illness contInues unabated. He wIll be under medIcal care for some tIme dependIng on hIS response to treatment. If you reqUIre more InformatIOn, please do not hesItate to contact me The claim was agaIn demed. The Insurer Interpreted Dr Glancy's report as IndIcatIng mIld symptoms or some dIfficulty In several areas of functIOmng but not as eVIdence of a totally dIsablIng psychIatnc Illness The folloWIng month, that IS January of 1998 Dr Paul Humphnes, Semor MedIcal Consultant of the Mimstry of the SOlICItor General and CorrectIOnal ServIces advIsed the Insurer that the referral to Dr Glancy had been done at hIS suggestIOn because he felt the claimant was Incapable of contInuIng as a correctIOnal officer He requested the decIsIOn to deny long term sIckness benefits be reconsIdered. ManulIfe's psychIatnc medIcal consultant revIewed the claimant's entIre file and confirmed hIS decIsIOn that no new medIcal InformatIOn had been provIded to persuade hIm to approve the applIcatIOn. The claimant appealed and advIsed Dr Glancy that he had consented to a release of medIcal InformatIOn In furtherance of that appeal Dr Glancy provIded the Insurer wIth the folloWIng letter dated February 16 1998 ThIS letter IS an addendum to my prevIOUS report upon the above named. Mr G.D has sIgned an authonzatIOn for release of medIcal InformatIOn. I would lIke to reVIse my AXIS IV assessment. I should note that I do not habItually use thIS scale In my clImcal work. I have not gIven thIS matter senous consIderatIOn pnor to thIS report. SInce thIS scale IS to be used for medIco-legal purposes In the case of thIS claim, I have thus applIed myself more carefully to thIS Issue CLAIM # 71064 On rereadIng the Global Assessment of FunctIOmng Scale (DSM-IV -page 32) It IS clear that Mr G.D must score approxImately 31-40 on thIS scale You wIll note from the scale that a score 31-40 ImplIes some Impairment In realIty testIng of commumcatIOn or maJor Impairment In several areas such as work or school, famIly relatIOns Judgment, thInkIng or mood. Mr G.D does dIsplay a maJor Impairment In mood, as well as maJor Impairment In work and famIly relatIOns He also has what could be termed a senous Impairment In socIal functIomng, not contactIng hIS fnends and not entenng Into any heterosexual relatIOnshI ps It IS possIble that hIS behavIOur IS Influenced by paranOId thInkIng whIch would gIve hIm a score of21-30 Overall, on gIVIng thIS senous careful thought demanded of thIS scale, I would score hIm as at approxImately 40 I hope you can reVIse your decISIOn based on thIS I am surpnsed that you based your decIsIOn on thIS scale whIch IS not generally consIdered amongst clImcIans as a valId and relIable tool In everyday practIce It would be my OpInIOn that Mr G.D suffers from a maJor depressIve epIsode wIth paranOId features His problem centres around the workplace He IS therefore unfit to work due to thIS Illness, and has been SInce the early part of March 1996 I am hopeful that wIth treatment, the sItuatIOn wIll resolve wIthIn the next year The claimant underwent an Independent MedIcal EXamInatIOn In Apnl of 1998 by Dr Cashman, the DIrector of the In-PatIent PsychIatnc Umt at St. Michael's HospItal Before seeIng Mr G.D Dr Cashman revIewed the reports of Dr FInkelsteIn, Dr Rivers and Dr Glancy He then allowed the claimant tIme to descnbe hIS feelIngs and perceptIOns of the recent past and arnved at the folloWIng conclusIOns The mental status showed a healthy powerful man, who spoke rapIdly and wanted to tell me every detaIl of hIS unfortunate sItuatIOn at MimIco He dId not appear sad. He appeared anxIOUS He was onented to tIme, person and place There was no thought dIsorder There were no perceptual abnormalItIes There were no hallucInatIOns I consIdered whether the story about MimIco was a delusIOn but dId not thInk It was His thInkIng was clear but dIffuse He was preoccupIed wIth the events at MimIco CorrectIOnal Centre His cogmtIve functIOns were Intact. His InsIght and Judgment was average On the Back DepressIOn Inventory Mr G.D scored 25 On the HamIlton DepressIOn Scale he scored 7 On the AgoraphobIa subscale of the Fear QuestIOnnaire he scored 11/40 and on the SocIal AnxIety subscale he scored 26/40 CLAIM # 71064 Formulation Mr G.D functIOned well up to the events of the last few years He states that he was always an outgOIng and actIve man who dId extremely well In school and had many fnends He was athletIc He had no specIfic complaInts about hIS chIldhood, hIS adolescence or hIS early adulthood. In the past few years he has been Involved In a negatIve InteractIOn WIth the MimIco CorrectIOnal Centre and the supervIsors there He IS of the firm OpInIOn that the supervIsory staff have been out to harm hIm professIOnally If not physIcally He IS convInced that he IS nght In thIS sItuatIOn and he IS clear that he wants redress ThIS concern has become the maJor focus of hIS lIfe He wIll not return to work. Mr G.D feels that the Mimstry of JustIce should VIndIcate hIm In hIS battle wIth MimIco CorrectIOnal Centre He has not receIved the appropnate support from hIS Umon. VindIcatIOn would consIst of a transfer out of MimIco CorrectIOnal Centre Into another posItIOn. I am not certaIn what thIS posItIOn mIght be Because of the CIrcumstances at work Mr G.D IS depressed. The depressIOn IS mIld and does not prevent hIm from functIOmng. In response to the dIrect questIOns posed In the Insurer's letter Dr Cashman concluded that the pnmary precIpItatIng factor In the claimant's Illness was work. His dIagnosIs was AdJustment DIsorder wIth depressed mood. Because of the lack of any hIStOry of a paranOId personalIty styl e, Dr Cashman made no dIagnosIs of paranOIa. He determIned that the claimant's expenences were IrratIOnal but not delusIOnal and that he had "overvalued Ideas" Dr Cashman noted that the claimant was takIng a small dose of Manenx, whIch he claimed helped hIm to leave hIS home and attend at Dr Cashman's office He concluded that the suggested treatment could Include psychotherapy to help hIm "turn hIS energIes In another dIrectIOn rather than an endless purSUIt of a goal whIch he wIll not achIeve" and pharmacotherapy to reduce the IntenSIty of hIS thoughts Dr Cashman felt the claimant would contInue to be "unhappy and uncomfortable" If he InsIsted on remaInIng fixed on the sItuatIOn at MimIco If he could put that aSIde and agree wIth the treatment proposed, there would be a "possIbIlIty of Improvement" Dr Cashman described Mr G.D ' s depreSSIOn as "not severe" He stated hIS preoccupatIOn wIth the wrongs done to hIm were paramount and that he was "motIvated to return to work as long as he dId not expenence persecutIOn. He wIll not be wIllIng to tolerate a return to work. His overvalued Ideas wIll make It dIfficult for hIm to accept returmng to work" With respect to the InCOnSIstencIes between hIS findIngs and the findIngs of the other physIcIan's who had seen the claimant, Dr Cashman stated The InfOrmatIOn provIded was sketchy Dr Glancy refers to the pOSSIbIlIty of paranOId thInkIng but he does not descnbe deluSIOn. It may have been dIfficult for hIm to be sure CLAIM # 71064 Dr Glancy also descnbes a GAP much lower than my functIOnal assessment suggests In fact, outsIde of work, Mr G.D would seem to be functIOmng at a hIgh level His GAF IS between 60-70 The functIOnal assessment referred to In hIS report IS provIded to treatIng physIcIans and IS entItled Mental Residual Functional Capacity Assessment. The purpose IS set out as follows, ThIS sectIOn IS for recordIng summary conclusIOns denved from the obJ ectIve medIcal eVIdence that eXIsts on eXamInatIOn and lor contaIned In the patIent's medIcal records Each mental actIvIty IS to be evaluated wIthIn the context of the IndIVIdual's capacIty to sustaIn that actIvIty over a normal workday or work week on an ongOIng basIs DetaIled explanatIOn of the degree of lImItatIOn for each category (A through D), as well as any other assessment InfOrmatIOn you deem appropnate, IS to be recorded after each category If ratIng category 5 IS checked for any of the folloWIng Items, you MUST specIfy In SectIOn II the eVIdence that IS needed to make the assessment. The assessment IS based on a ratIng scale from 1 to 5 1 beIng Not Significantly Limited 2 beIng Moderately Limited, 3 beIng Markedly Limited, 4 beIng No Evidence of Limitation in this Category and 5 beIng Not Ratable on Available Evidence The first group of questIOns deals wIth Understanding and Memory and asks about the abIlIty to remember locatIOns and work-lIke procedures, the abIlIty to understand and remember very short and sImple InstructIOns and the abIlIty to understand and remember detaIled InstructIOns The second group deals wIth Sustained Concentration and Persistence and asks about the abIlIty to carry out very short and sImple InstructIOns, the abIlIty to carry out detaIled InstructIOns, the abIlIty to maIntaIn attentIOn and concentratIOn for extended penods, the abIlIty to perform actIvItIes WIthIn a schedule, maIntaIn regular attendance and be punctual wIthIn customary tolerances The thIrd group IS entItled Social Interaction and asks about the abIlIty to Interact appropnately wIth the general publIc, the abIlIty to accept InstructIOns and respond appropnately to feedback from supervIsors, the abIlIty to get along wIth co-workers or peers wIthout dIstractIng them or exhIbItIng behavIOural extremes, the abIlIty to maIntaIn socIally appropnate behavIOur and adhere to basIc standards of neatness and cleanlIness The fourth and final group deals wIth Adaptation and asks about the abIlIty to respond appropnately to changes In the work settIng, the abIlIty to be aware of normal hazards and take appropnate precautIOns, the abIlIty to travel In unfamIlIar places or use publIc transportatIOn and the abIlIty to set realIstIc goals or make plans Independently of others In the claimant's case, Dr Cashman reported no eVIdence of lImItatIOns In the categones of Understanding and Memory and Sustained Concentration and Persistence Under the category of Social Interaction, there was no eVIdence of lImItatIOns WIth regard to hIS abIlIty to CLAIM # 71064 Interact appropnately wIth the general publIc and hIS abIlIty to maIntaIn socIally appropnate behavIOur and adherence to basIc standards of neatness and cleanlIness However he noted that there was marked lImItatIOns In the claimant's abIlIty to accept InstructIOns and respond appropnately to feedback from supervIsors and hIS abIlIty to get along wIth co-workers or peers wIthout dIstractIng them or exhIbItIng behavIOural extremes In the category of Adaption, the claimant was marked as beIng markedly lImIted In hIS abIlIty to respond appropnately to changes In the work settIng but exhIbItIng no lImItatIOns In the other three areas of the sectIOn. By letter dated Apnl 23 1998 the claimant was sent the folloWIng confirmatIOn of the demal of hIS claim We have receIved Dr Cashman's report wIth regard to the Independent MedIcal EXamInatIOn whIch took place on Apnl 9 1998 ThIS report has been revIewed In conJunctIOn wIth ManulIfe's PsychIatnc MedIcal Consultant. Based on the medIcal InfOrmatIOn on file, there IS InSUfficIent medIcal eVIdence to substantIate your claim for a contInUOUS total dIsabIlIty Dr Cashman's report descnbes a work-related conflIct that IS a source of anger for you, however clImcal eVIdence does not support the eXIstence of a totally dIsablIng psychIatnc dIsorder The mental status exam IndIcated that there was no eVIdence of thought dIsorder no perceptual abnormalItIes, and no hallucInatIOns Your thInkIng was descnbed as clear but dIffuse CogmtIve functIOns were Intact and your InsIght and Judgment were descnbed as average Dr Cashman dId note that you appeared anxIOUS and preoccupIed wIth your work-related Issues Although Dr Glancy's report dated February 16 1998 stated that you suffered from a maJor depressIve epIsode wIth paranOId features, Dr Cashman notes that there IS no eVIdence of lIfe long paranOId personalIty style and that your verSIOn of the events at MimIco CorrectIOnal Centre are wIthIn the realm of possIbIlIty Your depressIOn IS described as beIng not severe, and your score on the Global Assessment Scale whIch measures your level of functIOmng, IS noted as beIng between 60 and 70 ThIS score IS IndIcatIve of some mIld symptoms, but generally normal functIomng. A Mental ResIdual FunctIOnal CapacItIes Assessment completed by Dr Cashman notes no eVIdence In most areas of mental functIOmng, wIth the exceptIOn of marked lImItatIOns WIth regard to dealIng wIth your co-workers Dr Cashman's recommendatIOns wIth regard to your treatment have been forwarded to Dr Glancy As the current medIcal eVIdence IS not IndIcatIve of a total dIsabIlIty as defined by the polIcy your claim remaInS demed. CLAIM # 71064 Mr G.D's claim for benefits was removed from the JIBRC table on May 12, 1998 and was forwarded to me for reVIew SUBMISSIONS OF THE PARTIES Mr Don MartIn, for the Umon, submItted that the claimant was unable to work because of stress, anxIety and depressIOn due to problems In the workplace It IS Immatenal the cause of hIS problems The Issue IS whether he was fit to work In the CIrcumstances It was stated that the nature of hIS Job IS very relevant to the questIOn of hIS abIlIty to work. His Job reqUIres trust In hIS co-workers and very good concentratIOn concermng the atmosphere and attItudes of the Inmates His physIcIan and the Independent MedIcal EXamInatIOn agreed that he could not perform those dutIes as a result of hIS Illness A reVIew of the Job dutIes the Employer set out In the Employer's Statement IS proof of the InabIlIty of the claimant to be attentIve to several aspects of the Job Even theIr own semor medIcal consultant appealed to the Insurer to grant the claimant long term sIckness benefits because he dId not belIeve he was capable of performIng hIS Job dutIes Dr Glancy's medIcal OpInIOn of the claimant's condItIOn IS clearly stated In hIS letter of February 16 1998 He stated that Mr G.D suffered from a maJor depressIve epIsode wIth paranOId features and that he was unfit to return to work. He IS famIlIar wIth the claimant, has treated hIm over a penod of tIme and IS In the best posItIOn to determIne hIS state of health Mr Baker counsel for the Employer submItted that the reports before me do not IndIcate a dIagnosIs of total dIsabIlIty Dr FInkelsteIn was of the VIew that the claimant could not return to hIS former work sItuatIOn but dId no companson of the claimant's symptoms wIth the dutIes of hIS posItIOn. Even hIS comments about the claimant's work sItuatIOn at MimIco are vague and do not relate to hIS symptoms His faIlure do to so negates any OpInIOnS he has concermng a return to work. Dr River dId not relate the claimant's symptoms to the Job dutIes of a correctIOnal officer and, In any event, descnbed hIS symptoms as moderate and IntermIttent, hardly consIstent WIth a findIng of total and contInUOUS dIsabIlIty The Umon relIes on the reports of Dr Glancy whIch, In the OpInIOn of the Employer are InCOnsIstent and unrelIable It was submItted that there was a sIgmficant lapse In tIme between the July reports of Dr FInkelsteIn and Dr River and the first appoIntment wIth Dr Glancy In September of 1997 There IS no eVIdence of contInUOUS treatment dunng that lapse AgaIn, Dr CLAIM # 71064 Glancy makes no companson between the claimant's condItIOn and hIS actual Job dutIes He comments about the claimant's problems wIth socIal and famIly InteractIOns, whIch are not relevant to hIS abIlIty to perform hIS dutIes It was argued that Dr Glancy's reports are Internally InCOnsIstent and IndIcate hIS lack of attentIOn when completIng them He admItted In hIS second report that he had not gIven the matter senous thought when he completed hIS first report and he revIsed It WIth the IntentIOn of changIng the Insurer's mInd about the demal of benefits He also acknowledged that he does not use the GAF dIagnostIc scale regularly and therefore hIS scores cannot be gIven the same consIderatIOn as Dr RIver or Dr Cashman's AddItIOnally It was Said that the first report from Dr Glancy IndIcated some Improvement In cogmtIve thInkIng but hIS second report IS lackIng In any IndIcatIOn of the claimant's response to treatment, whIch would have been helpful In determInIng the contInUOUS nature of hIS dIsabIlIty The Employer submItted that, based on the medIcal eVIdence before It, It came to the nght conclusIOn when It decIded to deny long term benefits to the claimant. REASONS FOR DECISION Under the collectIve agreement between the partIes, Long Term Income ProtectIOn (LTIP) benefits commence after a qualIficatIOn penod of 6 months from the date an employee becomes totally dIsabled. Total dIsabIlIty IS defined as the "contInUOUS InabIlIty as the result of Illness, mental dIsorder or InJury of the Insured employee to perform the essentIal dutIes of hIS or her normal occupatIOn dunng the qualIficatIOn penod, and dunng the first twenty-four (24) months of the benefits penod and thereafter dunng the balance of the benefit penod, the InabIlIty of the employee to perform the essentIal dutIes of any gaInful occupatIOn for whIch he or she IS reasonably fitted by educatIOn, traInIng or expenence" That IS the test an employee must meet In order to succeed In a claim for L TIP benefits In the case of Mr G.D he was off work for SIX months of the qualIficatIOn penod for an anxIety dIsorder and depressIOn. KnowIng that those short term benefits would expIre In July of 1997 he applIed for LTIP benefits In June whIch were subsequently demed on the basIs that the medIcal eVIdence dId not meet the test of total and contInUOUS dIsabIlIty as set out above The first request from the Insurer to hIS famIly physIcIan resulted In a report In July of 1997 that descnbed Mr G.D as beIng emotIOnally upset and frustrated by the tensIOn at hIS workplace whIch affected hIS InteractIOn wIth hIS co-workers and supervIsor He had been seen monthly by Dr FinkelsteIn and although hIS condItIOn was descnbed as stable at the tIme he was referred to Dr Rivers, a psychologIst, for further treatment. CLAIM # 71064 A report ten days later from Dr RIvers to the Insurer IndIcated that he had seen the claimant four tImes between May and July and found hIm to be an artIculate and motIvated IndIVIdual who had been functIOmng well untIl recently when he began to feel the stress bUIldIng at work and felt unable to work wIth the detenoratIng relatIOnshIp between management and the employees He descnbed the claimant's symptoms as moderate and IntermIttent but noted as well that the precIpItatIng factors at the workplace, to the extent they eXIsted, caused hIS InabIlIty to contInue workIng In that envIronment. No companson was made to the dutIes of the claimant's posItIOn and hIS condItIOn and the report was eqUIvocal about hIS dIsabIlIty Dr RIvers commented on the claimant's stated InabIlIty to return to work but dId not make It clear whether he agreed wIth hIm In consIdenng the applIcatIOn for benefits, the Insurer Interpreted Dr FinkelsteIn's comment about the claimant's condItIOn beIng stable and Dr Rivers' comments about the moderate and IntermIttent nature of the claimant's symptoms as proof that he dId not meet the test of total dIsabIlIty It IS InterestIng to note that the demal of L TIP benefits by the Insurer prompted a referral by the Employer to a psychIatnst. That referral was made out of a mutual concern of the Umon and the Employer about the claimant's mental condItIOn. The Employer was uneqUIvocally of the VIew that Mr G.D was unfit to return to hIS dutIes as a correctIOnal officer It IS also sIgmficant that the referral was made by the Semor MedIcal Consultant for the Mimstry clearly someone who was famIlIar wIth the Job dutIes of the correctIOnal officers and had more than a layman's knowledge of mental dIsorders He mIght not have the expert knowledge of a psychIatnst or psychologIst but hIS OpInIOn on the claimant's abIlIty to perform the dutIes of hIS Job cannot be Ignored. His appeal to the Insurer was also based on hIS InterpretatIOn of Dr Glancy's first report of December 11 1997 In that report Dr Glancy dIagnosed the claimant as suffenng from a maJor depressIve epIsode wIth paranOId Ideas, probably sItuatIOnal In nature He rated hIm between 60- 70 on the GAF scale whIch the Insurer explaIned In ItS letter to the claimant, sIgmfied some mIld symptoms or some dIfficulty In several areas of functIOmng but was not eVIdence of a totally dIsablIng psychIatnc Illness Dr Glancy clearly felt a clanficatIOn of hIS earlIer letter was reqUIred In the CIrcumstances In that revIsed OpInIOn, he adJusted hIS GAP score to 31- 40 whIch ImplIes some Impairment In realIty testIng or commumcatIOn or maJor Impairment In several areas such as work or school, famIly relatIOns, Judgment, thInkIng or mood. The Employer has argued that thIS revIsed report CLAIM # 71064 should cast doubt on the relIabIlIty of both reports Dr Glancy had confessed In thIS second report that he dId not gIve the GAP scale much thought In hIS first report and that he dId not use It WIth any regulanty In hIS practIce AddItIOnally he suggests the claimant's score mIght be at the lower range of the scale because of hIS paranOId Ideas but then gIves hIm a score of 40 wIthout any explanatIOn of how he had arnved at hIS conclusIOn. His score IS InCOnsIstent WIth those of Dr Rivers and Dr Cashman and, In the Employer's VIew the bases for both of hIS reports are unrelIable and should be reJected. In my VIew that IS too ngId a VIew of Dr Glancy's letter of February 16 1997 He wrote an OpInIOn letter that was found to be lackIng In specIfics and when he was advIsed that the claimant had been demed benefits, he reconsIdered hIS approach. He acknowledged that he dId not use the GAP scale on a regular basIs and suggested that clImcIans do not consIder the scale to be a valId and relIable tool Because the Insurer relIed on the GAP score, he reconsIdered hIS prevIOus OpInIOn In an effort to assIst the claimant In hIS appeal Nevertheless, Dr Glancy's GAP score of 40 IS InCOnsIstent WIth the symptoms attributable to that range on the GAP scale and wIth hIS own descnptIOn of the claimant's actual symptoms A descnptIOn of the tests used by the clIamant's physIcIans IS found In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) publIshed by the Amencan PsychIatnc ASSOCiatIOn, WashIngton, D C The MultIaxIal Assessment, as the name ImplIes, Involves an assessment of a patIent on the folloWIng five aXIS AXIS I ClImcal DIsorders - Other condItIOns that may be a focus of clImcal attentIOn. AXIS II PersonalIty DIsorders - Mental RetardatIOn. AXIS III General MedIcal CondItIOns AXIS IV PsychosocIal and EnvIronmental Problems AXIS V Global Assessment of FunctIOmng It IS Said that the multI aXI al system provIdes a convement format for orgamZIng and commumcatIng clImcal InformatIOn, for captunng the complexIty of clImcal sItutatIOns and for descnbIng the heterogeneIty of IndIVIduals presentIng wIth the same dIagnosIs The first AXIS deals wIth clImcal dIsorders such as delenum, dementIa, substance related dIsorders, schIzophrema and other pSYChOtIC dIsorders, anxIety somatoform, factItIOus, dIssacIatIve, sexual, gender eatIng, sleepIng, adJustment dIsorders and other condItIOns that mIght be the focus of clImcal attentIOn. In thIS case the claimant was found to have a maJor depressIOn- sIngle epIsode The second AXIS deals wIth personalIty dIsorders and mental retardatIOn and Includes paranOId, SChIZOId, antIsocIal schIzotypal, borderlIne personalIty hIstnomc, narCIsstIC aVOIdant, dependent and obsessIve-compulsIve dIsorders The thIrd AXIS refers to general medIcal condItIOns relevant to the understandIng or management of the patIent's mental dIsorder whIch CLAIM # 71064 dId not eXIst In thIS case AXIS IV IS for reportIng psychosocIal and envIronmental problems that mIght effect the dIagnosIs, treatment and prognosIs of mental dIsorders descnbed In AXIS I and II. These would Include problems wIth pnmary support groups, problems related to the socIal envIronment, educatIOnal problems, occupatIOnal problems, hOUSIng problems, economIC problems, problem wIth access to health care servIces, problems related to the legal system or cnme and other pyschosocIal and envIronemental problems Dr Glancy noted that the claimant had problems wIth hIS pnmary support gruop occupatIOnal problems InvolvIng threat of Job loss, dIfficult workIng condItIOns and dIscord wIth hIS co-workers Finally AXIS V IS for reportIng the clImcIan's Judgement of the IndIVIdual's overall level of functIOmng. That IS done by USIng the Global Assessment of FunctIOmng Scale (GAF) whIch rates psychologIcal, socIal and occupatIOnal functIOmng. It IS generally used to rate current functIOmng. The scale ranges from a low of one to one hundred. A patIent who scored from one to thIrty on the scale would be senously Impaired and unable to functIOn In almost all areas The most common scores fall between 30- 70 USIng the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DMS-IV) the meamng of the vanous levels IS a follows 31-40 Some impairment in reality testing or communication (e g. speech IS at tImes IllogIcal, obscure, or Irrelevant) OR major impairment in several areas, such as work or school, family relations, judgement, thinking or mood (e g. depressed man aVOIds fnends, neglects famIly and IS unable to work; chIld frequently beats up younger chIldren, IS defiant at home, and IS faIlIng at school) 41-50 Serious symptoms (e g. sUIcIdal IdeatIOn, severe obsessIOnal ntuals, frequent shoplIftIng) OR any serious impairment in social, occupational or school functioning (e g. no fnends, unable to keep a J ob) 51-60 Moderate symptoms (e g. flat affect and cIrcumstantIal speech, occasIOnal pamc attacks) OR moderate difficulty in social, occupational or school functioning (e g. few fnends, conflIcts WIth peers or co-workers) 61-70 Some mild symptoms (e g. depressed mood and mIld Insomma) OR some difficulty in social, occupational or school functioning (e g. occasIOnal truancy or theft wIthIn the household) but generally functioning pretty well, has some meaningful interpersonal relationships. The first assessment by Dr Glancy resulted In a GAP score of 60-70 whIch would IndIcate some mIld symptoms but an abIlIty to functIOn. He later revIsed that to a score of 40 whIch IS sIgmficantly more senous a dIagnosIs and IS not supported by the symptoms descnbed by Dr Glancy Dr River and Dr Cashman. There has been no suggestIOn that the claimant had any Impairment In realIty testIng or maJor Impairment In hIS relatIOnshIp wIth famIly and fnends Dr CLAIM # 71064 River found hIS thInkIng to be clear and found no suggestIOn of sUIcIdal Intent or mood dIsorder He found some dIsruptIOn In personal relatIOnshIps but moderate and IntermIttent symptoms generall y He gave hIm a GAF score of 58 whIch IS consIstent WIth hIS findIngs Dr Cashman descnbed the claimant as "sad" but wIthout any "feelIng of ImpendIng doom" He was "not aVOIdant because of hIS anxIety but does stay home because he does not feel lIke gOIng out" He found hIm to be onented as to tIme and place WIth no thought dIsorder or perceptual abnormalItIes He had clear but dIffuse thInkIng, hIS cogmtIve thInkIng was Intact and hIS InSIght and Judgment was average He descnbed hIS depreSSIOn as mIld and as not preventIng hIm from functIOmng. He rated hIm at 60-70 on the GAF scale, whIch IS conSIstent WIth hIS findIngs Dr Glancy's score of 40 IS entIrely out of lIne WIth the GAP scores of the other treatIng phYSICIans and IS SImply not supported by any of the medIcal reports, IncludIng hIS own. I accept hIS first GAF score of 60-70 as more IndIcatIve of the claimant's general condItIOn, especIally SInce It IS In keepIng WIth the ratIngs of Dr RIver and Dr Cashman. However a GAP score In and of Itself IS not determInatIve of the questIOn before me but IS one of the factors to be conSIdered In reachIng a findIng of total dIsabIlIty Its usefulness must be evaluated on the baSIS of the medIcal InfOrmatIOn avaIlable and mIght result In dIfferent conclUSIOns on a case by case baSIS For example, a GAF score of 60-70 would appear to suggest moderate symptoms that do not Interfere WIth functIOmng. However the symptoms descnbed by Mr G.D' S phYSICIans are not necessanly conSIstent WIth that ratIng. As well, It would appear that a phYSICIan could rate a patIent at 60 on the GAF scale and stIll opIne that he could not return to work. In thIS case, the dIspanty between Dr Glancy's first and second ratIng IS further proof of the danger of relYIng on the score alone as the determInIng factor In deCIdIng whether someone IS suffenng from a dIsablIng condItIOn. The appropnate questIOn IS how the claimant's symptoms related to hIS abIlIty to perform the dutIes of hIS pOSItIOn. The Insurer relIed heavIly on the Independent MedIcal EXamInatIOn by Dr Cashman. Dr Cashman found the claimant to be preoccupIed WIth hIS sItuatIOn at MimIco clear but dIffuse about the detaIls, WIth Intact cogmtIve functIOns and average InSIght and Judgment. His sItuatIOn at the workplace had become the maJ or focus of hIS lIfe "He wIll not let It go He wIll not return to work." Because of those CIrcumstances at work he was suffenng from a mIld depreSSIOn whIch dId not prevent hIm from functIOmng. Dr Cashman also descnbed the preCIpItatIng and perpetuatIng factor In hIS dIsabIlIty as work. His dIagnOSIS was AdJustment DIsorder WIth depressed mood. He declIned to make a dIagnOSIS of paranOId personalIty because there was no eVIdence of a lIfe long paranOId personalIty and because he was not delusIOnal He dId belIeve some of hIS Ideas were IrratIOnal, such as hIS tenuous lInk between ManulIfe and the government, but descnbed these attItudes as overvalued. Dr Cashman prescnbed CLAIM # 71064 psychotherapy to help Mr G.D recogmze the unlIkelIhood of success In hIS purSUIt of JustIce and pharmacotherapy to reduce the IntensIty of hIS thoughts His prognosIs was that wIth that treatment there was a possIbIlIty of Improvement. However If the claimant persIsted In hIS sItuatIOn at MimIco he would contInue to be unhappy and uncomfortable FInally he stated that Mr G.D was motIvated to return to work as long as he dId not expenence persecutIOn and then stated that he would be unwIllIng to tolerate a return to work. His overvalued Ideas would make It dIfficult to return to MimIco I find Dr Cashman's report to be confusIng. He descnbes a man who IS totally preoccupIed, to use hIS words, on the wrongs that have been done to hIm at work. The claimant feels that the Insurer IS In a conspIracy WIth the government to deny claims and keep costs down. Semor management at the correctIOnal InstItute and the Umon have faIled to gIve hIm the support he needs and he IS under constant pressure at work from both of them AccordIng to Dr Cashman, he could have gone on for hours about hIS problems and he was confused and ramblIng about the detaIls The claimant told Dr Cashman that he had been "screwed" and that "everyone has turned theIr back on me" Dr Cashman noted that the claimant was anxIOUS and had been to the emergency tWIce In the last 6 months wIth palpItatIOns He told Dr Cashman that he was Isolated from everyone and that he has no fnends, "He IS In a sad sItuatIOn" WhIle Dr Cashman describes the claimant's depreSSIOn as mIld, he also stated that hIS overvalued Ideas would make It dIfficult for hIm to return to MimIco He marked on the Mental ReSIdual FunctIOnal CapacIty Assessment that the claimant was markedly lImIted In hIS abIlIty to accept InstructIOns and respond appropnately to feedback from supervIsors, hIS abIlIty to get along WIth coworkers or peers WIthout dIstractIng them or exhibItIng behavIOural extremes and hIS abIlIty to respond to changes In the work settIng. To be elIgIble for LTIP benefits the claimant must prove that he was totally dIsabled from performIng the essentIal dutIes of hIS own occupatIOn. As a correctIOnal officer he IS responSIble for the safety and dIsCIplIne of hIS co-workers and the Inmates He must warn and counsel Inmates about theIr behavIOur report mIsconduct and make wntten and oral reports on hIS findIngs He must be aware of the attItudes of the Inmates and hIS coworkers He must trust hIS coworkers In the CIrcumstances It IS hard to Image how the claimant can do that. He contInues to belIeve the management of the InstItutIOn, hIS coworkers and hIS Umon are agaInst hIm and he wants VIndIcatIOn before he can return to work and face them. If Dr Cashman IS of the VIew he wIll have marked lImItatIOns In hIS abIlIty to accept InstructIOn and respond POSItIvely to hIS CLAIM # 71064 supervIsors, one wonders how he could return to work In the very settIng and wIth the same people who precIpItated hIS condItIOn, factually or perceptIOnally Dr Cashman has recogmzed these lImItatIOns but seems to attnbute them to the claimant's unwIllIngness to accept hIS sItuatIOn realIstIcally rather than to any medIcal condItIOn. Dr Rivers and Dr Glancy on the other hand, have accepted hIS dIfficulty at work as part of hIS medIcal condItIOn, or at least as a contnbutIng factor In hIS InabIlIty to return to work for medIcal reasons The test for total dIsabIlIty does not reqUIre a reason for the dIsabIlIty only a dIagnosIs of a medIcal condItIOn that results In an InabIlIty to return to work. In thIS case the claimant has been dIagnosed by two treatIng practItIOners as suffenng from depressIOn and anxIety and who have stated clearly that he IS unable to return to hIS former workplace, notwIthstandIng theIr agreement on a GAF score of 60-70 The medIcal consultant from the Mimstry who IS famIlIar wIth the dutIes of a correctIOnal officer was also convInced that the claimant should not return to work at the tIme There IS no reason for me to reJect theIr OpInIOnS They are In the best posItIOn to determIne Mr G.D's abIlIty to wIthstand the stresses of the workplace Dr Cashman used the words " unhappy and uncomfortable" to descnbe the claimant's attItude of the sItuatIOn at MimIco and suggested that he was In a "sad sItuatIOn" Those mIld words are InCOnsIstent WIth hIS VIew that the claimant "wIll not let It go' and "wIll not return to work" AccordIng to the GAP the claimant suffers from moderate symptoms or moderate dIfficulty In socIal and occupatIOnal functIOmng. It would appear from the medIcal reports that IS true In all respects except for the workplace His attItude towards hIS employer and hIS co-workers would make a return to work Impossible so long as these feelIngs contInue There IS no doubt that the claimant could not return to work WIthout addItIOnal counsellIng and treatment. He therefore, at the tIme, met the defimtIOn of total dIsabIlIty as defined In the polIcy and I therefore uphold the appeal Dated thIS 10th day of December 2000 Loretta Mikus CLAIM # 71064 CLAIM # 71064