HomeMy WebLinkAbout2001-42744 Benefits Claimant 01-02-07 Decision
In the matter of an Appeal
Before
The Subcommittee of the
JOint Insurance Benefits Review Committee
Regarding Claim #42744
Chair: Felicity D. Briggs
Appearing for the Union: Don Martin
Marg Simmons
Appearing for the Employer: Yasmeena Mohamed
Jennifer Evans
ClaIm#42744 1
Included In the most recent collectIve agreement between the partIes are the folloWIng
provIsIOns
Article 22 - Grievance Procedure
Article 22.9 - Insured Benefits Grievance
229 1 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 2 Any other complaInt or dIfference shall be referred to the Claims
ReVIew SubcommIttee of JOInt Insurance Benefits RevIew
CommIttee (JIBRC), establIshed under AppendIx 4 (J OInt
Insurance Benefits RevIew CommIttee) for resolutIOn.
Appendix 4
JOINT INSURANCE BENEFITS REV IEW 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
ClaIm#42744 2
4 Duties of the Committee
The dutIes of the CommIttee shall consIst of the folloWIng
- 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 only)
- DetermInatIOn of the manner In whIch the specIficatIOns wIll be made avaIlable
for publIc tendenng;
- ConsIderatIOn and eXamInatIOn of all tenders submItted In response the
specIficatIOns for tender and preparatIOn of a report thereon,
- RecommendatIOn to the Government of Ontano on the selectIOn of the Insurance
carner or carners to underwnte the Group Insurance Plans,
- ReVIew of the semI-annual financIal reports on the Group Insurance Plan, and
- 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
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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
(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
"L TIP") 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.
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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
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
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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
The medIcal consultants wIll provIde InfOrmatIOn on the nature 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
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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.
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.
It was prevIOusly agreed by the partIes that a decIsIOn should sImply IndIcate whether a
claim was properly or Improperly demed. The Chair IS to refraIn from elaboratIng on the
quantum of the remedy but rather remaIn seIzed. Subsequent to the Issuance of the
decIsIOn the partIes wIll negotIate and execute a memorandum of agreement that wIll
Include the appropnate remedy
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
when consensus was not achIeved. 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 Loretta Mikus and I
were asked to act as the thIrd party or Independent chair
ClaIm#42744 7
In the Instant matter the claimant, Ms D.D has been employed SInce 1991 wIth the
Mimstry of Labour as an admInIstratIve clerk. After returmng from maternIty leave In
1994 Ms D.D expenenced dIfficultIes reIntegratIng Into the workforce She was also
havIng a number of personal famIly problems Her last day of work was August 31 1994
At that tIme she was dIagnosed wIth depressIOn. She receIved short term Income
protectIOn and was later accepted for L TIP The penod of coverage for dIsabIlIty from her
own occupatIOn ended on March 31 1997 and she contInued reCeIVIng benefits untIl June
30 1998 She ultImately returned to work on October 30 1999 ThIS claim, therefore, IS
lImIted to approxImately sIxteen months of L TIP all of whIch occurred the "any
occupatIOn" penod.
On January 19 1995 Dr M.T the claimant's attendIng physIcIan stated on the first
applIcatIOn for LTIP that Ms D.D suffered from depressIOn. Her symptoms were lIsted
as "sleep dIsturbance, anorexIa depressed mood, G I. DIstress" Dr M. T stated that she
was totally dIsabled from her own or any occupatIOn at that tIme and he was unsure of her
prognosIs
Although It IS wntten much later In tIme, a good reVIew of her Illness and sItuatIOn was
set out In a consultatIOn report dated June 17 1998 by Dr C.P That letter stated
I saw Ms D.D today In the Mood DIsorder ClImc for Dr M.N who had seen her
prevIOusly but was unavaIlable As you know she IS a 37 year old marned woman
wIth a four year old son. She worked as an admInIstratIve assIstant In the Mimstry
of Labour pnor to her sIck leave about 4 years ago She said that she had
requested the appoIntment because she was lOSIng her drug coverage and wanted
to know whether there were any cheaper herbal remedIes for depressIOn.
You have copIes of prevIOUS reports so I wIll confine thIS to the relevant current
InformatIOn. The hIStOry of DysthymIc DIsorder wIth a MaJor DepressIve epIsode
that began when her son was about 8 months old. ThIS was shortly after her return
from maternIty leave to find a number of changes In the workplace she has been
treated by several psychIatnsts, more recently by Dr M.T and It was qUIte a loss
when he retIred a few months ago She sees a therapIst at Halton FamIly ServIces
and wIll have you momtor the medIcatIOn.
Dr M.N last recommended that PaxIl be Increased slowly and Ms D.D has now
been takIng PaxIl 60 mg. for several months, along wIth Trazodone 50 mg. Her
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ImpreSSIOn IS that thIS cOmbInatIOn has not Improved her mood. She feels tIred
and apathetIc, sleeps a lot, has dIfficulty wIth concentratIOn and memory and
feels angry and dysphonc almost all the tIme She IS socIally wIthdrawn, fearful of
beIng seen, and at tImes hopeless, but not sUIcIdal She eats fast food because she
has no Interest In cookIng, and thIS has led to a large weIght gaIn In the last three
years She has occasIOnal pamc attacks that occur In new places, and she aVOIds
gOIng out or meetIng people She looks after her son for part of each day then
takes hIm to her mother's house She sews a lIttle, reads, often self-help
InformatIOn, and wntes her feelIngs In aJournal, but does very lIttle else
Ms D.D has Irntable Bowel Syndrome, headaches, and multIple thyrOId nodules
She has had kidney stones There IS no hIStory of mama, pSYChOSIS, self-
destructIve behavIOur and drug or alcohol abuse The only relevant famIly hIStOry
IS of alcoholIsm In her father
The last few years have been very stressful She and her husband stIll deal wIth
problems of access to hIS chIldren, and they went through a long legal battle She
found the responsIbIlItIes of havIng a chIld overwhelmIng at first, then was
angered by her treatment at work, later by the dIsabIlIty company There are many
examples of her vIctImIzatIOn, anger and sense of powerlessness Her dIfficultIes
make sense In the context of her recent dIsclosure of chIldhood sexual abuse by
her brother The lack of trust IS understandable, as IS her InterpretatIOn of ordInary
dISappOIntments as more eVIdence that the world IS agaInst her A recent example
was her gettIng a tIcket for dnvIng on the road shoulder because she was havIng a
pamc attack and wanted to get off the hIghway Another example IS the Insurance
company termInatIng her benefits because she dId not go along wIth theIr rehab
program Another one was an assumptIOn that FamIly ServIces would termInate
her therapy as soon as she was unable to pay These IncIdents are Interpreted as
betrayals She does not advocate effectIvely for herself, gets angry and then uses
these IncIdents as further eVIdence of her vIctImIzatIOn. She expects
dISappOIntment and to some extent, bnngs It on herself ThIS dIstortIOn regularly
leads to a downward spIral of depressIve, angry thoughts
Ms D.D says that her husband IS SupportIve and she has some help from her
famIly She values her therapy seSSIOns and IS complIant wIth therapeutIc
suggestIOns
When I saw her Ms D D was an overweIght woman, casually and neatly
dressed, but dIfficult to engage emotIOnally She was tearful throughout, was
ObvIOusly anxIOUS and appeared to be on guard, as If expectIng the worst. Her
anger was sharp and Just below the surface It was dIfficult to assess the seventy
of her depressIOn because she was so fearful of the IntervIew There was no
eVIdence of pSYChOtIC thought processes I dId not do formal cogmtIve testIng.
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I thInk that Ms D D fluctuates between MaJor DepressIOn and DysthymIc
DIsorder and that thIS has been gOIng on for the last four years It seems to have
been tnggered by her return, after maternIty leave, to a work envIronment where
she was not made to feel valued, and thIS set Into motIOn unhealthy responses that
she had learned early In lIfe Each lIfe stressor has strengthened her mIstrust and
made It very dIfficult for her to help herself She has occasIOnal pamc attacks that
are secondary to depressIOn. She reports that the PaxIl has not made any
dIfference Other antIdepressants, LudIOmIl and Zoloft were IneffectIve, and she
could not tolerate Effexor and Serzone
Before consIdenng another antIdepressant, you can try augmentatIOn of the PaxIl
She thought that thyrOId functIOn had been normal the last tIme It was tested over
a year ago but perhaps It needs testIng agaIn, consIdenng the multI-nodal gOIter
AugmentatIOn would be wIth Cytomel 25 to 50 mg. dally for 3 weeks or LIthIUm
900 to 1200 mg. for three weeks If there IS not a sIgmficant Improvement In
mood, you would change the antIdepressant. She has not responded to two SSRIs
so I would consIder a drug from another famIly a tncyclIc, MAOI or BupropIOn.
OccasIOnally It takes several tnals to find a drug that works
Pamc attacks are Infrequent, but there IS a lot of aVOIdance behavIOur whIch
should be addressed wIth cogmtIve-behavIOural psychotherapy IncludIng gradual
exposure to sItuatIOns that cause anxIety As Dr M.N suggested, she could
contact the Women's Centre and the CMHA for groups that deal wIth anxIety and
stress management. It IS a concern that her anger has caused her to reJect help She
asked her Insurance company to pay for more frequent therapy seSSIOns, and was
angry that they wanted to put her on a dIet and exerCIse program. I wondered
whether she had mIsInterpreted theIr IntentIOn, and whether she mIght benefit
from thIS kInd of practIcal help wIth mobIlIzatIOn. If she gets Into better eatIng
and actIvIty patterns, she wIll feel better and If she loses weIght her self esteem
wIll Improve In my OpInIOn that IS preferable to therapy that keeps her
dysfunctIOnal and mIred In the past, however she dId not agree wIth my
suggestIOns
I hope that Ms D.D has some relIef from these medIcatIOn suggestIOns, and that
she IS able to make use of the practIcal help she has been offered.
Ms D.D receIved LTIP for the full twenty four month penod of dIsabIlIty from her own
occupatIOn. The penod of dIsabIlIty from any occupatIOn began In March of 1997 In a
letter dated August 18 1997 the claimant was notIfied that her claim for contInued
elIgIbIlIty was beIng assessed. On an applIcatIOn for contInuIng benefits, dated September
16 1997 Dr M.N stated that the claimant was totally dIsabled from any occupatIOn and
It was unknown when she would be ready to return to work.
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In October of 1997 ManulIfe notIfied the claimant that It dId "not have sufficIent
InformatIOn to enable proper determInatIOn of benefit contInUatIOn" AccordIngly It
requested the Ms D D appear for an Independent medIcal assessment wIth Dr G T
That IntervIew took place and the Independent physIcIan wrote a lengthy consultatIOn
report dated October 30 1997 In addItIOn to seeIng the claimant, Dr G T was provIded
wIth a vanety of relevant documentatIOn IncludIng the attendIng physIcIan's statements,
prevIOus consultatIve notes from HamIlton PsychIatnc HospItal and Ms D.D 's Job
descnptIOn. I wIll set out relevant portIOns of that ten page document. It stated
The claimant descnbes a worsemng In her mood In the summer of 1994 After
returnIng to work from her maternIty leave, she found herself bored, feelIng
unapprecIated, wIth too much tIme on her hands She was expectIng to return to
her prevIOUS Job however the woman who had been hIred to replace her was kept
on. There wasn't enough work for two and she felt unchallenged and a "vIctIm of
office pOlItICS" She suggested that she be gIven a computer to do some of her
work at home but thIS was refused. She felt that the management was
unsym pathetI c
By October of 1994 It was clear that the FluoxetIne was not helpIng her She
was stIll cryIng and feelIng depressed and was havIng dIfficulty wIth sleep Her
weIght was now begInmng to clImb She had been 160 pounds before the baby
was born and was now 175 The FluoxetIne was stopped and she was started on
MaprotIlIne 150 mgs mghtly By February 1995 her weIght was 188 pounds and
her mood was no better Her famIly doctor referred her to a psychIatnst, Dr K, as
he also filled In an applIcatIOn for Canada PenSIOn Plan for long-term dIsabIlIty
because he felt she was makIng no progress The psychIatnst Dr K. changed the
medIcatIOn to ParoxetIne and gave her Clonazepam for sleep The ParoxetIne
seems to help wIth her depressIOn but Increased the frequency of her headaches
ThIS psychIatnst also "counselled me" but made her feel worse She went for only
three seSSIOns and then refused to contInue In March, 1995 her famIly doctor
referred her to Dr G a psychIatnst, who she saw for only one seSSIOn, refusIng to
see hIm agaIn, because he told her she was passIve-aggressIve ThIS doctor
suggested that she try Nefazodone whIch she could not tolerate due to a flu lIke
Illness She was then sWItched to VenlafaxIne, by her famIly doctor whIch
resulted In a rash.
Her famIly doctor Dr T then referred her to another psychIatnst, Dr B who
started her on SertralIne 100 mgs each mght and DoxepIn 75 mgs added to It. He
saw her from October 1995 to November 1996 He tned psychotherapy wIth her
However she felt that he was not understandIng and she had dIfficulty trustIng
hIm He referred her to the HamIlton PsychIatnc HospItal for consultatIOn where
ClaIm#42744 11
she has gone tWIce, once In September 1996 and once In September 1997 Dr N
of HamIlton PsychIatnc HospItal dIagnosed her as havIng a MaJor DepressIve
dIsorder and recommended to her famIly doctor that she be gIven ParoxetIne
startIng at 10 mgs slowly IncreaSIng to 40 mgs as tolerated. It was felt that the
ParoxetIne had produced the best effect for her depressIve symptoms and If the
dose was tItrated slowly she would not have the headaches that she had had
before It was also suggested that she try Trazodone at mghttIme startIng 50 mgs
It was also suggested LIthIUm may be used as an augmentor Dr N stressed she
find a psychotherapIst she could trust, to help her wIth her anger and self esteem.
Dunng all thIS tIme, her sadness, anhedoma, tearfulness, fatIgue and dIfficulty
concentratIng and makIng decIsIOns contInued. As well, her weIght has Increased
where she IS now over 200 pounds
It was In the fall of 1997 that her ParoxetIne went up to 30 mgs a day and two
weeks ago It was Increased to 40 mgs a day She has started wIth a socIal worker
at the counsellIng centre In BurlIngton and IS Just begInmng to trust thIS new
therapIst.
Affect
The patIent's affect was angry sad and anxIOUS Her stated affect was that she felt
angry about the IntervIew She felt that she was not gIven adequate InfOrmatIOn
about the IntervIew and was gIven the "round-around" by ManulIfe She had
wanted the tIme changed to the afternoon, and her request had been refused,
makIng her very angry She cned several tImes dunng the IntervIew especIally
when dISCUSSIng some of the stresses and frustratIOns she has expenenced.
DIagnosIs & FormulatIOn
AXIS I 1 Features of GeneralIzed AnxIety DIsorder
ThIS claimant descnbes a longstandIng condItIOn of exceSSIve worry IrntabIlIty
muscle tensIOn seen as headaches, and Irntable bowel It IS only recently
however that thIS worry and anxIety has caused clImcally sIgmficant dIstress In
Important areas of functIOmng. She has expenenced somatIc symptoms of
sweatIng, dry mouth, nausea, dIarrhea, and a lump In the throat. In the context of
the anxIety dIsorder she has had symptoms of pamc dIsorder
2 DysthymIc DIsorder
The claimant descnbes a five to eIght year hIStOry of dysphonc mood wIth
feelIngs of sadness, low energy low self-esteem, and dIfficulty makIng decIsIOns
3 MaJor DepressIve DIsorder - moderate - In partIal remISSIOn
It seems that In the fall of 1994 the claimant expenenced Increased symptoms of
depressed mood, tearfulness, problems wIth sleep anhedoma, fatIgue, weIght
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gaIn, dIfficultIes wIth concentratIOn and IndeCISIveness that met the cntena for a
MaJor DepressIve EpIsode
AXIS II. Traits of AVOIdant PersonalIty DIsorder The claimant has
longstandIng traits of aVOIdance of Interpersonal contact because of fear of
cntIcIsm, and shows dIStruSt In relatIOnshIps because of fear of beIng shunned.
AXIS III. 1 Irntable Bowel Syndrome
2 Headaches
3 ObesIty
AXIS IV 1 OccupatIOnal problems - Job dIssatIsfactIOn
2 EconomIc problems - Inadequate finances
AXIS V Global Assessment of FunctIOmng - current - 60
In your opinion, is the psychiatric management optimal and designed to
facilitate a return to work?
In my OpInIOn, her psychIatnc management IS optImal PsYChOtropIC medIatIOn
treatment IS optImal, although she IS presently takIng too much mghttIme sleep
medIcatIOn and It should be cut In half She IS not currently been seen by a
psychIatnst, expect for yearly VISItS to the HamIlton PsychIatnc Centre She has
not had more successful relatIOnshIps wIth the three psychIatnsts her famIly
doctor has sent her to I feel more psychIatnc consultatIOns would serve to make
her feel "sIcker" and to prolong her condItIOn. She IS seeIng a socIal worker now
and her medIcatIOn IS handled by her famIly doctor It seems to be that the therapy
IS not pnmanly to facIlItate a return to work but to help her deal more effectIvely
wIth her anger guIlt, lack of trust, lack of motIvatIOn, and lack of physIcal
actIvIty' her psYChOtropIC medIcatIOn IS desIgned to deal wIth the depressIOn,
anxIety and pamc and she IS slowly respondIng to It. Her DysthymIa IS
longstandIng, and does not prevent her from returmng to the workforce
In your opinion, is it likely this illness will result in functional improvement
sufficient to enable the claimant to return to the pre-disability job. When do
you anticipate such improvement will occur?
In my OpInIOn, thIS claimant IS ready to start a rehabIlItatIOn program on a part-
tIme baSIS, preferably mornIngs It IS dIfficult to say at present If she would be
able to do her pre-dIsabIlIty Job However the prognosIs for thIS IS fair gIven that
she would progress In a step-wIse fashIOn. I would antIcIpate that she would be
able to work In her pre-dIsabIlIty Job or a sImIlar work condItIOn In another
workIng envIronment In June of 1998
In your opinion, is motivation affecting the return to work? Is motivation
related to psychiatric illness?
I feel that motIvatIOn affects her return to work. The claimant feels that she was
caught In office POlItICS after her return to work In June, 1994 She was angry and
upset, and had left her baby to return to a dIfficult work posItIOn. I feel thIS
contributed to her leavIng work and contnbutes to her not returmng.
ClaIm#42744 13
Although she stIll feels herself unable to antIcIpate when she would be able to
start work or begIn a back to work program, she does state that thIS In her plan
sometIme In the future
In your opinion is there sufficient clinical impairment to totally disable this
claimant for (sic) performing the pre-disability job or similar work in
another working environment?
In my OpInIOn, thIS claimant IS not totally dIsabled from performIng her pre-
dIsabIlIty Job or sImIlar work In another workIng envIronment. As stated
prevIOusly she remaInS partIally dIsabled but could begIn a back to work
rehabIlItatIOn program on a part tIme basIs
ManulIfe based ItS deCIsIOn to dIscontInue the claimant's benefits on thIS IME Ms D D
was Informed In a letter dated January 21 1998 that her benefits would end as of June 30
1998
As has been mentIOned above, the claimant was seen by Dr M.N a psychIatnst at
HamIlton PsychIatnc HospItal on November 16 1996 and September 16 1997 and
February 11 1998 In her consultatIOn report of September 16 1997 she stated that
I do not feel thIS patIent IS ready to return to work at thIS tIme, gIven the fact that
she has not responded adequately to any tnal wIth antIdepressants so far and
because her functIOmng IS qUIte affected by her depressIve symptoms She shows
no sIgmficant Improvement In her condItIOn and also appears to be resIstant to
treatment. GIven the chromcIty of the depressIve and anxIety symptoms, the
prognosIs IS guarded.
Dr M.N 's consultatIOn note dated February 11 1998 stated the folloWIng
Thank you for refernng Ms D D for a treatment reVIew She was first seen by
me In November 1996 and then agaIn In September 1997 Ms D D has been
dIagnosed wIth maJor depressIve epIsode, chromc, recurrent, and dysthymIa.
Ms D D stated that currently she IS takIng PaxIl 50 mg, and IS toleratIng thIS
well wIthout sIde effect. She stated that after her last VISIt WIth me she was put on
Trazodone 50 mg at mght to help her sleep dIsturbance, and she took thIS for one
month. Her sleep Improved consIderably and she expenence a lIttle Improvement
In her abIlIty to look after household chores wIth some "ambItIOn to do thIngs"
Although she dId not expenence sIgmficant Improvement In her depressIve
symptoms, she defimtely notIced a posItIve change on the cOmbInatIOn of
Trazodone and PaxIl whIch she attnbuted to better sleep Later It was stopped.
Apparently Ms D D was sleepIng too much on the cOmbInatIOn of Trazodone
and PaxIl She stated she was sleepIng approxImately mne to ten hours at mght.
ClaIm#42744 14
Later she was started on LIthIUm whIch she was unable to tolerate and she
descnbed thIS as havIng "seIzures" She would be able to take CarbolIth for only
three weeks wIth several sIde effects, e g. shortness of breath, she would
expenence moments when she would stop talkIng or dOIng thIngs and would not
know what was gOIng on around her Her LIthIUm level was 04 therefore, she
contInued wIth the PaxIl only The LIthIUm augmentatIOn was In December 1997
Ms D D complaIned of all her prevIOUS depressIve symptoms, e g. that she was
feelIng qUIte depressed and sad, cryIng qUIte frequently She feels exhausted all
day long, has no motIvatIOn to do thIngs, and has to push herself very hard to get
the easy thIngs done She complaIns of sleep dIsturbance, all phases of sleep are
affected, and she also has mghtmares almost every mght. She feels qUIte anxIOUS
and vulnerable, and she has paSSIve sUIcIdal thoughts, however she stated she
would never kIll herself because the only reason she IS strugglIng wIth thIS IS
because of her commItment to her famIly
Ms D D IndIcated that her ongOIng stressors wIth her husband's legal problems
wIth hIS ex-wIfe contInue, and also she IndIcated that In October 1997 the
Insurance company sent her for an assessment to an Independent medIcal
specIalIst. She perceIved thIS as rather dIsturbIng, especIally as soon after that she
receIved a letter from the Insurance company statIng that she was ready to go back
to work and they wanted her to start on a part tIme basIs first, and later Increase It
to full tIme She was very dIstressed about thIS and the faIlure of these
professIOnals to understand her sItuatIOn. She contacted the umon two weeks ago
and IS hopIng to receIve some support from them
On eXamInatIOn, Ms D D was a 36 year old woman who was casually dressed
and appeared dIsheveled. She appeared very sad and tearful throughout the
IntervIew She descnbed her mood as anxIOUS and down. She showed no eVIdence
of pSYChOtIC symptoms or gross cogmtIve Impairment. She demed thoughts of
hurtIng herself or others Her InsIght and Judgment appeared appropnate
DIagnostIc ImpressIOn.
Her dIagnosIs remaInS maJor depressIOn, chromc recurrent, and dysthymIc
RecommendatIons.
I understand that Ms D D has expenenced mIld Improvement on the addItIOn of
Trazodone 50 mg at mght to her PaxIl 50 mg per day I feel that thIS patIent
should be gIven another chance wIth thIS cOmbInatIOn, gIven that her sleep
dIsturbance IS makIng her depressIOn a lot worse, and the above cOmbInatIOn
appeared to be useful I would certaInly explore thIS first before consIdenng her a
candIdate for shock treatment at thIS pOInt. I thInk that PaxIl may be Increased
from 60 mg to even 80 mg per day If tolerated well, In addItIOn to Trazodone 50
ClaIm#42744 15
mg at mght. If thIS cOmbInatIOn IS not effectIve wIthIn two months, then I thInk a
reassessment would be IndIcated In terms of the next treatment step
In terms of her abIlIty to return to work, my OpInIOn IS that thIS patIent IS not ready
to return to work, gIven that there has not been a sIgmficant change In her maJor
depressIOn. She has a good relatIOnshIp wIth her therapIst whIch appears to be
helpful for the patIent; however she would need to expenence more Improvement
In her depressIve symptoms before she would have a chance to perform at work.
The claimant receIved a letter from the claims adJudIcator assIgned to her file dated June
29 1998 It stated, In part
Further to your letter of June 18 1998 and your verbal conversatIOn wIth Claims
AdJudIcator V S ManulIfe FinancIal would lIke to address some of the concerns
you have raised.
. The Report from Dr G T states "In my OpInIOn, thIS claimant IS not totally
dIsabled from performIng her pre-dIsabIlIty Job or sImIlar Job In another
workIng envIronment" She states that you remaIn partIally dIsabled and could
begIn a return to work on a part tIme basIs You are not totally dIsabled under
the terms of the PolIcy and ManulIfe was prepared to offer you an adaptatIOn
penod from - Jan 28 to June 30 1998 as well as a work tnal program
. The program at MedWorks IS called Workfit. It has both a work and a physIcal
component whose Intent IS to not only re-Introduce the clIent to work tasks,
but to buIld up stamIna to the level of a regular day after an absence from the
work force The hours and length of program can be adapted, as can be the
components of the program It was planned that you start wIth 4 hours days for
the first two weeks
. As for not completIng the Workfit program, you not only dId not start the
program, your lack of response to phone messages IndIcated an unwIllIngness
to make yourself avaIlable to set up the necessary appoIntments In addItIOn,
the Intake IntervIews were not completed as a result of your decIsIOn to leave
the premIses when there was a delay In the start of your assessment.
. The chOIce of thIS partIcular program was In response to your request, dunng
the InItIal IntervIew that a work tnal be set up In your local area as you
preferred not to travel to Toronto and, for the qualIty of the Workfit program
The decIsIOn to arrange an off-sIte tnal was not made untIl after your own
employer was contacted and IndIcated that they couldn't accommodate your
work tnal
. Dr G T 's prognosIs that you could do a full tIme Job by June 30 1998
should not be Interpreted as an 8 month work tnal, but as preparatIOn tIme as
you change your lIfestyle to Include a full work day ThIS Includes your own
preparatIOn a) employer - contactIng your employer to InqUIre about your
employment status find out what software your office IS USIng and do you
need any upgradIng; can you get a transfer to a local office If that was you
ClaIm#42744 16
WIsh? b) home envIronment - arrangIng chIld care for your chIld, changIng
household routInes to Include commutIng etc The actual work tnalIs only one
component In the preparatIOn for a return to work. It IS ManulIfe's
understandIng that you dId not contact your employer earlIer not even when
you receIved the letter of January 28 1998 IndIcatIng that your LTIP Benefits
would termInate on June 30 1998 nor at the request of the Rehab SpecIalIst
on May 18 1998
. With regard to the program at Women's Centre suggested by Dr P you have
had SInce January 28 1998 or earlIer to have partIcIpated In such a program If
you had IdentIfied the need. In addItIOn, there IS no IndIcatIOn that thIS IS a
work related program whIch would prepare you for the workplace
The tIme allowed for you (sic) partIcIpatIOn In the work hardemng program at
MedWorks In BurlIngton has now termInated wIthout any partIcIpatIOn on your
part. The Claim IS termInated as of June 30 1998
It IS ManulIfe FinancIal's understandIng that you have contacted your employer
and they are prepared to accommodate you. We wIsh you luck In your future
endeavours
The final correspondence from ManulIfe to the claimant IndIcated that It was not InclIned
to change ItS vIew that LTIP should dIscontInue as of June 30 1998 after readIng the
consultatIOn letters of Dr M.N (February 11 1998) and Dr C.P (June 17 1998) In that
letter dated December 10 1998 ManulIfe stated, In part
Dr C.P 's consultatIOn letter of June 1 ih 1998 IndIcated that upon eXamInatIOn
there was no eVIdence of pSYChotIC thought pattern. You stated to Dr C.P that
you expenence only occasIOnal pamc attacks and these are tnggered by beIng In
new places Dr C.P noted that the pamc attacks are very Infrequent and there IS a
lot of aVOIdance behavIOur whIch should be addressed wIth cogmtIve-behavIOural
psychotherapy Dr C.P concurred wIth the recommendatIOns made by Dr M.N
that you should contact the Women's Centre and the CMHA for groups that deal
wIth anxIety/stress management. Dr C.P 's other recommendatIOns were that you
would benefit from better eatIng and actIvIty patters ThIS would assIst you to lose
weIght and Increase your self-esteem ThIS accordIng to Dr C.P would be a more
preferable treatment programme rather than the current forms of treatment whIch
keep you dysfunctIOnal and mIred In the past. It IS our understandIng that when
Dr C.P expressed thIS InfOrmatIOn to yourself, you dId not agree wIth her
suggestIOns
In summary the documentatIOn on file does not support that you are totally
dIsabled from performIng the essentIal dutIes of any occupatIOn as defined above
Ms D.D you have also demonstrated an unwIllIngness to partIcIpate (WIth the
assIstance of our rehabIlItatIOn department) In the programmes offered to you.
ClaIm#42744 17
Therefore, we regret to Inform you that we are unable to reInstate your L TIP claim
and that our prevIOUS decIsIOn remaInS unchanged.
The claimant eventually returned to work sIxteen months after her L TIP benefits were
dIscontInued.
SUBMISSIONS
It was the Umon's posItIOn that the claimant's benefits were dIscontInued based solely on
a two and one half-hour assessment performed by the 1MB Other than the InterventIOn of
the 1MB, nothIng changed In Ms D D's lIfe or treatment. Further at no pOInt was her
dIagnosIs dIsputed nor was It suggested that her treatment was Inappropnate It IS dIfficult
to comprehend why the VIew of the 1MB should be preferred over the OpInIOn of others,
IncludIng the claimant's famIly practItIOner and Dr M.N the psychIatnst who had seen
her tWIce
Mr MartIn, for the Umon, suggested that It sImply IS not credIble that the 1MB physIcIan
would know that the claimant's depressIOn was "In partIal remIssIOn" gIven that she had
never seen Ms D D before However that determInatIOn would be more easIly accepted
In companson wIth the 1MB's predIctIOn that the claimant wIll be ready to return to her
own occupatIOn on the specIfied date of June 30 1998 It was the Umon's VIew that when
ManulIfe was faced wIth two contradIctory reports It sImply opted for the least expenSIve
optIOn, that IS to dIscontInue the L TIP benefits That was Inappropnate The proper
course would have been for ManulIfe to have further InvestIgated to determIne whIch
VIew of the claimant's treatment and readIness to return to the workplace was correct.
Included In the documentatIOn I receIved was a memorandum wntten by a rehabIlItatIOn
specIalIst at ManulIfe outlImng her attempts to have the claimant partIcIpate In a return to
work program. The Umon said that I should take very lIttle from thIS memo In the
ClaIm#42744 18
absence of the claimant's VIew It would be wrong for me to sImply determIne that
ManulIfe's perceptIOn of those events IS accurate Even If the claimant was not as
cooperatIve as ManulIfe mIght have lIked, It cannot be forgotten that In the Instant matter
the claimant IS a woman WIth a maJor depreSSIve dIsorder who fundamentally sees herself
as a vIctIm and has dIfficulty trustIng people She was oblIged by ManulIfe to see an IME
and then she was perfunctonly Informed that she would be able to return to work at the
end of June of 1998 It would not be surpnsIng If she dId not feel completely co-
operatIve
Ms Mohamed, for the Employer asserted that the only dIspute between the partIes IS
whether the claimant was totally dIsabled from any occupatIOn at the tIme her benefits
were dIscontInued. In ItS VIew the eVIdence substantIates that she was not. ManulIfe was
entItled to ascertaIn the ongOIng legItImacy of any claim and ItS decIsIOn to do so cannot
be seen as an unJust or an Inappropnate exerCIse of It nghts In thIS Instance the claimant
had been absent from the workforce for a penod In excess of three and a half years
ManulIfe was not satIsfied from the InfOrmatIOn It had on ItS file that the claimant was
totally dIsabled from performIng the essentIal dutIes of any occupatIOn. There was
nothIng SImster In that reVIew It cannot be said that such a reVIew was Intended to defeat
the purposes of the plan, that IS, to provIde coverage for employees who are totally
dIsabled.
The Employer contended that the !ME was metIculous In detaIl The questIOns posed
were very focused and were answered clearly It IS to be remembered that the !ME had the
claimant's complete file and her Job descnptIOn that was probably more InformatIOn than
any other physIcIan had when wntIng a report. It IS to be remembered that the claimant
was paid for a penod of some seven months beyond the date that she met wIth the !ME to
ensure a proper return to the workforce The claimant faIled to make use of that tIme and
that was to her detnment. All of the medIcal reports predate the end date of the claimant's
benefits There IS not one document before me that IndIcates the claimant's condItIOn
ClaIm#42744 19
after the termInatIOn of her benefits was one of total dIsabIlIty to perform the essentIal
dutIes of any occupatIOn.
In reply the Umon suggested that It IS ObVIOUS that In Instances where the dIagnosIs IS
one of mental InCapacIty the consIderatIOns for the abIlIty to return to work are dIfferent.
AccordIng to the !ME the claimant spent much tIme In the IntervIew cryIng. GIven that
InformatIOn, It IS dIfficult to ImagIne how could Ms D D perform her dutIes at work
when she became dIstressed. The medIcal condItIOn of depressIOn prevents people from
functIomng properly
Finally regardIng ManulIfe's abIlIty to audIt any claimant's file, It was the Umon's
posItIOn that there must be some reasonable IndIcatIOn that an Improper dIagnosIs or
treatment has occurred and such IS not the case here A mere passage of tIme IS not
sufficIent, In and of Itself, to prompt an audIt.
DECISION
I wIll first address the Umon's argument that there must be some legItImate ratIOnale for a
file audIt. In my VIew It was not unreasonable In these CIrcumstances for ManulIfe to
request an !ME AccordIng to the documentatIOn before me, there was lIttle InfOrmatIOn
avaIlable on Ms D.D 's file for ManulIfe to make an Informed determInatIOn as to
whether she was totally dIsabled from performIng the essentIal dutIes of any occupatIOn.
Apart from the vanous attendIng physIcIans' statements of contInuIng benefits, there was
no medIcal InfOrmatIOn provIded regardIng the claimant's condItIOn between Apnl 28
1995 when she was ImtIally provIded LTIP benefits and November of 1996 At thIS tIme
ManulIfe was begInmng ItS process of reVIeWIng the file to ascertaIn whether the claimant
would contInue benefits beyond the first twenty four months ManulIfe receIved a one
and a half page letter from Dr AB dated November 20 1996 I note that dunng the tIme
that ManulIfe was attemptIng to obtaIn further InformatIOn It dId not dIscontInue the LTIP
benefits DespIte requests for further InformatIOn, nothIng more provIded after the
ClaIm#42744 20
November 1996 report. The letter InformIng the claimant that an IME had been arranged
was dated October 8 1997 whIch was approxImately SIX months Into the "any
occupatIOn" penod. I am not convInced that It IS accurate to suggest that ManulIfe
conducted an "audIt" It would appear that the IME request was Just another step In
ManulIfe's proceSSIng of thIS file In any event, I see nothIng SImster Inappropnate or
unfair about the request for an IME under these CIrcumstances
After much consIderatIOn I am of the VIew that the appeal must be demed. It was the
Umon's posItIOn that If ManulIfe had concerns after the IME, a further InVestIgatIOn
should have been undertaken to determIne the claimant's readIness to return to the
workplace I understand that posItIOn. However the claimant went to see another
psychIatnst a few weeks pnor to her benefits beIng dIscontInued and that report was set
out above In total SImply put, there was nothIng In that report that was InCOnsIstent WIth
the IME's report. Indeed, there was confirmatIOn of the findIngs of the IME For example
the IME stated that her depressIOn appeared to be In "partIal remIssIOn" The report from
Dr C.P of June 17 1998 stated that the claimant "fluctuates between MaJor DepressIOn
and DysthymIc DIsorder and thIS has been gOIng on for the last four years" Both referred
to aVOIdance behavIOur At no pOInt dId Dr C.P state that the claimant was totally
dIsabled from performIng the essentIal dutIes of any occupatIOn. Indeed, she stated
Pamc attacks are Infrequent, but there IS a lot of aVOIdance behavIOur whIch
should be addressed wIth cogmtIve-behavIOural psychotherapy IncludIng gradual
exposure to sItuatIOns that cause anxIety As Dr M.N suggested, she could
contact the Women's Centre and the CMHA for groups that deal wIth anxIety and
stress management. It IS a concern that her anger has caused her to reJect help She
asked her Insurance company to pay for more frequent therapy seSSIOns, and was
angry that they wanted to put her on a dIet and exerCIse program. I wondered
whether she had mIsInterpreted theIr IntentIOn, and whether she mIght benefit
from thIS kInd of practIcal help wIth mobIlIzatIOn. If she gets Into better eatIng
and actIvIty patterns, she wIll feel better and If she loses weIght, her self-esteem
wIll Improve In my OpInIOn thIS IS preferable to therapy that keeps her
dysfunctIOnal and mIred In the past, however she dId not agree wIth my
suggestIOns
I hope that Ms D.D has some relIef from these medIcatIOn suggestIOns, and that
she IS able to make use of the practIcal help she has been offered.
ClaIm#42744 21
The IME was certaInly the most thorough report wntten that was provIded to me The
Umon was partIcularly cntIcal of Dr G T's suggestIOn that the claimant's depressIOn was
In "partIal remIssIOn" However I am of the VIew that there was support for that dIagnosIs
on page 4 of the IME report. A reVIew of the current symptoms stated
1 DIfficulty wIth Mood and Sleep
The claimant stIll complaIns of feelIng sad, down, fearful, havIng lIttle
motIvatIOn, lIttle Interest In her hobbles or socIalIzIng, and decreased lIbIdo she
stIll feels Irntable and tIred. However SInce the Trazodone she has been sleepIng
normally and even sleepIng longer than usual Although she does not feel her
mood Improved to normal wIth ParoxetIne, she does admIt that she has tIme
dunng most days where she feels better She IS able to address chores and do
them, complete tasks, and concentrate However she cannot be sure that she wIll
feel thIS way each day She does not feel sUIcIdal She IS hopeful that she wIll
recover and resume functIOmng as she dId In the past. The claimant feels that her
weIght gaIn IS both a symptom of her depressIOn and IS now makIng her feel
worse She has been Instructed to go to the gym and to try to eat In a more
healthful way however she feels that she IS stIll not motIvated enough to make
healthy meals, or to work out on a regular basIs
2 DIfficultIes wIth AnxIety
The claimant stIll feels that she has symptoms of what anxIety and pamc She
feels palpItatIOns, lIghtheadedness, dIZZY nausea, a sense of derealIzatIOn and
occasIOnally chIlls She had such an epIsode yesterday when worryIng about the
seSSIOn today However yesterday these symptoms dIsappeared when she was
dIstracted by somethIng else and she was able to recover her eqUIlIbnum She
does not have dIfficultIes gOIng out or gOIng to crowded places, however she wIll
aVOId gOIng to places where she may meet people she knows SometImes she feels
she cannot concentrate as well as she used to however she has no dIfficulty
dnvIng her car and she reads the paper each day She does worry a lot about the
famIly sItuatIOn, theIr finances, and the problems wIth her step-chIldren.
The !ME report was the only tIme any psychIatnst provIded the DSM-IV dIagnosIs and
her Global Assessment of FunctIOmng score was said to be 60 An assessment of 60 for
the GAF was never dIsputed by further medIcal reports and, although that score In and of
Itself IS not determInatIve, It could be said to be congruent wIth a findIng that the claimant
was not totally dIsabled.
In her report, Dr GT said that, notwIthstandIng that the claimant's psychIatnc
management was "optImal" further psychIatnc consultatIOns would only serve to make
ClaIm#42744 22
the claimant feel "sIcker" AccordIngly Dr G T opIned that the claimant was not totally
dIsabled from performIng her pre-dIsabIlIty Job or sImIlar work. It was acknowledged that
she was partIally dIsabled but that she could be rehabIlItated for full tIme work. SImIlarly
In the June 17 1998 medIcal report of Dr C.P suggested therapy that Included the
claimant ImproVIng certaIn habIts and stated that such actIOns were preferable to "therapy
that keeps her dysfunctIOnal and mIred In the past" AccordIng to the report, the claimant
dId not agree wIth thIS therapy
The Umon suggested that It was absurd that the IME could set an arbItrary date when the
claimant would be able to return to work. I mIght have agreed wIth that VIew If the date
establIshed by Dr G T was only a month or two from the date of the report. However It
was eIght months Into the future I am of the VIew that that "settIng an arbItrary date" IS
not an accurate descnptIOn of what Dr G T dId. She found the claimant to be partIally
dIsabled and thought that It was medIcally appropnate that she begIn a rehabIlItatIOn
program on a part-tIme basIs progressIng "In a step-wIse fashIOn" Dr G T "antIcIpated"
that the claimant would be able to return to work by June of 1998 It was ManulIfe who
accepted thIS date as the appropnate date to end the claimant's L TIP benefits I do not
fault ManulIfe for thIS approach In the CIrcumstances That date for a return to full tIme
work was eIght months Into the future There was plenty of tIme bUIlt Into that tImetable
to re-adJust end-dates If problems wIth rehabIlItatIOn had occurred. Further I cannot find
It Inappropnate for Dr G T to have estImated a plausIble return to full tIme work eIght
months Into the future In the face of a findIng that the claimant was not totally dIsabled as
of the reportIng date It was unfortunate that, for whatever reason, the claimant elected to
not partIcIpate In a rehabIlItatIOn program
It IS the task of the neutral chair In these matters to determIne whether the claimant was
totally dIsabled at the pOInt the benefits were eIther refused or dIscontInued. AccordIng to
the documents provIded, the claimant was not totally dIsabled from performIng the
essentIal dutIes of any occupatIOn. Therefore, thIS appeal IS demed.
ClaIm#42744 23
Dated In Toronto thIS 7th day of February 2001
FelIcIty D Bnggs
ClaIm#42744 24