The difference between two psychiatric rating methods just decided a catastrophic impairment claim at Ontario's Licence Appeal Tribunal.
In a decision released April 14, 2026, the Tribunal denied Michael Lapointe's bid for catastrophic impairment designation following a May 2016 motor vehicle accident, ruling against him in Lapointe v. Intact Insurance Company, 2026 ONLAT 24-008030/AABS. The case came down to a deceptively simple question: how do you convert a psychological impairment rating into a whole person impairment percentage?
The answer, it turns out, depends entirely on which method you use.
Lapointe's assessor, Dr. Henry Rosenblat, diagnosed him with major depressive disorder (likely recurrent) with anxious distress and somatic symptom disorder with predominant pain. To calculate the mental and behavioural portion of his whole person impairment, Dr. Rosenblat used the Global Assessment of Functioning scale paired with the California Method, a well-known approach that produced a rating of 30 to 34 percent. Combined with physical impairment ratings for scarring, lower extremity, and upper extremity injuries, Lapointe's total whole person impairment landed at 55 percent, right at the threshold required for catastrophic designation under the Statutory Accident Benefits Schedule.
Intact's assessor, Dr. Velan Sivasubramanian, saw things differently. He diagnosed a mild adjustment disorder with anxious and depressed mood and used Table 3 of Chapter 4 of the AMA Guides, Fourth Edition. His mental and behavioural rating came in at 14 percent. Swap that number in, and Lapointe's total drops to roughly 42 percent, well short of the 55 percent mark.
The Tribunal sided with Intact. Vice-Chair Jeremy A. Roberts and Adjudicator Sam Moini found that the higher rating did not square with what Lapointe actually did after the accident. He enrolled at George Brown College. He attended Alcoholics Anonymous. He maintained a relationship with his partner. He filed income tax returns for the previous five years. That level of functioning, the panel found, pointed to a rating closer to 14 percent than 34 percent.
Pre-existing conditions did much of the heavy lifting for the defence. The Tribunal noted Lapointe's documented history of substance abuse and mental health concerns, including antisocial personality disorder, ADHD, and polysubstance use disorder, all of which predated the accident. Applying the but for causation standard, the panel concluded those impairments would likely have been present regardless of the collision.
Lapointe also fell short on the second pathway to catastrophic designation. He conceded only moderate impairment in activities of daily living and concentration, persistence, and pace. The Tribunal found he did not reach marked impairment in social functioning or adaptation, the two areas where he needed it most.
With catastrophic designation off the table, everything else fell with it. Attendant care benefits, outstanding treatment plans, and additional assessment funding were all denied. The $50,000 funding limit had already been exhausted, and without catastrophic status, there was no route to enhanced benefits.
For claims teams handling similar files, the takeaway is concrete: the method used to convert psychiatric ratings into whole person impairment percentages can swing a catastrophic determination by up to 20 percentage points, and post-accident functioning paired with documented pre-existing conditions remains a potent combination in defending these claims.
