2017 CanLII 81583 (ON LAT)
Licence Appeal Tribunal | File No. 16-002346/AABS | Date: 2017-11-22 | Hearing: Written hearing | Adjudicator: Paul Gosio
PSR Role: validity testing
The insurer’s independent psychological examination reported elevated PSR scores suggesting symptom magnification. However, the adjudicator preferred the treating psychologist’s diagnosis of Adjustment Disorder and awarded psychological assessment and treatment benefits.
Why It Matters: The decision demonstrates PSR being used as part of a symptom validity analysis in psychological independent medical examinations presented to the LAT.
Key Holding: PSR evidence was considered but was not determinative because the adjudicator preferred the competing psychological evidence.
This decision records the use of the Pain Symptoms Ratings instrument in an insurer psychological examination assessing the credibility of the applicant’s self-reported symptoms.
Citation
16-002346 v Unifund Assurance Company, 2017 CanLII 81583 (ON LAT), released November 22, 2017.
Facts and Context
The applicant was injured in a motor vehicle accident on January 19, 2016 and sought payment for psychological treatment and related benefits.
Two psychological reports were before the tribunal: one from the treating psychologist and one from an insurer-retained independent examiner.
Role of PSR
The insurer-retained psychologist administered several psychological tests, including the Pain Symptoms Ratings instrument.
The applicant’s PSR score was reported as more elevated than 97 percent of the normative sample, which the examiner interpreted as evidence of symptom magnification.
Tribunal Treatment of the Evidence
The adjudicator concluded that the independent examiner had not sufficiently reconciled his findings with the treating psychologist’s diagnosis.
Greater weight was given to the treating psychologist’s assessment and treatment recommendation.
Why the Decision Matters
This decision shows PSR being used as part of symptom validity testing within a psychological insurer examination.
Although the PSR interpretation suggested symptom magnification, the tribunal ultimately preferred the competing clinical assessment.
Practice Note
This decision should be presented as an example of PSR appearing in psychological IME methodology rather than as an adjudicative endorsement of the PSR interpretation itself.
Quoted Passages
PSR findings
Pain Symptoms Ratings: The applicant achieved more elevated scores than 97 percent of the normative sample which suggests that his self-report of pain and impairment is invalid due to symptom magnification.
para. 16
Tribunal preference
I prefer the evidence of Dr. Pilowsky and conclude that the applicant has met his onus in establishing that the psychological assessment and corresponding treatment is reasonable and necessary.
para. 19
Issues
Entitlement to psychological treatment benefits: Approved
Entitlement to payment for psychological assessment: Approved
Entitlement to medical services benefits: Approved
Special award under Regulation 664: Denied
Findings
Result Summary: The applicant was awarded psychological treatment benefits, a psychological assessment, and reimbursement for medical services.
PSR-Related Finding: The insurer psychologist reported PSR scores indicating symptom magnification, but the adjudicator ultimately preferred the treating psychologist’s assessment.
Quoted Outcome: I prefer the evidence of Dr. Pilowsky and conclude that the applicant has met his onus in establishing that the psychological assessment and corresponding treatment is reasonable and necessary.
Cautions
The tribunal did not reject PSR methodology but gave greater weight to the treating psychologist’s interpretation of the applicant’s condition.
Best presented as an example of PSR use in insurer examinations rather than an endorsement of PSR conclusions.