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This Blog is authored by British Columbia personal injury lawyer Erik Magraken. Erik is a partner with the British Columbia personal injury law-firm MacIsaac & Company. He restricts his practice exclusively to plaintiff-only personal injury claims with a particular emphasis on claims involving orthopaedic injuries and complex soft tissue injuries. Please visit often for the latest developments in matters concerning BC personal injury claims and ICBC claims.
Erik Magraken does not work for and is not affiliated in any way with the Insurance Corporation of British Columbia (ICBC). Please note that this blog is for information only and is not claim-specific legal advice. Erik can only provide legal advice to clients. Please click here to arrange a free consultation.
Posts Tagged ‘arthritis’
March 13th, 2012
Reasons for judgement were released earlier this month assessing damages for a knee injury caused in a 2007 collision.
In the recent case (Dulay v. Lachance) the Plaintiff was injured in a broadside collision. Fault for the crash was admitted by the offending motorist. The Plaintiff suffered from chronic knee pain and dysfunction following the crash. The trial focused largely on whether the collision was responsible for this.
Investigation following the collision revealed that the Plaintiff had pre-existing arthritis in his knee. As is often the case, this condition was asymptomatic prior to the crash.
The plaintiff presented medical evidence suggesting the collision was responsible for the onset of pain. The defendant argued the collision was coincidental to the onset of symptoms. The court preferred the Plaintiff’s evidence. In assessing non-pecuniary damages at $75,000 Madam Justice Maisonville applied the ‘golden years‘ doctrine and provided the following reasons:
 Dr. McLeod had described the contusion to the right medial femoral condyle and medial tibial plateau (very simply put ‚Äď the area where the femur meets the lower leg bones) as mild, but as noted he separated this injury from the triggering of the arthritis as clarified in his second report. I accept his evidence on this point and find that his attribution of ‚Äúmild‚ÄĚ to the injury did not mean to incorporate the onset of symptoms of osteoarthritis.
 Dr. McLeod stated: ‚ÄúIt is impossible to predict whether or not this right knee would have become symptomatic should this accident not have occurred.‚ÄĚ I accept his evidence on that issue.
 The plaintiff asserts that his injuries arose from the accident. While it is true that he had osteoarthritis before the accident, the plaintiff‚Äôs position is that his condition was rendered symptomatic as a consequence of the accident.
 The plaintiff relies on the report of Dr. Grover who wrote:
It is also my opinion that, but for the motor vehicle accident in question, he would likely have remained pain free and symptom free (as far as the right knee is concerned) for many years to come, on balance of probability.
As noted above Dr. McLeod also found that the osteoarthritis was rendered symptomatic from the accident…
 There was no evidence that any other event triggered the arthritis to become symptomatic. While it was indeed the evidence of both orthopaedic surgeons that asymptomatic arthritis can became symptomatic from no event at all, here, I find that the complaints followed on the accident. I find on a balance of probabilities that the plaintiff has proven the injury caused the osteoarthritis to become symptomatic causing pain to his right knee and residual pain to his elbow. This was as a consequence of the accident…
 There is no issue that Mr. Dulay has suffered a loss. He will no longer be able to enjoy all the activities he did with his family and for his temple. Further, as noted by Griffin J. in Fata v. Heinonen, 2010 BCSC 385, the injury to a person nearing retirement is frequently more difficult to endure. As aptly stated by Griffin J. at para. 88:
 The retirement years are special years for they are at a time in a person‚Äôs life when he realizes his own mortality. When someone who has always been physically active loses his physical function in these years, the enjoyment of retirement can be severely diminished, with less opportunity to replace these activities with other interests in life. Further, what may be a small loss of function to a younger person who is active in many other ways may be a larger loss to an older person whose activities are already constrained by age. The impact an injury can have on someone who is elderly was recognized in Giles v. Canada (Attorney General),  B.C.J. No. 3212 (S.C.), rev‚Äôd on other grounds (1996), 21 B.C.L.R. (3d) 190 (C.A.).
 I find Griffin J.‚Äôs reasoning apt here in Mr. Dulay‚Äôs case where he is nearing retirement and has lost the ability to function in a way that has altered how he lives.
 Additionally, Mr. Dulay continues to work and perform everything he can. He has not asked for his employer to accommodate him. He is a team player and endeavours to do everything he can even though he must stop, take medication, and bear much pain. Again, as stated by Verhoeven J. citing Stapley v. Hejslet, 2006 BCCA 34 at para. 46 in Power v. White, 2010 BCSC 1084 at para. 68:
Stoicism of the plaintiff should not reduce the award.
 In all the circumstances of the case I award the plaintiff $75,000 in non-pecuniary damages.
January 25th, 2012
One of the recognized objections to the introduction of expert opinion¬†evidence¬†in a personal injury trial relates to the opinion relying on novel or untested scientific theory. ¬†Reasons for judgement were released last week by the BC Court of Appeal addressing this objection and taking a practical view of the benefits of experts providing opinions based on their years of experience in a clinical setting.
In last week’s case (Cassells v. Ladolcetta) the Plaintiff was injured in a 2005 collision. ¬†He suffered from a pre-existing condition, namely psoriatic arthritis. ¬†The Plaintiff presented evidence that this¬†condition¬†was aggravated due to the trauma of the collision. ¬†This evidence was accepted at trial and damages were assessed accordingly.
The Defendant appealed arguing the medical¬†opinion¬†was based on novel science. ¬†The BC Court of Appeal disagreed finding the foundation for an expert opinion can be laid based on clinical experience. ¬†In dismissing the Appeal the Court provide the following reasons:
 The defendants challenged reliance on Dr. Gladman‚Äôs evidence on essentially the same basis at trial as they do now.¬† Their contention was and remains that her opinion was based on what they say is novel science: no scientific data established, beyond mere speculation, that her ‚Äútheory‚ÄĚ was valid.¬† They say that at most the theory is an unproven hypothesis.¬† They cite the criteria for evaluating the soundness of novel science found in¬†R. v. Mohan,  2 S.C.R. 9, 89 C.C.C. (3d) 402, as drawn from¬†Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S.Ct. 2786 (1993), and discussed in¬†Taylor v. Liong, 2007 BCSC 231,  7¬†W.W.R. 50.
 The judge said the criteria pertain to the admissibility of expert evidence.¬† Admissibility requires the weighing of threshold reliability.¬† No issue had been taken with the admissibility of Dr. Gladman‚Äôs opinion which it was evident is consistent with a widely held belief in the scientific community.¬† Quoting from¬†R. v. Terceira¬†(1998), 38 O.R. (3d) 175, 123 C.C.C. (3d) 1 (C.A.), aff‚Äôd  3 S.C.R. 866, to the effect the threshold test of reliability must adapt to changing circumstances, the judge said that, in the face of studies that did reflect a wide provisional acceptance of Dr.¬†Gladman‚Äôs hypothesis, the lack of a conclusive study should not be fatal to either the admissibility or the weight of her opinion.
 Unlike instances where, as in¬†Taylor, the opinion of an expert which is shown to be no more than uncertain theory has been ruled inadmissible, here, as the judge said, Dr. Gladman expressed her opinion on the basis of what she said she had seen in response to trauma among her patients with psoriatic arthritis.¬† What is said to be the inconclusive literature she referenced was, as the judge said, not the only foundation for the opinion she held.¬† It was an opinion based on thirty years of her experience.
 The judge reached the ultimate conclusion he did concerning the aggravation of the respondent‚Äôs psoriasis and psoriatic arthritis relying on the evidence of the various physicians whose opinions he had to consider.¬† Dr. Gladman‚Äôs opinion on the effect of trauma on psoriatic arthritis is consistent with the other opinion evidence which the judge found acceptable, as well as with the evidence of the respondent‚Äôs medical condition and, for that matter, the deterioration in his life after the accident.¬† I¬†do not consider there to be any sound basis on which it can now be said the judge made an overriding and palpable error in concluding the respondent‚Äôs psoriasis and psoriatic arthritis were aggravated by trauma and stress attributable to the accident by relying on Dr. Gladman‚Äôs opinion.
May 20th, 2010
Quite often when people are injured in a car crash and experience pain they have X-rays or other diagnostic images taken of the painful areas. ¬†Often times these studies show arthritis or other degenerative changes which didn’t pose any problems before the accident.
A common defence¬†tactic¬†is to argue that these degenerative changes would have become painful around the time of the accident in any event and therefore the person is entitled to less compensation. ¬†Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, dealing with (and rejecting) such a defence.
In today’s case (Eblaghie v. Lee) the Plaintiff was injured when¬†she¬†was crossing the street in a marked crosswalk and was struck by the Defendant’s car. ¬†Fault was admitted by the driver. ¬†The Court found that the Plaintiff suffered ‘mechanical back pain…a soft tissue injury that affected the cervical spine” and also right knee “tear in the medial meniscus and patellofemoral derangement“.
The Defendant argued that the Plaintiff’s symptoms would have manifested even without the car crash because of underlying degenerative changes. ¬†Mr. Justice Stewart outright rejected this argument holding as follows:
 I find as a fact that Dr.¬†Regan is more likely than not correct when he says, in effect, that degenerative changes in the plaintiff‚Äôs spine were present as of February 27, 2007 but if they were asymptomatic¬†‚Äď and I find as a fact that they were¬†‚Äď then the onset, consistency and persistence of her pain and discomfort must lead to the conclusion that as a result of the defendant‚Äôs negligence that which had been asymptomatic became symptomatic.¬† The only other alternative is that we are in the presence of a remarkable coincidence.¬† And I reject that alternative as being so unlikely that it must be ignored.¬† In the result, the defendant‚Äôs negligence on February 27, 2007 is the head and source of pain and discomfort in the neck and low back that plague the plaintiff to this very day.
The Court found that the Plaintiff’s symptoms of pain were likely going to continue and awarded $60,000 for her non-pecuniary damages (money for pain and suffering and loss of enjoyment of life).
The Court also had some critical comments to make with respect to the expert witness that testified for the¬†Defendant. ¬†The Defendant relied on Dr. Leith, whose opinion differed from the Plaintiff’s experts with respect to the cause of some of her symptoms. ¬†Mr. Justice Stewart rejected Dr. Leith’s evidence and in doing so made the following critical comments:
 I must speak to the evidence of the orthopaedic surgeon Dr.¬†Leith called to testify by the defendant.
 Dr.¬†Leith‚Äôs evidence appears before me at Exhibit 13 Tab 2.¬† In addition, he testified before me.
 I found this witness‚Äôs evidence unhelpful.¬† There were a number of problems with his evidence and for this trier of fact the cumulative effect of these problems was such that I am not prepared to rely on Dr.¬†Leith‚Äôs evidence on any point that actually matters.
 I will give a few examples of the problems I encountered.
 Dr. Leith‚Äôs simply dismissing out of hand the thought that overuse of the left knee as the plaintiff protected the right knee could result in damage to the left knee with resulting pain and discomfort is not ‚Äúin harmony with human experience‚ÄĚ (Cahoon v. Brideaux, 2010 BCCA 228, para.¬†4).¬† Deciding which evidence to rely upon is not simply a matter of counting heads, but¬†‚Äď as noted above¬†‚Äď it is a fact that two of the doctors who testified before me in effect say that Dr.¬†Leith is simply wrong.¬† For this trier of fact common human experience and the opinions of the two doctors noted above carry the day.
January 11th, 2010
Reasons for judgement were released today by the BC Supreme Court, New Westminster Registry, awarding a Plaintiff $54,000 in damages for a wrist injury.
In today’s case (Zigawe v. Rance) the Plaintiff was involved in a 2006 rear end car crash. ¬†The issue of fault was admitted by ICBC leaving the court to decide the value of the Plaintiff’s injuries.
The Plaintiff suffered various soft tissue injuries which largely resolved by trial. ¬†The main focus of the trial was the Plaintiff’s wrist injury. ¬†The evidence established that the Plaintiff had pre-existing arthritis in her wrist but this was asymptomatic. ¬†The crash caused this pre-existing condition to become painful. ¬†The court valued the Plaintiff’s non-pecuniary damages at $60,000 then reduced this award by 10% for the contingency that the pain may have come on even without the car crash.
In coming to the above valuation Madam Justice MacKenzie reasoned as follows:
¬†¬†¬†¬†¬†I find the plaintiff experienced neck pain for over three years, but it is almost resolved.¬† The headaches appeared to be associated with the neck pain and have resolved.
¬†¬†¬†¬†¬†I also accept the plaintiff’s evidence that the plaintiff’s shoulder pain had mainly resolved six months post-accident but she had some pain in her left shoulder in May 2009, which is now resolved…
¬†¬†¬†¬†¬†On the whole of the evidence, and in particular that of Dr. Shuckett who agreed the plaintiff’s current overall condition was “not inconsistent with” rheumatoid arthritis, I find it likely that the accident exacerbated pre-existing, but asymptomatic tenosynovitis related to rheumatoid arthritis in the plaintiff’s left wrist.¬† While it is an atypical presentation in that the condition is not mirrored in the right wrist, this finding makes the most sense.¬† It is proven on the balance of probabilities.
¬†¬†¬†¬†¬†I do not accept the defendant’s submission that the rheumatoid arthritis in the left wrist arose independently of the accident.¬† In my view such a conclusion is not consistent with its temporal connection to the accident, and Dr. Shuckett’s evidence that the inflammation that accompanies this sub-acute condition can take weeks or months to develop…
¬†¬†¬†¬†¬†Thus, on the totality of the evidence, the accident at least exacerbated the pre-existing tenosynovitis related to rheumatoid arthritis in the left wrist, given its history.
¬†¬†¬†¬†¬†The swelling and significant, long standing pain has not improved since the accident.
¬†¬†¬†¬†¬†Thus, I find the accident activated the plaintiff’s pre-existing condition in a wrist that was asymptomatic for some years before the accident.¬† The left wrist may indeed have remained asymptomatic of tenosynovitis related to rheumatoid arthritis for many years had the accident not intervened.¬† It may have not manifested into rheumatoid arthritis, given Dr. Shuckett‚Äôs evidence as to the nature of that condition.
¬†¬†¬†¬†¬†The neck injury was caused by the accident and its recovery was probably prolonged as a result of her pre-existing but asymptomatic osteoarthritis.
¬†¬†¬†¬†¬†The asymptomatic left wrist condition was triggered by the accident, resulting in significant pain and swelling that still has not resolved more than three years post-accident.¬† Hopefully, the scheduled injection of what is likely cortisone will greatly improve the wrist, but that is unknown, and the plaintiff may require surgery on that wrist.¬† But for the accident, the pre-existing asymptomatic condition in the left wrist may never have manifested…
¬†¬†¬†¬†¬†In this case, I agree with the plaintiff that only a modest deduction is appropriate to account for the plaintiff’s pre-existing left wrist tenosynovitis related to rheumatoid arthritis.¬† It was asymptomatic before the accident.¬† It might never have resulted in symptoms but for the accident.¬† However, there remains a measurable risk that it would have detrimentally affected the plaintiff in the future given the plaintiff’s left wrist problem in 2001 as seen by Dr. Hollands.¬† He thought it might represent early onset of rheumatoid arthritis although I realize the signs and symptoms presented differently in the post-accident wrist tenosynovitis.
¬†¬†¬†¬†¬†Therefore, in my view, a discount of 10 percent from non-pecuniary damages appropriately reflects the contingency of the condition developing in the future…
 In my view, having considered all the evidence and all the cases, non-pecuniary damages of $60,000 discounted by 10 percent, or $6,000, which amounts to $54,000 is appropriate in all the circumstances.
This case is also worth reviewing for the Court’s discussion of credibility.
The Court found that the Plaintiff was a “vague historian” and had a “poor memory“. ¬†The Court also found that the Plaintiff “exaggerated the degree to which she could not use her left wrist.“. ¬†The Plaintiff told her doctor that the wrist was “useless” and this was contradicted by video surveillance evidence obtained by ICBC. ¬† This evidence seemed to negatively impact some of the plaintiff’s claims and the judgement is worth reviewing in full to see how the Plaintiff’s credibility was scrutinized at trial.
October 14th, 2009
A common set of facts Courts grapple with in ICBC Injury Claims is when an accident causes a Whiplash Injury and also causes pre-existing but symptom free neck degeneration to become painful. ¬†Reasons for judgment were released today by the BC Supreme Court dealing with exactly these facts.
In today’s case (Prednichuk v. Spencer) the Plaintiff was involved in a 2004 BC Car Crash. ¬† The Defendant was travelling at about 100 kmph when he lost control and the collision occurred. ¬† He was found 100% responsible for the collision. ¬† In addressing the Plaintiff’s damages the majority of the medical evidence focused on the extent that this accident was responsible for the Plaintiff’s degenerative neck condition. ¬†Dr. Hershler, a specialist in physiatry gave the following opinion evidence which was largely accepted by the court:
¬†¬†¬†¬†¬†¬†¬†¬†¬†In Dr.¬†Hershler‚Äôs opinion, the accident caused the following musculoskeletal injuries, which fall into three diagnostic categories:
(1)¬†¬† Musculoligamentous injury to the lower region of her cervical spine (moderate severity);
(2)¬†¬† Musculoligamentous injury at the thoracolumbar junction (moderate severity);
(3)¬†¬† Mild bilateral carpal tunnel syndrome….
¬†¬†¬†¬†¬†¬†¬†¬†¬†Dr.¬†Hershler‚Äôs overall view is that while the spinal degenerative changes were probably present before the accident occurred, it is more likely than not that the accident accelerated their development and rendered them symptomatic.¬† Dr.¬†Hershler clarified that, in his view, had the accident not occurred, it is not likely that Ms.¬†Predinchuk would have developed the same degree of cervical degeneration and that, in all probability, her degenerative condition was contributing to her pain.
¬†¬†¬†¬†¬†¬†¬†¬†¬†In Dr.¬†Hershler‚Äôs view, the prognosis for Ms.¬†Predinchuk‚Äôs complete recovery is guarded.¬† He believes it more likely than not that she will continue to have to deal with some level of symptoms indefinitely.¬† At the same time, however, he stated that he would not rule out completely the prospect of further healing and additional improvement occurring over the next two years.
In assessing the Plaintiff’s non-pecuniary damages at $80,000 Madam Justice Ballance of the BC Supreme Court made the following findings and highlighted the following facts:
 Based on the evidence as a whole, I conclude that, in all probability, the accident caused Ms.¬†Predinchuk‚Äôs soft tissue injuries to her neck, back and shoulders, her headaches and intermittent arm and hand numbness.¬† I conclude also that the accident caused the formerly dormant degenerative condition throughout Ms.¬†Predinchuk‚Äôs spine to become symptomatic, which has added another component to her overall discomfort and pain and the chronicity of her symptoms….
¬†¬†¬†¬†¬†Members of Ms.¬†Predinchuk‚Äôs family and her friends testified at trial.¬† Without exception, their evidence was reliable and credible.¬† Their evidence, in conjunction with testimony of Ms.¬†Predinchuk, Ms.¬†Chu, Mr.¬†Mason and Mr.¬†Markus, establishes that before the accident Ms.¬†Predinchuk was a highly industrious, successful businesswoman with many recreational interests and pursuits.¬† She was self-confident and strong with an established social network.¬† She was ‚Äúhouse proud‚ÄĚ and spent considerable energy maintaining and improving her homes over the years.¬† She kept a garden and did most small household repairs herself.¬† Over the years, Ms.¬†Predinchuk had painted her various homes, removed wall-to-wall carpeting, sanded wood floors, laid ceramic tile and laminate flooring, jack-hammered a wall, installed cupboards, drywalled a play room for her grandchildren, and tiled a fireplace surround.¬† I accept that she had no physical limitations in carrying out those activities and enjoyed performing them.
¬†¬†¬†¬†¬†Ms.¬†Predinchuk‚Äôs life at work and outside of work changed dramatically after the accident.¬† Her impairments with respect to work with Crown have already been canvassed.¬† In terms of her non-work activities, I find that she significantly curtailed her participation in the social activities that she had once enjoyed, such as line dancing, playing bingo and cards and dinner parties with friends.¬† She became increasingly reclusive.¬† Her energy levels became markedly depleted after the accident, and have never fully revived.
¬†¬†¬†¬†¬†Ms.¬†Predinchuk‚Äôs daughter-in-law, who has known her for 26¬†years, testified that currently Ms.¬†Predinchuk does not accomplish half or even a quarter of the activities that she previously carried out in a typical day.¬† She routinely complains of a sore neck, back and arm, and avoids driving.¬† I accept that Ms.¬†Predinchuk‚Äôs worry over driving has prevented her from driving across town to see her grandchildren and son as much as she would like.¬† She no longer hosts large family dinners on her own, which was a long-standing tradition that she assumed from her mother and which she enjoyed immensely before the accident.
¬†¬†¬†¬†¬†For a self-made and self-sufficient woman like Ms.¬†Predinchuk, her perceived loss of independence due to a weakened body and difficulty performing her work, doing mundane chores and driving is especially distressing, and continues to bother her deeply today.
¬†¬†¬†¬†¬†I find that the physical symptoms caused by the accident have brought about unwelcome and disruptive changes to the enjoyment and quality of Ms.¬†Predinchuk‚Äôs life and continue to do so.¬† She is an older plaintiff and has not recovered the way a younger person might have.¬† While her symptoms have clearly improved, the prognosis for a full recovery is poor.¬† Ms.¬†Predinchuk is not the woman that she was a moment before the accident occurred and probably never will be again.
¬†¬†¬†¬†¬†A tragedy occurred in Ms.¬†Predinchuk‚Äôs family in 2006.¬† There was a mild suggestion made by counsel for ICBC that certain aspects of Ms.¬†Predinchuk‚Äôs apparent unravelling could be attributed to that.¬† The evidence does not support that contention, and I reject it.
¬†¬†¬†¬†¬†Ms.¬†Predinchuk seeks an award for non-pecuniary damages in the range of between $80,000 and $125,000, and has provided case authorities in support.¬† The defendants have provided case authorities favouring significantly smaller awards.
¬†¬†¬†¬†¬†Having reviewed the authorities provided by the parties, and considered the totality of the evidence pertaining to Ms.¬†Predinchuk‚Äôs specific circumstances, I conclude that a fair and reasonable award for non-pecuniary damages is $80,000.
August 26th, 2009
(UPDATE: ¬†The below decision was upheld by the BC Court of Appeal in Reasons for Judgement released on January 19, 2012)
Reasons for judgment were released today by the BC Supreme Court (JFC v. Ladolcetta) awarding a Plaintiff just over $500,000 in total damages as a result of a serious BC motor vehicle collision.
The Crash occurred in 2005 and was a near head-on collision for which the Defendant was found 100% at fault. ¬†As a result of this crash the Plaintiff suffered various serious injuries including a compression fracture in the low back, a brain injury with post concussive problems and various cuts, bruises and soft tissue injuries.
The majority of the judgement dealt with the Plaintiff’s pre-existing¬†psoriasis and psoriatic arthritis and the extent to which this was affected by the collision.
Mr. Justice Brown concluded that in addition to the above serious injuries the Plaintiff’s pre-existing conditions were made significantly worse by the car crash. ¬† The Plaintiff’s non-pecuniary damages were assessed at $150,000 although this award was then reduced to $120,000 to account for the plaintiff’s ‘failure to mitigate’.
In summarizing the Plaintiff’s accident related injuries and their effect on his life Mr. Justice Brown found as follows:
 I find no sufficiently persuasive reason to doubt that the plaintiff sustained significant soft tissue neck, thoracic, lumber spine, right shoulder, ankle, right knee and other soft tissue injuries, as set out in paragraph 3 of these reasons, together with a compression fracture in the lumbar spine, and ongoing sequelae. The ultimate residual effect of these injuries absent the influence of the plaintiff‚Äôs psoriatic arthritis will have to wait on the full remediating effects of medication, unfortunately unknown to the date of trial. However, given the history and opinions in this case, I find that the evidence supports a finding that, more likely than not, he will continue to experience some residual symptoms that may be alleviated to a degree by further therapy….
In this case, a belief based on clinical experience that physical or psychological trauma can initiate or influence the course of both psoriasis and psoriatic arthritis, is one, based on the sufficiently weighty evidence heard in this case, widely held among dermatologists and rheumatologists in their respective fields…
 Given the evidence before me from rheumatologists and dermatologists, as well as Dr. O‚ÄôShaughnessy and other experts called, there are sound and substantial reasons for concluding that emotional trauma/stress, as well as physical trauma, may exacerbate both psoriasis and psoriatic arthritis…
I find the evidence, including the plaintiff‚Äôs, persuades that the plaintiff‚Äôs psoriasis and psoriatic arthritis worsened sufficiently soon after the accident…
 What is important here is that the evidence sufficiently establishes that the plaintiff was struggling when he returned to work in mid-February 2006 experiencing joint pain and limitation that he thought he needed to hide for the sake of job security. He saw some improvement in the summer, to be expected because of the sun‚Äôs benefits and the fact that he had most of June and July off work, presumably a time when he golfed and was in the sun more. As it is, I note that by early October 2006, he saw Dr. Hong, reporting a flare-up. I accept the plaintiff‚Äôs evidence that over-all he had experienced a change in the pattern of the disease from a slow gradual worsening over time between treatments to one of intense flares involving both skin and joints. The basic pattern and course of the disease had manifestly altered; I accept the plaintiff‚Äôs evidence that pre-accident he never had to abrade the skin for over two hours each day; that the plaques and other aspects of the disease had taken on an aggressive flaring pattern. This is not to overlook the fact that the worsening condition went largely untreated, which likely worsened his situation; but that points to questions of mitigation discussed below.
 Further, as also discussed below, I find that the evidence well establishes that accident-induced ongoing emotional trauma and persistent stress are the pre-dominant and most significant exacerbating factors of both the plaintiff‚Äôs psoriasis and psoriatic arthritis.
 I also reject the defence argument that the onset of psoriatic arthritis suffered by the plaintiff was too temporally removed from the accident to be related to it. There is sufficient accepted evidence to show that the plaintiff‚Äôs psoriatic arthritis flared within a few weeks of the accident and involved new areas and that to the date of trial he has not returned to his pre-accident level of functioning…
 It must be borne in mind that although the plaintiff in this case did suffer from a psoriatic arthritis condition pre-accident, it was very mild; and he was able to work in what were heavy labor intensive positions. Accepted evidence indicates that the plaintiff‚Äôs condition, both in relation to his psoriasis and psoriatic arthritis, were set upon a new and more aggressive course after the accident. This was not a short term exacerbation‚ÄĒwhich said, is not to over look the contribution that the plaintiff‚Äôs failure to seek or follow treatment advice played in his worsening condition psoriasis. Further, I find that the plaintiff suffered significant sequelae from his brain injury; and further, and very significantly, as earlier explained, that his other physiological and emotional accident-induced stressors amplified his symptoms, which gradually became worse over time. He has obviously suffered a serious depression and remains vulnerable in that regard. Moreover, he suffered significant soft tissue injuries, the ultimate prognosis for which is not certain. As Dr. Shahid explained, most people do make a good fairly uneventful recovery from compression fractures and are able to return to work; but a significant proportion of those people continue to suffer pain and disability and some of those are unable to return to labor intensive work.
 Further, the plaintiff has suffered a substantial loss of enjoyment of life, is now unable to participate in golf and other activities he enjoyed before the accident. With successful treatment, he may be able to return. As I view the evidence, his suffering, both physiological and physical, has been quite intense, albeit partly in relation to his failure to follow treatment recommendations.
¬†¬†¬†¬†¬†Considering all of the evidence and the submissions of counsel, for non-pecuniary damages I award $150,000, and taking into account the plaintiff‚Äôs failure to mitigate before the date of trial, reduced to $120,000.
In addition to the above, today’s case contained an interesting discussion of causation when it comes to traumatic injury. ¬†Often in ICBC Injury Claims different experts come to different conclusions as to the reasons for a Plaintiff’s disabilities. ¬†In this case there was a debate whether many of the Plaintiff’s problems were due to a head injury, depression, chronic pain or perhaps other causes. ¬†Mr. Justice Brown gave useful reasons holding that it is not necessary to pigeon-hole a Plaintiff’s injuries into specific categories to find that a compensable loss occurred. ¬†Specifically he stated as follows:
I find the conclusion that most accords with the testimony and medical evidence that I have accepted is this: All of the plaintiff‚Äôs injuries and associated symptoms, including those from his mild concussive frontal lobe injury, his subclinical PTSD and its symptoms, the stress and anxiety he experienced related to pain from his soft tissue injuries, his incrementally worsening psoriasis and psoriatic arthritis, and his inability to work operated over time to produce a serious depression. These factors in varying degrees punctuated the plaintiff‚Äôs experiences from the time of the accident onwards, and produced the levels of psychological stress that produced the ongoing exacerbation of the plaintiff‚Äôs condition that plaintiff experts identified as the cause of the worsening of the plaintiff‚Äôs psoriasis and psoriatic arthritis. Given the extensive evidence heard, I find this consilient view of the evidence and medical opinions removes the need to reduce judicial findings to specific diagnostic categories; at the same time more accurately reflecting the actual subjective experiences of the plaintiff. These causative stressors were caused directly or indirectly by the accident, subject to consideration of mitigation arguments.
The above quote, particularly the bolded part, could prove persuasive in ICBC Injury Claims where experts agree that a Plaintiff suffers a deterioration in health and functioning following a colliison but cannot agree on the exact medical cause for the same.
May 12th, 2008
In reasons for judgement released today the Honourable Mr. Justice Smith awarded a 46 year old mechanic over $200,000 in compensation as a result of 2 rear-end motor vehicle accidents.
The first accident was in May 2002. The Plaintiff’s vehicle was rear-ended with enough force to push it into the vehicle ahead of the Plaintiff. The second accident for which compensation was sought occurred 3 years later in May 2005. The Plaintiff’s vehicle was ‘struck from behind with enough force to break the back of the driver’s seat and push the vehicle into the vehicle ahead‘.
The Plaintiff had pre-existing, asymptomatic, osteoarthritis. A rheumatologist gave evidence that “The Plaintiff’s major current symptoms are in the neck and some pain and restricted movement will likely continue given the established nature of the osteoarthritis“. He went on to state that “asymptomatic arthritis often becomes symptomatic following a motor vehicle accident or other trauma and although the relationship is poorly understood and contraversial, it’s something I often see in practice“.
A physiatrist (a specialist in physical medicine and rehabilitation) who assessed the Plaintiff at the request of the Plaintiff;s family physician gave evidence that “the Plaintiff’s complaints could not be fully explained based upon the physical findings” and he diagnosed a pain disorder.
This diagnosis of a chronic pain disorder was shared by the Plaintiff’s treating psychiatrist.
After hearing all of the evidence the court found that the Plaintiff suffered soft tissue injuries in the first accident with the most severe symnptoms being in his lower back. There was substantial improvement withing the first 6-8 months, and chronic but not disabling pain conintued for another 2.5 years. The court alos found that the back pain was not as “severe or as frequent as the Plaintiff now recalls it“.
Addressing the second accident the court found that “the Plaintiff has had some increase in back pain, but the most significant pain was in the neck, where he has the more significant spondylosis. This pain is likley to worsen as (the Plaintiff) gets older. Again, this pain is nto disabling and the plaintiff could, if necessary, return to either of his former occupations but, given the pain and discomfort he experiences, he is well advised to seek lighter work”
In discussing the connection between the accident and the pre-existing condition the court noted that “the Plaintiff in this case had a degenerative condition that was not symptomatic. He had no prior neck or back pain prior to these accidents. Temporal connection between an accident and the onset of symptoms does not, in and of itself, prove causation…It is not necessary for the Plaintiff to prove that he would never have developed symptoms from his degenerative condition ‘but for’ the accident. He must only prove that ‘but for’ the accident, he would not have developed these symptoms when he did….I find that the Plaintiff has proved, on a balance of probabilities, that his spondylosis would not have become symptomatic when it did but for the third accident.”
In the end the court awarded damages as follows:
For the Accident of May 18, 2002:
Past income loss
(subject to deduction for Income tax)
For the Accident of May 5, 2005
Past income loss
(subject to deduction for Income tax)
Loss of Future Earning Capacity
Cost of Retraining
Cost of Future Care
April 25th, 2008
In a judgement released today by BC Supreme Court, Madame Justice MacKenzie awarded a total of $30,900 plus wage loss in compensation as a result of a September, 2005 rear-end accident which occurred in Langley, BC.
The Plaintiff was a 55 year old woman. Prior to the accident she suffered from back pain, particularly she had osteoarthritic changes affecting all of her lumbar discs.
ICBC, on behalf of the Defendant, called evidence trying to paint the picture of a minor accident. ICBC called vehicle estimators who gave evidence that the vehicles basically sustained minimal damage. The purpose of this is to cast doubt on the ability of a minor accident to cause injury. The theory is basically that if the vehicle damage is not significant the injuries must not be significant. This tactic is often used by ICBC defence lawyers as a result of ICBC’s Low Velocity Impact (LVI) policy.
After hearing all the evidence the court found that the Plaintiff’s pre-existing condition did not impair her previous activities, that the accident caused mild to moderate soft tissue injuries, that these injuries have resolved somewhat by the time of trial and that there was no evidence of a minor permanent partial disability as a result of her accident related injuries. In other words, she should get better.
The court was not persuaded that a substantial possibility existed that the injuries would result in a diminished earning capacity. The court concluded that “In my opinion, with exercise and motivation, the Plaintiff will return to her condition before the accident”. In the end the court awarded $30,000 for non-pecuniary damages (Pain and Suffering), $400 for special damages (out of pocket accident related expenses), compensation for lost past income, and $500 for future care to permit the Plaintiff to pay for a 6 month gym membership with some supervision with a personal trainer.