June 12, 2017

The SAAQ: the after-effects of an automobile accident must be properly assessed

Corps

The complaint

keyboard compensation

A man claimed compensation from the Société de l’assurance automobile du Québec (SAAQ). He said that his face scar from an automobile accident a few years before had gotten worse. The SAAQ turned down his claim and he complained to the Québec Ombudsman.

The investigation

  • The man had had an automobile accident a few years before.
  • At the time, he received compensation for the aesthetic sequelae of a face scar.
  • He felt that the scar had gotten worse in the last few years. In a medical report, his physician confirmed that there was new sensitivity because of the scar.
  • The investigation by the Québec Ombudsman showed that the SAAQ had misestimated the scar’s category of severity.
  • The scar was more visible and pronounced than indicated in the citizen’s file and the category of severity had been underestimated.
  • The scar had not been sensitive at the time of the accident. The sensitivity was therefore a new after-effect that the SAAQ had to assess.

The result

After the Québec Ombudsman intervened, the SAAQ reassessed the citizen’s sequelae and acknowledged that the category of severity estimated at the time had been inaccurate. It also considered the sensitivity of the scar as a new after-effect, and the citizen was theref0re able to obtain the compensation to which he was entitled (more than $10,000).