January 23, 2017

SAAQ: an income replacement indemnity cut without just cause

Corps

Coupe argent

The complaint

A lady complained to the Québec Ombudsman because the Société de l'assurance automobile du Québec (SAAQ) had unjustly terminated her income replacement indemnity. The SAAQ claimed that the woman was fit to return to work despite the expert report confirming the opposite.

The investigation

  • A woman who had been in a road accident remained with several functional limitations and restrictions.
  • She worked for many years after this before having to undergo surgery for an injury stemming from the accident.
  • At the time, the SAAQ recognized a relapse of the woman's condition and granted her an income replacement indemnity.
  • After this, so as to reassess the woman's condition, the SAAQ called for specialized orthopedic tests.
  • The expert cited several functional limitations and restrictions and concluded that the woman was unfit to work.
  • Despite this result, the SAAQ determined that the lady was fit to work. It therefore terminated her income replacement indemnity.
  • The investigation by the Québec Ombudsman showed that the woman was still unfit to work because of her functional limitations, in particular, her trouble walking, which obliged her to use a cane.
  • Given that the SAAQ had not taken into account all the elements in the lady's file (medical reports, specialized orthopedic tests, new permanent after-effects), the Québec Ombudsman asked for a review of the decision.

The result

Further to the Québec Ombudsman's intervention, the SAAQ recognized the woman's unfitness to work. She therefore regained her income replacement indemnity and was paid retroactive to the date when the indemnity was cut without just cause.