The SAAQ: check whether the traffic accident caused new medication to be prescribed

The context

• A man had a traffic accident. Even since, the man’s migraines had caused him problems more and more often.  His physician prescribed pain medication.
• The man therefore contacted the Société de l’assurance automobile du Québec (SAAQ) because he wanted to be reimbursed for the medication. However, the agency refused.

The complaint

The man felt that the accident had worsened his health condition. As a result, he considered that the SAAQ should approve his claim.

He complained to the Protecteur du citoyen.

What the investigation showed

• Before the accident, the man was already dealing with various health problems.
• The medication which his physician prescribed for him had a dual purpose. In addition to preventing headaches, it treated the other health problem.
• The SAAQ considered that the purpose of the medication was to only treat the other problem. Given that the other problem was unrelated to the accident, it turned down the man’s claim.
• The agency had not checked whether it was the accident that had caused the migraines to become more frequent. Yet, the medical documents in the man’s file indicated precisely that.
• If the SAAQ had established the causality between the two events, the citizen could have gotten the reimbursement he had requested.

The outcome

At the Protecteur du citoyen’s request, the SAAQ did the required checking and concluded that the accident had indeed worsened the man’s health condition. The agency reviewed its decision and the man was finally reimbursed.