SGI ordered to build and maintain disabled man's lap pool
Government insurance company didn't want to pay $10,000 for annual pool upkeep
A man who was severely injured in a crash and needs a water-based rehabilitation program has won a court case that will see Saskatchewan's public insurer spend $278,000 to build a lap pool at his home and pay $10,000 per year to maintain it.
The case, from the Saskatchewan Court of Appeal, was recently published to an online legal database.
SGI admits that it determined the lap pool was considered necessary.- Court of Appeal decision
According to the decision, Dennis Scott, of Whitewood, Sask., was in a crash on Dec. 23, 2005. His vehicle struck a moose. Scott suffered a serious spinal cord injury that left him a partial quadriplegic.
Following extensive therapy at the Wascana Rehabilitation Centre in Regina, Scott was able to return home to Whitewood some six months after being admitted to the WRC, although he kept up his pool exercises as an out-patient as often as he could.
Long trip saps energy
Whitewood, however, is about 175 kilometres east of Regina.
"The four-hour round trip from Whitewood to the centre drained Mr. Scott’s energy, especially when coupled with his attempts to return to part-time employment," the panel of judges said. "He believed that the trip to and from the centre diminished the benefits he received from the pool therapy he took there."
In 2010, Scott was able to convince Saskatchewan General Insurance to build a lap pool at his home at an estimated cost of $278,782. But the insurance company, a provincial Crown corporation, said it would only contribute $692 per year to maintain the pool. SGI called it an annual recreation allowance.
Actual upkeep expenses for the pool were estimated at around $10,000 when the cost of chemicals, heating and power were taken into account. Scott and his family committed to doing the necessary work to test the pool water and maintain it.
The relevant SGI regulation:
If the insurer considers it necessary or advisable for the rehabilitation of the insured, the insurer may provide the insured with one or more of the following:
(i) to pay for the insured’s occupational, educational or vocational rehabilitation if the rehabilitation is consistent with the insured’s occupation prior to the accident and his or her skills and abilities after the accident;
(ii) to lessen the insured’s disability; and
(iii) to facilitate the insured’s recovery from an accident to improve his or her earning capacity and level of independence.
The court ruled that SGI had to cover all of those costs, since it had already committed to the lap pool.
"SGI had agreed that the lap pool was an approved form of rehabilitation for Mr. Scott," the court said. "The upshot of this is that SGI admits that it determined the lap pool was considered necessary or advisable for the rehabilitation."
The court said that decision means the costs associated with the rehabilitative measure — in this case a lap pool — must be paid by SGI.
The only exception is that SGI does not have to pay the additional property taxes associated with the increased value of Scott's home, since it will have a pool, nor the additional home insurance — unless the company wants to.
The court noted there was ample precedence, including a case in 2009, where SGI's regulations were to be given a wide and liberal interpretation.