The claimant sought a catastrophic impairment designation under criterion 8. The insurer denied the designation based on a number of IE reports. Under the previous SABS, only one Marked impairment or higher rating was needed in any of the four heads of functionality. Adjudicator Cezary Paluch reviewed the evidence of both parties and compared it with the AMA Guides for each functionality heading. On review, Adjudicator Paluch favoured the evidence of the insurer’s experts and considered each to be a more balanced and comprehensive analysis of the claimant and the Guides. It was also noted that in cases where pain is a major factor, a multidisciplinary approach to assessments is preferred. Moreover, the mere diagnosis of a mental disorder will not qualify as a catastrophic impairment; it must be viewed in conjunction with the Guides. While it was noted the claimant unsuccessfully attempted to return to work, Adjudicator Paluch indicated that the Guides require failures and repeated failed attempts – one attempt without context or evidence as to why the return to work failed was considered insufficient evidence. The claimant was said to have not suffered a catastrophic impairment and the claims dismissed.
Menu