The claimant was involved in a serious motor vehicle accident in October 2016, in which he sustained fractures to both arms and his left leg. He applied to the LAT seeking CAT determination under Criteria 7. The claimant’s CAT assessors opined that the claimant had a combined WPI of 60%, and the insurer’s assessors opined the claimant had a combined WPI of 34%. Adjudicator Gosio held that the relevant time for determining the impairment of the claimant is the time of the hearing and found that it was appropriate to assess the claimant’s condition following knee surgery, which occurred after the initial CAT reports were completed. In this regard, Adjudicator Gosio preferred the opinion of the insurer’s orthopaedic assessor, which addressed the change in status post-surgery at the time of the hearing. After analyzing competing opinions on WPI percentages related to fractures, scars, cane use, and other physical impairments, as well as mental/behavioural impairments, Adjudicator Gosio found that the claimant had a 46% WPI and had not sustained a catastrophic impairment as defined by the SABS.
Menu