Category: Catastrophic Impairment

The claimant was involved in an MVA wherein she suffered, among other things, a mild traumatic brain injury. She had not returned to work following the MVA. The claimant sought a catastrophic designation asserting she met the 55% threshold whole person impairment rating. The insurer commissioned IE reports in which it was found she had a 40% WPI. Adjudicator Susan Sapin concluded that the claimant’s impairments equated to a 51% WPI and was therefore not CAT.

As a result of the accident, the claimant suffered GCS scores in the range of 12 to below 9 and sought an order that her impairment was catastrophic. The insurer argued that the GCS scores below 9 were not caused by a brain impairment. Adjudicator Flude concluded that the SABS did not require ongoing neurologic impairment to qualify for a catastrophic impairment. Adjudicator Flude accepted evidence that a GCS score from an intubated patient is reliable, and that the claimant’s blood loss would have resulted in decreased brain function, which was sufficient to meet the “brain impairment” requirement.