Category: Catastrophic Impairment

The claimant applied for a CAT determination based on GCS. The insurer denied the determination based on a paper review of a neurologist. Adjudicator Bickley reviewed the medical evidence, which included two ambulance call reports both showing GCS scores of 15. However, during the course of hospitalization, the claimant scored GCS scores of 7, 8, and 9 at various hours. The insurer argued the sub-9 scores were due to medication and intubation and not a reflection of a brain injury. Adjudicator Bickley concluded the claimant’s diagnosed concussion constituted a brain impairment, which resulted in a subsequent intubation, which caused a sub-9 GCS. Relying on the Ontario Court of Appeal decision in Liu v 1226071 Ontario Inc., it was concluded the claimant sustained a catastrophic impairment, since scores of 9 or less were recorded in a reasonable time following the accident.

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.