Category: Catastrophic Impairment

The minor claimant sought a determination that he suffered a catastrophic impairment as a result of the accident due to traumatic brain injury under the post-2016 definitions. Section 3.1(1)5.i. of the SABS required that a person under 18 years of age be accepted for admission on an in-patient basis to a public hospital with positive findings on a computerized axial tomography scan, MRI, or other medically recognized brain diagnostic technology, indicating intracranial pathology resulting from the accident. The insurer denied that the claimant met the test because the hospital admission was due to a fractured femur rather than brain injury, and the imaging showing intracranial pathology a few months after the claimant was discharged from hospital. Adjudicator Gosio accepted the insurer’s position, holding that the definition required a temporal connection between the imaging and the person being in-patient at the hospital. He reasoned that the changes to the catastrophic impairment definitions were made to make the process more accurate, consistent, and objective, and speed up determinations and reduce dispute costs.

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 marked impairment due to somatic symptom disorder. The insurer argued that the claimant had made functional improvement and that the impairments described by her assessors were brought on by the stressful nature of assessments. Adjudicator Mazerolle concluded that the claimant suffered Class 4 marked impairments in activities of daily living and adaptation. He accepted that the claimant suffered from somatic symptom disorder as a result of the accident and a minor traumatic brain injury, and that the two resulted in a downward spiralling of her function. He also accepted that the claimant’s psychological condition was potentially permanent. The claimant relied upon the support of her mother to manage day-to-day responsibilities and that she required cueing to conduct many household tasks. Adjudicator Mazerolle concluded that the catastrophic impairment designation was effective as of the date that her OCF-19 was signed, rather than the two-year mark or the date of the accident.

The claimant sought a determination that she suffered a catastrophic impairment. She suffered serious physical injuries as a pedestrian struck by a vehicle. Vice Chair Flude held that the claimant suffered a Class 4 marked impairment in adaptation and therefore had a catastrophic impairment. The claimant was largely housebound since the accident due to tiredness and lack of motivation, more than five years after the accident. He preferred the opinions of the claimant’s treating occupational therapist and expert neuropsychologist, as they had more interaction with the claimant and had a more fulsome picture of the claimant’s abilities. Vice Chair Flude found the insurer’s IE reports to be more conclusory and unsupported by evidence.

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 Marked Impairment in either concentration, persistence, and pace, or adaptation. Adjudicator Ferguson held that the claimant did not satisfy the criteria to meet a Class 4 marked impairment in either category. While the claimant did suffer mental impairments as a result of the accident, her impairment was only sufficient to meet a Class 2 or Class 3 impairment. The claimant was able to live independently, travel on her own, she was not receiving psychiatric treatment any longer, and was not using psychiatric medications. The claimant’s subjective reporting in her assessments was of limited value because of factual errors and poor validity testing.

The claimant sought a catastrophic impairment determination, attendant care benefits, and housekeeping expenses. The insurer argued that the claim for HK expenses was barred by the limitation period. Adjudicator Hines concluded that the claimant suffered a catastrophic impairment as a result of Class 4 Marked impairments in each of daily living, social functioning, and adaptation. While the claimant had been involved in an earlier accident which caused serious physical injuries, the subject accident caused a severe decline in his emotional functioning which satisfied the catastrophic impairment definition. Adjudicator Hines held that the limitation period did not apply to the HK expenses claim based on the Court of Appeal’s reasons in Tomec v. Economical, and that the claimant was entitled to HK expenses of $100 per week, but only if incurred. There was no basis on which to find expenses deemed incurred. The claim for ACBs was denied. Adjudicator Hines held that entitlement only began in December 2018 when Form 1s were submitted, but that the Form 1 submitted did not reflect the claimant’s current need for assistance. The claim for both past and ongoing ACBs was dismissed.

The claimant sought a catastrophic impairment determination and entitlement to NEBs. Adjudicators Hines and Punyarthi held that the claimant suffered a catastrophic impairment as a result of a 55 percent WPI as a result of the accident, and that he was entitled to NEBs. The Tribunal accepted that the claimant was entitled to 26 percent WPI for a cervical spine injury, 3 percent for medications, 2 percent for sleep disorder, 5 percent for occipital neuralgia on each of the left and right side, and 29 percent for four Class 3 Moderate Impairments. The Tribunal rejected any WPI for erectile dysfunction and urinary dysfunction, migraine headaches, and knee instability. The Tribunal also rejected 15 percent WPI for emotional or behavioural disturbances, on the basis that it would “double count” the WPI assigned under mental and behavioural disorder. The Tribunal also accepted that the claimant was entitled to NEBs due to the effect of the accident on his ability to work, his recreational activities, his ability to drive, his social life, his relationships, and his resilience.

The claimant sought a catastrophic impairment determination. The insurer argued that the claimant’s impairment were a result of degenerative changes to the claimant’s spine rather than the accident. Vice Chair Flude agreed with the insurer, and found that the claimant’s accident-related impairments were not sufficient to meet a 55 percent WPI. He held that the claimant’s cauda equina like symptoms (which accounted for 40 percent WPI) were not a result of the accident.