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Applicant v. Wawanesa Mutual Insurance Company (16-000004)

  • July 14, 2017

The claimant sought a declaration of catastrophic impairment due to a Class 4 marked impairment. She had sustained soft tissue injuries and a mild concussion in the accident. Adjudicator Sapin concluded that the claimant suffered a Class 4 marked impairment in the functional category of “adaptation”. Adjudicator Sapin heard extensive evidence on the claimant’s pre-accident and post-accident life from the claimant, the claimant’s husband, and medical assessors. She concluded that the claimant suffered impairments in adaptation due to her inability to cope with household chores, leaving the home, and social situations. Although not necessary to address, Adjudicator Sapin was critical of the claimant’s and insurer’s assessors’ choice of whole person impairment related to the psychological impairment. She wrote that it was inappropriate for the claimant’s assessor to have simply picked the impairment rating at the highest end of the range in the AMA Guides, and that the insurer’s assessor had failed to consider the totality of testing when assigning an impairment rating.

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment
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