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H.V. v. Certas Direct Insurance Company (18-008349)

  • January 20, 2021

The claimant sought a catastrophic impairment based on a Class 4 Marked Impairment in adaptation. Vice Chair Marzinotto rejected the claimant’s position, and concluded that he did not suffer a catastrophic impairment. She began by noting that a comparison of the claimant pre-accident and post-accident over a long period should be considered, rather than the “”snap shot”” of the claimant’s functioning at the time of the OCF-19. At the time of the claimant’s catastrophic impairment assessments, he had been employed at a coffee shop for approximately six weeks. The occupational therapist completing the report in support of the OCF-19 required the claimant to perform an assessment that was confusing and not based in reality. The occupational therapist also did not use an interpreter when performing the simulated exercise. Vice Chair Marzinotto was critical of the lack of standard comparison between the simulation and the real work-life scenario. There was also no validity testing. The OT’s opinion regarding the claimant’s abilities was rejected. Vice Chair Marzinotto found it unrealistic that the claimant would have remained employed for 1.5 years at the coffee shop if his functioning was as poor as alleged. It was also noted that the claimant’s employer had no knowledge of the alleged impairments and the claimant was not being given modified tasks. No evidence was called from the employer or any co-workers about the claimant’s work performance. From the time of the accident to the date of the LAT hearing, the claimant’s employment followed an upward trajectory. Vice Chair Marzinotto accepted the opinion of the insurer’s psychologist that the claimant’s impairment was at most a Class 3 Moderate Impairment (and likely on the low end of that range). Aside from the claimant’s work status, he was independent with self-care, shared responsibility with his partner for groceries, shared laundry duties, performed housekeeping, and maintained a regular sleep schedule.

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment
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