The claimant sought catastrophic impairment designation under Criterion 7, arguing that he developed chronic pain from the soft tissue injuries sustained in the accident along with exacerbation of pre-existing asymptomatic degenerative disc disease and knee osteoarthritis. The insurer submitted that the claimant’s present health condition was caused by an unrelated subsequent fall. The claimant’s assessors found a total WPI of 44 to 55%, while the insurer’s assessors found a total WPI of 9%. The WPI percentages most disputed by the parties were for the claimant’s gait derangement (20% from the claimant; 0% from the insurer), mental status impairment (1-14% from the claimant; 1% from the insurer), and spine (10% from the claimant; 0% from the insurer). With respect to gait derangement, Adjudicator Neilson agreed that but for the accident, the claimant would not have suffered knee issues and attributed a 15% WPI, which was appropriate for a patient who required part-time use of a cane for distance walking, but not at home. With respect to mental status impairment, Adjudicator Neilson accepted the insurer’s 1% WPI rating as its assessor provided a rationale for his rating, while the claimant’s assessor gave no reasonable explanation for choosing the top of the range. In doing so, she noted that providing a range of WPI percentages did not assist her in determining whether the claimant has a catastrophic impairment, and ignores the instructions provided in the AMA Guides. With respect to the spine, Adjudicator Neilson accepted the claimant’s WPI of 10%, because EMG studies pointed to radiculopathy. In total, Adjudicator Neilson found that the claimant did not sustain a catastrophic impairment. As his policy limits were exhausted, the remainder of his claim for benefits was dismissed.
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