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M.L. v. Primmum Insurance Company (17-002915)

  • July 31, 2020

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.

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment
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