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Patchett v. Optimum Insurance Company (19-008902)

  • November 26, 2020

The claimant applied for a catastrophic impairment under Criterion 2(iii) of the new definitions, requiring a SCIM score of five or less on an indoor mobility test. The claimant’s score was below five shortly following the accident when she was recovering from fractures in her extremities. However, the score was above five after a number of months when the IE took place. The claimant argued that the temporary score below five was sufficient for a catastrophic impairment designation. The insurer argued that a permanent score below five was required. Adjudicator Boyce agreed with the insurer that the score below five had to be permanent. Use of a temporary score below five did not meet the Legislature’s intention of providing enhanced benefits only to persons with permanency of impairment.

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment
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