The claimant sought catastrophic impairment designation under Criterion 7 (53% WPI, rounded to 55%) and/or Criterion 8 (marked impairment in Adaptation) of the SABS, as well as entitlement to various medical benefits. Vice Chair Lester found that the claimant was not catastrophically impaired. With respect to Criterion 8, Vice Chair Lester felt that the claimant suffered a moderate (not marked) impairment in Adaptation. The claimant had no issues completing the tasks assigned during either of the OT assessments, and showed no failures to adapt or decompensate in the face of work-like stressors. The claimant also testified that he was able to take his son to daycare every day, showing no reliability issues with attendance. With respect to Criterion 7, Vice Chair Lester accepted the insurer’s lower WPI rating for psychological impairments, given her determination that the claimant suffered a moderate (not marked) impairment in Adaptation, which brought the WPI down to 37%. Vice Chair Lester accepted that three denied treatment plans for physical treatment were reasonable and necessary (up to the remaining policy limits), emphasizing that pain relief is a legitimate goal of treatment. Vice Chair Lester went on to award the claimant costs in the amount of $500 with respect to counsel for the insurer’s conduct in providing an erroneous opinion on the validity of a summons issued to an IE assessor, which resulted in the assessor not attending the hearing on the date he was scheduled to appear.
Menu