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Applicant denied catastrophic impairment and ongoing benefits due to surveillance contradicting claimed physical disabilities.
The applicant was injured in a low-speed rear-end motor vehicle accident and claimed statutory accident benefits, including caregiver, attendant care, and housekeeping benefits, as well as a determination of catastrophic impairment.
The insurer denied the claims and sought repayment of an alleged overpayment.
The arbitrator found that the applicant's physical presentation of torticollis was inconsistent with extensive video surveillance showing her performing normal daily activities.
Relying on expert evidence that her symptoms had a psychogenic overlay and did not meet the threshold for catastrophic impairment under the AMA Guides, the arbitrator dismissed the claims for ongoing caregiver and housekeeping benefits, and the catastrophic impairment designation.
The applicant was awarded a modest amount for attendant care during the first 104 weeks.
The insurer's claim for repayment was dismissed due to inadequate notice, and the applicant's claim for a special award was denied.
Income replacement benefits and special award granted where insurer unreasonably ignored psychological evidence of chronic pain.
The applicant was struck by a vehicle while walking across an intersection and sustained physical and psychological injuries.
The insurer terminated her income replacement benefits based on an orthopaedic assessment.
The applicant sought arbitration, arguing she suffered from chronic pain with a significant psychological component that prevented her from working.
The arbitrator found that the applicant was completely unable to engage in any employment for which she was reasonably suited, preferring the evidence of her psychological experts over the insurer's assessors.
The arbitrator also granted a special award, finding that the insurer unreasonably withheld benefits by misfiling and ignoring a key psychological report that supported her claim.
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