Dr. Brigham

The appellant insurer appealed an arbitrator's decision finding that the respondent pedestrian sustained a catastrophic impairment under clause 2(1.1)(g) of the Statutory Accident Benefits Schedule.

The insurer argued that the arbitrator erred by requiring a marked impairment in only one of four areas of functioning, rather than an overall marked impairment, and by failing to separate physical pain from psychological impairment.

The Director's Delegate dismissed the appeal, holding that the plain language of the Schedule requires only a single marked impairment in one area of functioning.

The Delegate also found no error in the arbitrator's conclusion that the respondent's marked impairment in activities of daily living was due to a mental or behavioural disorder, specifically a pain disorder associated with both psychological factors and a general medical condition.

The applicant was injured in a pedestrian motor vehicle accident and sought a determination that she suffered a catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant's combined physical and psychological impairments resulted in a 39% whole person impairment, falling short of the 55% threshold under clause (f), she did meet the criteria under clause (g).

Specifically, the arbitrator accepted the CAT DAC assessment that the applicant's pain disorder and physical limitations resulted in a Class 4 marked impairment in her activities of daily living.

The arbitrator held that a single marked impairment is sufficient to meet the definition of catastrophic impairment.