Dr. Kim Payne

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 of the Schedule following a 2022 motor vehicle accident.

The respondent denied the claim, arguing her impairments stemmed from pre-existing conditions, including a prior accident and childhood trauma.

The Tribunal applied the 'but for' test for causation and found that the 2022 accident exacerbated her pre-existing psychological issues, resulting in marked impairments in activities of daily living, social functioning, and adaptation.

The Tribunal preferred the evidence of the applicant's experts and found she met the threshold for catastrophic impairment.

The applicant sought a catastrophic impairment designation and attendant care benefits following a motor vehicle accident.

The Tribunal evaluated the competing multidisciplinary assessments to determine if the applicant met the 55% whole person impairment threshold under Criterion 7.

The Tribunal rejected several of the applicant's proposed impairment ratings, including those for the lumbar spine, headaches, mental status, and medication, finding them inconsistent with the AMA Guides and medical evidence.

The Tribunal concluded the applicant's combined whole person impairment was 45%, falling short of the catastrophic impairment threshold.

The application for benefits, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for an occupational therapy treatment plan that the insurer denied.

The adjudicator found that the applicant suffered from chronic pain and psychological impairments as a result of the accident.

The adjudicator concluded that the proposed occupational therapy, which focused on pain management and increasing functional activity, was a reasonable and necessary method of treating the applicant's impairments.

The insurer was ordered to pay the treatment plan amount of $3,358.14 plus interest.