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Applicant deemed catastrophically impaired under both physical and psychological criteria following severe bicycle accident.
The applicant was struck by a pickup truck while riding his bicycle, sustaining severe injuries to his left heel and ankle.
He applied for a determination of catastrophic impairment, which the insurer denied.
At arbitration, the arbitrator preferred the evidence of the applicant's experts, finding that his need for two crutches and a short leg brace resulted in a 55% Whole Person Impairment under the AMA Guides.
Furthermore, the arbitrator accepted that the applicant's chronic pain and depression resulted in a Class 4 marked impairment in at least one area of functioning.
The arbitrator concluded that the applicant sustained a catastrophic impairment under both paragraphs 2(1.2)(f) and (g) of the Schedule.
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.
No linked lawyers found.
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