Nikita D'Souza

The applicant sought a determination of catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a motor vehicle accident.

The Tribunal found that the applicant's multidisciplinary catastrophic impairment evaluation was not conducted by a physician as required by the Schedule, as the physicians merely rubber-stamped the findings of a neuropsychologist and an occupational therapist.

Because a neuropsychologist is precluded from determining catastrophic impairment outside of Criterion 7, the Tribunal gave no weight to the medical evidence and dismissed the catastrophic impairment claim.

However, the Tribunal ordered the insurer to pay up to $2,000 each for the neuropsychological and occupational therapy assessments, as they were reasonable and necessary to explore the applicant's impairments.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment as a result of a minor traumatic brain injury from a motor vehicle accident.

The applicant argued the adjudicator erred in law regarding the temporal analysis of the GOS-E, by discrediting his neuropsychologist's report because an occupational therapist conducted the GOS-E interview, and by failing to weigh the respondent's occupational therapist's observations.

The adjudicator dismissed the request, finding no error of law or fact.

The adjudicator affirmed that a flexible approach to the timing of the GOS-E is appropriate, that the GOS-E interview must be conducted by a physician or neuropsychologist, and that occupational therapists cannot opine on whether impairments are caused by a brain injury versus other injuries.

The applicant sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The central issue was whether the applicant's traumatic brain injury resulted in a Severe Disability or Lower Moderate Disability under the Extended Glasgow Outcome Scale (GOS-E).

The Tribunal found that the GOS-E assessment must be conducted by a physician or neuropsychologist, not an occupational therapist, and must isolate the effects of the brain injury from other physical or psychological injuries.

Preferring the evidence of the respondent's neuropsychologist, the Tribunal concluded the applicant sustained only a mild traumatic brain injury and did not meet the threshold for catastrophic impairment.

The application was dismissed.