2 total
Insurer's appeal dismissed; GCS score of 9 met catastrophic impairment definition despite confounding medical factors.
The appellant insurer appealed an arbitrator's decision finding that the respondent insured sustained a catastrophic impairment following a motor vehicle accident.
The arbitrator found the respondent met the definition under the Statutory Accident Benefits Schedule based on a Glasgow Coma Scale (GCS) score of 9 recorded four days post-accident.
The insurer argued the score was invalid due to consciousness-lowering drugs and was not taken within a reasonable time.
The Director's Delegate dismissed the appeal, holding that the definition of catastrophic impairment is a legal test, not a medical one, and does not require excluding confounding factors.
The Delegate found no error in the arbitrator's conclusion that the GCS score resulted from a brain impairment and was taken within a reasonable time.
Appeal of preliminary catastrophic impairment finding rejected to avoid delaying the scheduled final arbitration hearing.
The appellant insurer sought to appeal a preliminary arbitration order which found that the respondent insured had sustained a catastrophic impairment based on Glasgow Coma Scale scores.
The Director's Delegate declined to exercise discretion to hear the appeal at this time, noting that the issues raised were not novel and that hearing the appeal would prejudice the respondent by delaying the final substantive arbitration hearing scheduled for two months later.
The appeal was rejected without prejudice to it being raised after all issues in dispute have been finally decided.
