1. Troy Lehman Strategies for Proving CAT Impairment

2. Why is CAT so important?

3. CAT vs. Non-CAT Medical-RehabilitationMedical-Rehabilitation –CAT = $1,000,000 –Non-CAT = $50,000 Attendant CareAttendant Care –CAT = $1,000,000 –Non-CAT = $36,000

4. What is a CAT Impairment?

5. CAT Definition Paraplegia or Quadriplegia.Paraplegia or Quadriplegia. Loss of use of limb.Loss of use of limb. Loss of vision in both eyes.Loss of vision in both eyes. Brain impairment resulting in:Brain impairment resulting in: –GCS of 9 or less, or –GOS of 2 (vegetative) or 3 (severe)

6. CAT Definition Combination of impairments reaching 55% WPI.Combination of impairments reaching 55% WPI. Marked/Extreme impairment due to mental or behavioural disorder.Marked/Extreme impairment due to mental or behavioural disorder. Generally must wait 2 years for these.Generally must wait 2 years for these.

7. CAT Process Application (OCF 19)Application (OCF 19) Acceptance or IE.Acceptance or IE. Acceptance or Arbitration, Lawsuit.Acceptance or Arbitration, Lawsuit.

8. The Application Put best foot forward on application.Put best foot forward on application. Obtain medical report(s) to support application whenever necessary.Obtain medical report(s) to support application whenever necessary.

9. GCS Brain impairment resulting in score of 9 or less administered within reasonable period of time.Brain impairment resulting in score of 9 or less administered within reasonable period of time. If there is one score of 9 or less that is enough – Liu (Court of Appeal).If there is one score of 9 or less that is enough – Liu (Court of Appeal). With respect to brain impairment, significant weight given to diagnosis of treating physician – Kraja v. WawanesaWith respect to brain impairment, significant weight given to diagnosis of treating physician – Kraja v. Wawanesa

10. GOS Need to be vegetative or severely disabled.Need to be vegetative or severely disabled. First case to consider this issue = Watters v. State Farm (2015)First case to consider this issue = Watters v. State Farm (2015) Focus on level of independence inside and outside the home.Focus on level of independence inside and outside the home.

11. GOS Good OT assessment on function and need for attendant care is key.Good OT assessment on function and need for attendant care is key. Collateral information is crucial.Collateral information is crucial. Familiarity with literature on how to apply GOS important – eg. Wilson et al, “Structured Interviews for Glasgow Outcome Scale”, Journal of Neurotrauma, Vol. 15, p. 573.Familiarity with literature on how to apply GOS important – eg. Wilson et al, “Structured Interviews for Glasgow Outcome Scale”, Journal of Neurotrauma, Vol. 15, p. 573.

12. Loss of Use of Limb “Total and permanent loss of use”“Total and permanent loss of use” Boyd v. St. Paul Fire (2014)Boyd v. St. Paul Fire (2014) –Total loss of use of arm found even though Boyd maintained grip strength. –Key is loss of useful function. –OT/PT evidence crucial –Demonstrative Evidence Helpful

13. Loss of Use of Limb

14. Whole Person Impairment 55% Whole Person Impairment according to AMA Guides 55% Whole Person Impairment according to AMA Guides

15. Whole Person Impairment Multi-Disciplinary Assessment typically required. Again, OT assessment very important. Willsay statements add value. Clear notes from treating practitioners confirming impairments important.

16. Mental & Behavioural Disorders

17. Quality of activities judged by their: –Independence –Appropriateness –Effectiveness –Sustainability Assess ability to initiate and participate Assess the overall degree of combination of restrictions Activities of Daily Living

18. Social Functioning refers to an individual’s capacity to interact appropriately and communicate effectively with other individuals. Social functioning includes the ability to get along with others, such as family members, friends, neighbors, grocery clerks, landlords, or bus drivers… Social Functioning

19. Assess the ability to sustain focused attention long enough to permit the timely completion of tasks commonly found in work settings. In evaluating fitness for work, capability may be assessed by the completion of such tasks as filing index cards, locating telephone numbers and disassembling and reassembling objects. Concentration

20. Deterioration or decompensation in work or worklike settings refers to repeated failure to adapt to stressful circumstances. Stresses common to the work environment include attendance, making decisions, scheduling, completing tasks and interacting with supervisors and peers. Adaptation

21. Solid expert report. Minimize credibility issues. Rely on evidence of lay witnesses and treating providers on impairments in the 4 spheres. Keys to Proving Marked Impairment

22. SABS This way for treatment