Our client was involved in a motor vehicle accident in February 2015 where she was rear ended at a red light, causing her to strike her head on the roof. That same day she was taken to the hospital. Shortly after she was diagnosed with a concussion and had complaints of headaches, nausea, reduced focus, increased fatigue, depression, anxiety and other difficulties with mental processing, memory, and word-finding. In addition to her cognitive and psychological impairments, she also suffered for neck, upper back and shoulder pain.
Our client was denied certain benefits from the insurer and submitted an application to the LAT to determine whether she sustained a catastrophic impairment and was entitled to a variety of benefits.
During the hearing, we outlined that at the time of the accident our client had been a successful elementary school teacher with a Masters degree in education who was heavily involved in various extra-curricular activities both within and outside of her work. However, as a result of her accident her life completely changed.
Adjudicator Grieves agreed with our client’s explanations for her failure to return to work. A pattern emerged that our client was only able to return to work on a limited basis when she had significant support and at the expense of her ability to take of herself at home. The adjudicator noted that the when attempting to work at even a part-time basis she experienced a decline in her ability to take care of home, which was evidenced by the clutter and garbage scattered throughout her home, including scattered cat feces. Our client struggled to shower and prepare meals due to low levels of motivation and major psychological issues. Her mother would frequently help her with house cleaning. In addition, our client moved in with her mother several times post-accident for assistance. After attempting to work on and off for several years on a limited basis with significant accommodations from her school, she stopped working completely in 2020.
The adjudicator indicated that the evidence supported the fact that our client could not engage in the meaningful roles and responsibilities of her normal life. She required support to perform basic self-care and hygiene activities. Although she was highly motivated to return to work, she continued to struggle and had difficulty keeping up despite significant support and accommodation.
Ultimately, the adjudicator held that our client was catastrophically impaired, finding that she was markedly impaired in the domain of adaptation.
With respect to the issue of attendant care benefits, the adjudicator preferred the evidence from our client, her mother, two of her friends, her registered social worker, and two of her occupational therapists, who all confirmed that she had enormous difficulty maintaining a clean or hygienic home. As such, the adjudicator held that our client was entitled to attendant care benefits.
The adjudicator also was satisfied that our client required medical benefits. She found that the insurer denied these benefits without justification. Instead, the adjudicator was persuaded that our client’s inability to stay organized and take care of home supported the need for professional organizing services.
Lastly, the adjudicator found that our client required benefits for vision therapy. He agreed that our client consistently reported issues about her vision following the accident, which was substantiated by her psychologist, Dr. MacDonald, who noted that she experienced issues with light sensitivity and blurred vision.