Troy Lehman Strategies for Proving CAT Impairment Why is CAT so important? 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 What is a CAT Impairment? 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) 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. CAT Process Application (OCF 19)Application (OCF 19) Acceptance or IE.Acceptance or IE. Acceptance or Arbitration, Lawsuit.Acceptance or Arbitration, Lawsuit. 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. 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 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. 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. Loss of Use of Limb Total and permanent loss of useTotal 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 Loss of Use of Limb Whole Person Impairment 55% Whole Person Impairment according to AMA Guides 55% Whole Person Impairment according to AMA Guides 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. Mental & Behavioural Disorders 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 Social Functioning refers to an individuals 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 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 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 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 SABS This way for treatment