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Whether a psychological injury in conjunction with a physical injury can be considered catastrophic: Fourniev v. Coachman

January 2010

In Fourniev v. Coachman. FSCO A07-000297, the claimant was injured in a motor vehicle accident on August 11, 2004. He sustained injuries to his left heel, left ankle, left thumb and lost some teeth. He applied to Coachman Insurance for a determination of catastrophic impairment under the Schedule and Coachman concluded that he was not catastrophically impaired. The parties applied for Arbitration since they were unable to resolve their dispute through mediation.

The issue in dispute was whether the claimant suffered a catastrophic impairment under paragraph 2(1.2)(f) or (g) of the Schedule. Under paragraph 2(1.2)(f), a catastrophic impairment was defined as an impairment that resulted in 55% or more impairment of the whole person according to the Guides. Under paragraph 2(1.2)(g), a person was considered catastrophically impaired if he had a class 4 marked impairment or class 5 extreme impairment according to the Guides.

Chapter 14 of the Guides does not provide a percentage rating with respect to psychological or mental impairment. Class 1 is considered no impairment. Class 2 is considered mild impairment compatible with most useful functioning. Class 3 is considered moderate impairment, meaning the impairment is compatible with some but not all useful functioning. Class 4 is considered marked impairment which significantly impedes useful functioning. Class 5 is considered extreme impairment which precludes useful functioning. Under the Guides, an impairment under Class 4 or 5 is considered catastrophically impaired. The Guides do not provide a mechanism to translate class ratings into percentage rating.

In the alternative, it was argued on behalf of the claimant that if his mental or behavioural impairment did not fall within the ambit of Class 4 impairment, that when his mental and/or behavioural impairment was combined with his physical impairment, his total impairment exceeded the 55% impairment of the whole person. The insurer recognized that the plaintiff suffered from a physical impairment but had no psychological problems, wherein if he had a pain disorder, it was not related to psychological problems.

FSCO recognized that it was possible to combine physical and psychological impairments but did not decide on the issue since the claimant was determined to be catastrophically impaired both physically and psychologically.


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