Dhanraj Jaggernauth v. Economical Mutual Insurance Company
Overview
After being struck by a car in August 2006, Mr. Jaggernauth sustained multiple serious injuries, including fractures of his cervical spine, right forearm and left shoulder. He also incurred deep lacerations to his head and right calf. As a result of the injury, Mr. Jaggernauth underwent surgeries to both shoulders and his right forearm.
Since the accident, Mr. Jaggernauth has not been able to return to work and suffers from chronic pain as well as a loss of sensation in his right forearm. He has been diagnosed with numerous psychological conditions for which he continues to receive treatment. He also requires several medications for his physical and psychological pain.
Mr. Jaggernauth made a claim for accident benefits from his own insurer, Economical. While they paid some ongoing benefits, Economical argued that despite the seriousness of his injuries, Mr. Jaggernauth did not suffer from a "catastrophic impairment" as defined in the Statutory Accident Benefits Schedule. The schedule entitles persons suffering from impairments that are deemed "catastrophic" to claim from an enhanced level of accident benefits for increased housekeeping, attendant care and medical and rehabilitation expenses.
Mr. Jaggernauth was represented by Kelley Campbell of our firm. Over the course of the hearing Ms. Campbell presented evidence from Mr. Jaggernauth, his wife, a number of his healthcare providers and experts who assessed him on the issue of catastrophic impairment. The insurer presented their own experts on the issue of catastrophic impairment.
Result
While there were numerous issues in dispute, this hearing focused on one key question—did Mr. Jaggernauth sustain a catastrophic impairment as defined in the Statutory Accident Benefits schedule?
After 8 days of evidence and a day of closing arguments, Arbitrator Richard Feldman determined that Mr. Jaggernauth did in fact sustain a catastrophic impairment considering both the physical and psychological impairments that he suffered in the motor vehicle accident. This allows Mr. Jaggernauth to maintain his claims for ongoing housekeeping and attendant care benefits as well as claims for necessary medical and rehabilitation expenses up to $1,000,000.00.
Case & Appeals Synopsis